April 21, 2025
end of life issues

Black and white in the healthcare rationing debate

Michael Cook

Thanks to Jacob M. Appel

The bitter debate over President Obama’s
healthcare plan can be baffling. With a finite supply of money, surely the cost
of treatment has to be taken into account, one side argues. The other side
contends passionately that lives cannot be measured with dollars.

Most of the time, the battle rages over
grey areas. However, the controversial freelance bioethicist Jacob M. Appel,
writing in the Huffington Post, helpfully discusses a case which makes the
issue black and white. This involves a dispute over a New Jersey man, Ruben
Betancourt. Mr Betancourt was in a vegetative state, after his brain had been
starved of oxygen. His relatives wanted him kept alive; the Catholic hospital
wanted to withdraw his respirator and other care because they were merely
prolonging his death.

Mr Betancourt passed away before New
Jersey’s Superior Court was able to issue an order. However, it may soon
clarify whether hospitals can discontinue care in such cases. Mr Appel believes
they should.

He says: “[the] court [should] decide that physicians and taxpayers only have a
duty to provide unlimited care to patients who have a meaningful chance of
returning to consciousness. Let us make no mistake about what this would mean:
It would mean declaring that the lives of PVS patients are worth less than
those of others. Rather than shying away from this outcome, progressive
bioethicists should have the courage to acknowledge and to embrace this
proposition.”

There
you have it: an example of “healthcare rationing” in its starkest form. If care
of the estimated 25,000 PVS patients in the US were withdrawn all at once, the
system would save US$6 billion a year, according to futility law expert Thaddeus Mason Pope.

In response, on Bioethics
Forum, at the Hastings Center Report, L.
Syd M Johnson says it’s not that simple – even the Betancourt case. Johnson
points out that Betancourt was not actively dying, that some PVS patients
recover; that some PVS patients are misdiagnosed; and that other patients are
unlikely to benefit from the savings. Besides, Johnson continues, “There
are substantial social costs to declaring an entire class of patients
‘worthless’.” ~ Bioethics
Forum, July 2; Huffington
Post, June 23  



Michael Cook
futile care
healthcare rationing

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