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Rationing Health Care: What is Catholic Teaching?

If you read the New York Times Magazine this weekend, you will see a lengthy article by Princeton professor Peter Singer. In this article he argues for health care rationing. Read this article very carefully. This paragraph seems to capture the moral problem with his reasoning:

As a first take, we might say that the good achieved by health care is the number of lives saved. But that is too crude. The death of a teenager is a greater tragedy than the death of an 85-year-old, and this should be reflected in our priorities. We can accommodate that difference by calculating the number of life-years saved, rather than simply the number of lives saved. If a teenager can be expected to live another 70 years, saving her life counts as a gain of 70 life-years, whereas if a person of 85 can be expected to live another 5 years, then saving the 85-year-old will count as a gain of only 5 life-years. That suggests that saving one teenager is equivalent to saving 14 85-year-olds. These are, of course, generic teenagers and generic 85-year-olds. It’s easy to say, “What if the teenager is a violent criminal and the 85-year-old is still working productively?” But just as emergency rooms should leave criminal justice to the courts and treat assailants and victims alike, so decisions about the allocation of health care resources should be kept separate from judgments about the moral character or social value of individuals.

This is exactly the strategy used by the National Institute of Clinical Excellence (NICE) in the United Kingdom's National Health Service. They call it the Quality Adjusted Life Years(QALY). Care is determined by cost per QALY. And note that the QALY is not the same as your expected life span. Any years where you might be disabled, unable to feed yourself, have decreased mobility, or have decreased mental abilities are not included in the QALY. As you can see, the older and more infirm you are, the smaller your Quality Adjusted Life Years value is. This increases the ratio of your cost of care per QALY. The director of NICE, Michael Rawlins, has said that once this ratio exceeds £25,000-£35,000, care will likely be denied.

The ethical issue with both Peter Singer's argument and the NICE strategy is that they judge the value of the life of the patient. They value the strong over the weak and vulnerable. Catholic teaching is that the value of the life of a teenager and the value of the life of an 85-year-old are equal. Each of these lives is of inestimable worth. In an attempt to allocate limited health care resources, Singer and the NICE ration health care based on chronological age with those who are old receiving less care than those who are young. Such a system violates Catholic principles because it does not evaluate the proportionate vs. disproportionate nature of the care being denied. An individual has a moral obligation to pursue and a health care provider has a duty to provide ordinary or proportionate care. Care that is found to be beneficial to a patient and does not impose undue burden on the patient or others is deemed proportionate. Care that is found to be without benefit in relation to the burden it imposes is deemed disproportionate. This determination is made from the perspective of the patient or the patient's surrogate. This determination should not be imposed by a bureaucrat far removed from the individual patient. Chronological age can and should be used to evaluate a therapy to determine if it is proportionate or disproportionate for an individual patient. The moral imperative is that the treatment is to be judged as to its usefulness and not the life of the patient.


Rosemary Bogdan said…
Thank you so much for drawing attention to these issues. This is chilling stuff. Wasn't Singer the one who once argued for infanticide too?

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