What Kind of Life
Higgins, Thomas
TAKING OUR MEDICINE WHAT KIND OF LIFE The Limits of Medical Progress Daniel Callahan Simon & Schuster, $19.95, 318 pp. Thomas Higgins The health-care system in America could, with moral...
...Thomas Higgins The health-care system in America could, with moral justification, consume every dollar thrown at it...
...Daniel Callahan has written a graceful, if somewhat repetitious book that makes a substantive contribution to our thinking about the legitimate claims of the individual on society, and the unexamined values behind the development of medical technology...
...It seems doubtful, if I read his standards correctly...
...Callahan writes approvingly about the Oregon experiment, but I find it deeply troubling...
...In calling attention to our misplaced priorities, he offers a vision that is both wise and compassionate for addressing the most pressing domestic problem of our time...
...We know about low-birth-weight babies whose brief lives supported by intensive care equipment are hell for them and their parents...
...There is better evidence that it has not been tried...
...There are always people, particularly at what Daniel Callahan, the noted medical ethicist, calls "the ragged edge," whose lives can be prolonged or enhanced by the performance of additional medical procedures...
...Coby needed a life-saving bone marrow transplant because he suffered from leukemia...
...Basing a rationing system on outcomes research would be a welcome improvement in public policy...
...The implementation of his recommendations would require a paradigm shift in our values, as he acknowledges...
...One must perforce agree with much of the analysis and conclusions in this book...
...Instead of cost containment, we have had two decades of cost shifting...
...Applying such a standard to Medicaid recipients is invidious discrimination on the basis of class, and affects people of color, women, and children disproportionately...
...Beyond basic levels of care, he proposes limits on curative medicine...
...Would they have access to AZT if they were Medicaid recipients...
...It is also unclear how Callahan's standards for rationing curative medicine would apply to people with AIDS...
...He says it hasn't worked...
...are unnecessary and unproductive...
...His basic argument is that "Once society has provided the base line of preventive care and public health...it has done most of what ought morally to be required of it...
...It is almost impossible to have too much health care...
...It is also singularly unnecessary...
...Because resources are finite, however, such medicine comes at the expense of other pressing claims on our national treasure, like a decent education and protective services for children...
...The will to use them has been lacking, but is more likely to be found for improved management than for the degree of rationing Callahan advocates...
...em of our time...
...But my quarrel with his thesis is more a matter of degree than kind...
...By properly applying the results of health outcomes research, we can redirect the resources which go into ineffective medical care, and avoid the necessity of denying the Coby Howards of our society life-saving care...
...Coby Howard, a twelve-year-old Oregon boy, is a good example of the danger in being too dogmatic about rationing...
...A recent study by the Rand Corporation showed that at least one-third of medical procedures performed in the U.S...
...Following Oregon's experiment, however, is an invitation to inequity...
...To Callahan's credit, he is more specific and rigorous in his thinking about those standards than many of his colleagues...
...He was denied the operation, and subsequently died, because the state of Oregon decided that Medicaid would no longer pay for tissue transplants...
...Many of us have had elderly relatives whose final days or months were degraded by excessive medical interventions which were neither efficacious nor pain-relieving...
...The tools to control excess utilization are available...
...It may be seen as a companion to his earlier work Setting Limits: Medical Goals in an Aging Society...
...Callahan confronts the dilemma of too much health care in his newest book What Kind of Life, subtitled, The Limits of Medical Progress...
...Such rationing would be accomplished according to a set of standards weighed toward the public interest over individual needs...
...Callahan is less persuasive, however, in his dismissal of greater efficiency as a strategy for health cost containment...
Vol. 117 • May 1990 • No. 10
