DEL.ICIO.USLife-and-death questions dog health-care debate
Thursday, December 18, 2008
He’s just a dog, you tell yourself. Yet somehow, that utterly rational thought doesn’t fend off the choking sensation in your throat as the vet delivers the news.
Just a dog?
He’s just the dog who was young and playful back when your kids were young and playful, a dog who grew up as the family grew up, and who, in the last few years, began to turn gray just as you have.
He’s just a dog who has always looked more fierce than he really is, which is just what you want in a family pet. He’s just a dog who insists on climbing upstairs every night in pain to sleep at the foot of your bed, loyal even in his arthritic old age.
Just a dog? No, no way.
But in the end, yes.
“We’re pretty sure Jackie has lymphoma — cancer of the blood,” the vet says. “We’ll run some tests, but that’s how it’s looking.”
A few days later, when the diagnosis is confirmed, you start asking questions: How long does he have, is he in pain, what’s the treatment?
He’s not in pain, the vet says, but left untreated the disease could take him in a matter of weeks. Steroids could improve the situation for a little while, but with “canine chemotherapy” we could probably give Jackie another six to nine months.
So you ask the next question — “How much would canine chemotherapy cost?” — even though you know the answer will be “too much.”
And sure enough. It’ll cost up to $2,000, plus another $500 or so for X-rays and more tests. That’s a fraction of what similar treatment would cost for a human being, but for a 12-year-old dog, it’s still too much. So you decline. And right there, with that cold-blooded calculation, is where the free market approach to medical care starts to fall apart.
With a dog’s life at stake, you can think through the problem in terms of cost and benefit. With a human being, it would be inconceivable. And that’s not because an insurance company or other third party would pay most of the bill.
No, you don’t ask the price because with a human life at stake, it wouldn’t matter. You already know that whatever the cost, you’re going to do everything possible to pay it.
And in economic terms, that’s the problem. In theory, a willing seller and willing buyer will work out a fair price, with the potential buyer free to walk away if no deal can be struck. But when you combine a willing seller with a desperate, maybe pain-wracked or hope-starved buyer, the market warps and theory fails. The buyer is in no position to say no, and as a result can’t demand a lower price.
There’s another difference as well. Because of Jackie’s status as “just a dog,” we’ll be able to intervene to make sure he does not suffer needlessly in the days ahead. It’s an assurance that we cannot offer each other as human beings — the same profound respect for human life that ensures we do not deny medical care to loved ones also makes it taboo to accelerate the process of death.
That taboo is costly. According to studies, an estimated 30 to 50 percent of all health care costs are incurred in a patient’s last six months of life. From a strict cost-benefit analysis, that is often money poorly spent because the odds of success are low. But it’s a price we correctly choose to pay to protect the dignity of human life.
Sometimes, though, the lines between right and wrong aren’t drawn so easily. A few years ago, Congress rushed into emergency session to try to ensure that artificial life supports weren’t removed from Terri Schiavo, a brain-dead Florida woman who had been comatose for years. To those who wanted to keep Schiavo alive, the case was about respect for life, about human dignity. To those who wanted to let her die, the case was about the very same thing.
We’re also still divided about whether health care ought to be a basic human right in this country. Personally, I think the case is settled. Once you accept the innate dignity of human life, then morally you cannot decide to provide basic care to some but deny it to others on grounds of cost.
You can’t, in other words, apply the same value to a human being as to a pet.
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