The Ethics of Utility: Dust Thou Art, to Dust Return


October 15, 1991|By CAL THOMAS

SALT LAKE CITY — Salt Lake City. - Former Colorado Gov. Richard Lamm says he hasn't been invited to address any meetings of the American Association of Retired Persons. No wonder. Mr. Lamm once said of the elderly that they have ''a duty to die and get out of the way'' and not tie up medical resources that could be used to benefit those with longer lives to live.

Mr. Lamm, who is director of the Center for Public Policy and Contemporary Issues at the University of Denver, brought his message advocating radical reforms in the American health care system to a meeting of editorial writers at the University of Utah Medical Center.

He believes ''there is a fundamental tension between the health of an individual and the health of a society.'' His concern is that we spend too much to save the life of an elderly person when, if we just let that person die, more money could be freed up to treat younger people.

Governor Lamm is right that the American health system is in need of transformation. America spends more and gets less for health care than any other nation. Arnold Relman, former editor of the New England Journal of Medicine, said there are three major flaws in American health care:

* It doesn't take care of everybody.

* The costs are horrendous. We spend more per capita than any other country -- $750 billion a year, or 12 percent of our gross national product.

* There is growing evidence of intolerable waste, duplication and inefficiency. Dr. Relman estimates that one-third of surgeries and tests are unnecessary.

As reformers like Dr. Relman and Governor Lamm propose changes, one hears nothing about the foundation on which the current health-care system is based. The medical profession was built on a philosophy that viewed human beings in a different category from other living things. Even the Hippocratic Oath, formulated in ancient Greece, recognized the uniqueness of human life and the medical profession as a kind of priesthood to administer the sacraments of medicine in a manner designed to preserve life.

No matter how you slice it, Governor Lamm and others who speak of costs before dignity, or even sanctity, are proposing a new medical world order based not on the worth of man as made in the image of God but on a utilitarian standard. Access to such a system will be based on the bottom line.

Any reformation of health care must begin with the proper philosophical view of man. Otherwise, medical science and technology replace God, and the rest of us will be judged by a standard established by authoritarian elites in the medical and political professions.

With a flawed view of man, doctors and medical technocrats will decide life-and-death issues like ancient Caesars in the Roman Colosseum by turning their thumbs up or down. Without a proper respect for the sanctity of human life, plug-pulling on 90-year-olds could quickly develop into active euthanasia for those deemed ''unfit'' or ''unwanted'' by a society seeking to unburden itself of those straining the federal budget.

When cost rather than the worth of a single human life becomes paramount in medicine, all sorts of indignities and inhumanities can result. As the former surgeon general C. Everett Koop has written, ''When a hospital is geared to save lives at any cost, this attitude affects health care down to the most mundane level. On the other hand, when one set of patients can be eliminated at will, the whole spirit of struggling to save lives is lost, and it is not long before a doctor or nurse will say, 'Why try so hard on anybody? After all, we deliberately fail to treat some patients and we kill others.' Even if it were not expressed this blatantly, an erosion takes place, which over a number of years would undermine the care of all patients in any institution that kills any patient placed in its care.''

Medicine has traditionally protected the weak, the old, the infirm, the young and the unborn. Now, legislators may be faced with debating whether to maintain these protections with no greater concern than they might bring to export-import quotas.

Without a foundation on human dignity, the humanistic-materialistic view of man becomes paramount, as expressed in 1978 by the Nobel laureate Francis Crick, who proposed that ''no newborn infant should be declared human until it has passed certain tests regarding its genetic endowment and if it fails these tests it forfeits the right to live.''

It is a short step indeed from there to declaring other lives null and void when they fail a test established by such as Richard Lamm, who says they should emulate leaves of the season that ''fall off a tree, forming humus for the other plants to grow.''

It is the difference between seeing your aging parents as unique human beings or as potential bags of fertilizer for the societal lawn.

Cal Thomas is a syndicated columnist.

Baltimore Sun Articles
Please note the green-lined linked article text has been applied commercially without any involvement from our newsroom editors, reporters or any other editorial staff.