Sunday, April 04, 2010

Morality and Healthcare

Morality is intrinsic to any healthcare system for the simple reason that healthcare involves choices, and especially because it involves choices that affect the lives and interests of others. This is apparent at the macroscopic, policy level where the choices determine what portion of the population will bear the brunt of the consequences of rationing, whether future generations will be indentured for the medical costs of their ancestors, and whether individual values should yield to the policy preferences of distant functionaries. Were this all there was to the moral aspect of healthcare, boards and comissions and government departments could proceed in their missions, unvexed by the implication for individual cases, but this is not all there is to the matter.

Morality is an inherently personal phenomenon, and cannot be delegated to government agencies or political operatives. Moral issues in medicine arise precisely because people do not all share the same values regarding what is meaningful, or sacred or important in life when confronted with a health issue. It might be possible for one person afflicted with amyotrophic lateral sclerosis to find exquiste meaning in overcoming the impairments of his condition, and for another, meaning may be found in deferring to the inevitable. Some people might find life more worthwhile if they ignore the risk factors associated with the way they live, while others may opt for a more objectively prudent path. The government does not contain a "Department of Meaningful Life" and should not pretend that it does by usurping decisions that implicate what a person finds most meaningful into the Department of Health and Human Services.

Only the person involved can say for sure whether the most meaningful part of a stroke victim's life might be in having her daughter hold her hand waiting for the end, or whether the same patient might value living to see her granddaughter graduate from college. Some people want to exit this world figuratively kicking and screaming, raging as it were against the dying of the light; others would prefer to avoid the fuss. The key principle however is that these are choices people make based on what is important to them, based on their values. This, essentially is the key difference between a healthcare market and a government healthplan.

If a person wishes to exhaust his own resources living his life in the manner most meaningful to him, even if it would make a government accountant frown, then allowing him to do so is not only moral, it is a matter of respect for personal dignity.It is no simall coincidence that a free market involves individual people making free choices in the context of their individual circumstances, and a moral society does the same. The alternative to either involves the government depriving the individual of his moral choices by force, either proscribing them directly or by rationing them away. When society begins to abrogate moral choices in the interests of efficiency, it assumes less the character of a civilized society, and more the droning uniformity of a hive.

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