Ramblings: The Ethics and Economics of Days Lived

I remember, like it was yesterday, sitting around a table in a graduate course on medical ethics. We would have these scenarios presented, and then we would have to make an ethical decision on the best course, as an ethics panel. Many hospitals have such panels.

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For example, on your floor you have a) 25 year-old woman, prostitute and drug user with liver failure related to drug abuse, b) a 75 year-old retired banker, who is quite wealthy and in good health before a virus destroyed his liver, c) a 30 year-old mother of 2 who liver failed from a genetic flaw, but who has to insurance and no private means of payment. Then the hospital has one liver that matches all three. The one who gets it, lives, and the other two will certainly die. You can just imagine how hard these decisions are to make.

Okay, I’m going to talk about money, but, before I get started on this thought, please know that this is not some type of set up where I end up discussing financial needs and a “Go Fund Me” account. There is no hidden agenda. I have no plans to do that. I have no idea what my health care bills is going to cost us, and how much the insurance will cover. My out-of-pocket costs is not supposed to be more than $2,000 year, but insurance companies have a way around that.

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So, I have received our basic bill from my hospital stay. This bill does not cover many procedures or physicians’ bills for their services. That bill is $135,000. We will see how much the insurance company is going to pay.

On top of that are several other visits to ER and physicians’ offices, not to count dialysis three times a week. I have no idea how much dialysis cost, but it would surprise me if it was $500-$1000 each time.

We are looking ahead to the treatment that will have the best chance of saving my life for a number of years, stem cell transplant. There is no cure, but this could buy up to 5-20 years, before it will eventually fail. There may be a cure by then.

The cost of doing the stem cell transplant, will probably cost $500,000. Now one has to stop and think about, is my life work that much?  It is very hard to put a price on someone’s’ life or years of life.

When you step back and look at the money, it is true that you could take that same amount and save the lives of 1,000 kids in Yemen, who are starving from the war. Or, save the lives of hundreds of people who have things like malaria. I’ve worked in isolated villages and refugee camps overseas where people are allowed to die for the simple lack of resources. It is common.

It is not that easy just to take the money and switch it to such a noble cause. I mean, if we were paying the amount, out-of-pocket (and we couldn’t do that) you could re-designate the money to those more noble causes.

If I were alone, no wife, no kids, refusing treatment and sending the equal amount of money, or putting something like the work in Yemen, in my will, that would be a good option for me. But I’ve promised my family that I would fight this disease with all I have, and that includes my (and the insurance company’s) money. Isn’t it selfish, again if I were alone, for me to spend the money on myself just because I love living so much?

When you look at the real picture, either you spend the insurance company’s money to extend your life, or the money remains in the insurance company’s coffers, allowing them to pay their CEO (many who get 50-90 million dollars per year in salary and stock options) more and their stock holders more. So, if I do not get the treatment done, they buy yet another vacation home or Lamborghini.

I do feel some guilt and the guilt will worsen if I start to deplete our savings, leaving Denise in a more precarious retirement situation.

But these things are not easy to figure out. How do you put a price on your life or the years added to your life? These are the thoughts going through my head today.  Mike


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