A Dubious Solution
ETZIONI, AMITAI
A Dubious Solution What Kind of Life: The Limits of Medical Progress By Daniel Callahan Simon and Schuster. 288 pp. $19.95. Reviewed by Amitai Etzioni University Professor,...
...The moral justification for the author's position is far from self-evident...
...He then would have the agency pay for the services required to bring the vast majority of Americans (80 per cent or so) up to par...
...Nobody, for example, is forced to submit to dialysis...
...Anything beyond that would come from one's own pocket...
...and we should often merely offer comfort and amelioration where we now attempt a cure...
...science and technology are suspect...
...An ethic that justifies cutting care short would soon lead to dumping more of the infirm in public institutions, and—Callahan's predictions notwithstanding—to skimping on necessities from nursing to antibiotics...
...We want to live too long, and expect medical advancements to make this possible...
...Healthcare often entails a considerable cooperative effort by members of the family, nurses and physicians...
...But the author is likely to be challenged most of all on the practical steps he proposes to implement his plan...
...Or we might place a ceiling on the annual growth in the budget for hospitals and nursing homes—while allowing the staffs of each to allocate the money internally as required...
...As someone who lives in a Washington eaten up by interest groups, I find this an invitation for more pork barreling...
...As a result, says Callahan, costly new medical technology is being used to provide what might be called (my term) junkhealth: extending lives of poor quality...
...Moreover, the consequences of a change in values from "do all you can for your loved ones" to " enough is enough" should not be taken lightly...
...Why should that prospect make us break out in hives...
...It is not apparent why we should distribute healthcare according to some set of national priorities, while leaving everything else as maldistributed as it is...
...Assuming a slightly slower growth rate, the proportion would be 13.6 per cent by the year 2000, and 15.7 percent by 2010...
...Doubts set in, however, when we find the author arguing that the problem is not inefficiency, government intervention or profiteering physicians—but our own pursuit of the wrong values...
...The counterargument asserts that they are using taxpayers' money...
...On what moral grounds are we to prevent them from having this service...
...Finally, I do not share the alarm Callahan's views reflect about some rise in the proportion of the GNP dedicated to healthcare...
...He prefers to have it out in the open and streamlined...
...In a contemporary application of a '60s counterculture idea, he suggests that less is more...
...Some additional services would be provided by employer-based insurance...
...It is clear that many whose treatment he wishes to curtail find their quality of life satisfactory...
...Strategies to reduce the enormous inefficiency and some profiteering in this sector would of course also be helpful...
...So the question raised by Daniel Callahan's new book seems at first perfectly reasonable: How much is enough...
...Reviewed by Amitai Etzioni University Professor, George Washington University...
...The figure was 9.2 per cent in 1980, and it was up to 11.5 per cent in 1989...
...Obviously, patients who do would rather be hooked up to a machine three times a week for four hours and lead an otherwise nearnormal life, than die...
...It might be feasible, for instance, to move Federal funds from where they are most outrageously wasted to the healthcare areas in greatest need, without a comprehensive planning system...
...To opponents of his scheme who might protest that even the USSR is refraining from so much central control these days, Callahan answers that we have such a system already in place—only it is implicit...
...He would have a central government agency determine societal—not individual!— needs for healthcare...
...Why is that "too much to ask...
...author, "The Moral Dimension " Nearly everyone is concerned with increasing healthcare costs...
...Skeptics who consider Callahan's position morally dubious and politically naïve will point out other ways to deal with healthcare costs...
...Why couldn't we buy somewhat fewer other goods (e.g...
...Again, one must ask what the moral justification is for not funding, say, the bonemarrow transplants Callahan opposes, if we continue to spend billions of dollars exploring outer space, maintaining obsolete military bases, and so on...
...Priorities would include law and order, a solid economy, defense, procreation, and education...
...Callahan means to limit care for those who might be returned to full functioning: patients in need of chemotherapy or organ transplants, as well as people who are ill and "too old"—in their late 70s or early 80s...
...setting limits" is better than the quest for growth...
...It is important to stress that the issue being talked about here is not whether to keep people going as vegetables or completely fettered to machines...
...delay the purchase of newer model cars a few months, respond somewhat less to the latest fad in clothes), and buy more kidney dialysis, bone-marrow transplants, and similar health requirements...
Vol. 73 • March 1990 • No. 4
