Wednesday, May 13, 2009

Is All Healthcare Triage?

Charles Camosy, assistant prof of Theology at Fordham, has received a faculty grant in support of his project, “Treatment of Critically Ill Newborns: The Social Quality of Life Model in Light of Catholic Social Teaching.”

According to Inside Fordham, the project
examines the ethics of withholding or withdrawing life-sustaining treatments for profoundly ill newborns, rather than spending millions on life support systems, therapies and lifelong institutional care. Camosy, who is using his grant to finish a book on the subject, Too Expensive to Treat? Limited Healthcare Resources and the Neonatal ICU for Eerdmans Publishing, admitted that he may be pressing a hot button once again.

Here's a bit about his theory from the article, my emphases:
“Nobody wants to talk about this issue,” Camosy said. “Our society has a limited amount of money to spend on health care, and we need to allocate it in ways that will help more people, instead of blindly spending it.

“My first move is to uphold the full moral value of even the sickest newborn babies. They do not count less than any other human life,” said Camosy. But, he said, it also means that they do not count more. Therefore, the disbursal of resources might lead to a situation, given health care constraints, where doctors might have to choose between a 47-year-old diabetic and a 24-week-old baby, he said.

“We mustn’t sweep this problem under the rug by hiding behind easy euphemisms like, ‘You can’t put a price on life,’” he said. “When you have a society that has 50 million people without health insurance, you have to allocate resources fairly. . .

. . .Camosy described himself as most emphatically “pro-life.” But as he sees it, the moral and ethical issue on the table is one of social quality of life (SQL) in Catholic teaching, a model that includes considerations for the just distribution of resources when determining how much treatment to bestow upon a profoundly ill or wounded life no matter what the age. . .

. . .The foundation for SQL, he said, is social teaching that clearly recognizes God’s desire to use the earth’s resources—whether it be energy, health care, food or otherwise—in fair proportion for the common good of humankind.

I'm no expert on the subject, but it looks like he's talking about the ethics of triage and applying it at a macro level. In fact, he says this Social Quality of Life standard from Catholic social teaching, which I've not heard of with respect medical ethics,
dates to 16th-century Catholic theology, when “omissions” of treatment were allowed for ill or wounded people if such treatment would put too many other lives at risk; for example, a battlefield doctor deciding who best to save.

I don't see how a battlefield scenario translates to medical decisions in infant ICU. Again, I'm no expert in this field, but if the paradigm of battlefield triage is to be applied at a macro level, aren't we just talking about rationing? What are the implications of this mentality in a nationalized health care system?