Sunday, April 29, 2012

The Prejudiced Future of Lifestyle Rationing

Imagine you're sitting in your doctor's office, waiting on what could be the worst day of your life.  I'm not talking about finding out that you've been diagnosed with stage four cancer, or that only twenty-five percent of your liver is still functioning, or that you have ALS, or any other diagnosis that assures the end of your life is near.  In my fictional scenario, you are already fully aware of the severity of your disease and you've had time to deal with the weight of your own mortality.

Imagine instead that you're sitting in a cold, hard leather office chair, re-reading your physicians diploma for the tenth time, nervously shifting back and forth as you wait for him or her to walk through the door just so you can find out if you qualify to be treated for your life-threatening illness.  The cure is available, but is your life worth saving?  For in the modern era of risk assessment and cost analysis, we are on the verge of lifestyle rationing, where a set of doctors decide whether or not you are deserving or undeserving of treatment.

Have you ever applied for a mortgage or a loan from a bank where you didn't know your credit?  Remember the anxiety and insecurity you felt as you frantically scanned through the memories of your personal finances?  Did the bank see you as a good investment?  What were they saying about you?

Now put yourself back in that leather chair.  Try to imagine a committee of doctors you've never met, or worse - a statistical analysis run by poorly written software, deciding whether or not your DNA or the choices you've made over the course of your life qualifies you for a medical treatment that will save your life.

When I think about the future of medical technology in an unregulated capitalist market, this scenario seems the most horrifying.  Mostly because everything that I've written here seems the most plausible given the current political environment; both in Europe and the United States.

Don't get me wrong, I absolutely understand the necessity of prudence when it comes to treatments - especially surgery.  For example, those that are extremely (or morbidly) obese.  Physicians have to weigh the current stability of the patient, the risks to the patient during the procedure, and finally the likelihood of the patient to survive the rehabilitation period.  These are all valid concerns, and they are all valid points of contention when deciding the best course of action for a particular patient.

But where do these medical trusts draw the line?  As our understanding of the human genome grows, who's to say these trusts won't use this data as well?  Take me, for example.  What if I needed a heart or liver transplant?  At five feet, nine inches in height and roughly 180 pounds, I'm considered overweight.  Sure, I exercise regularly, but already I have a risk factor.  Strike one against me.  Like every other male that I'm aware of in my ancestry, the DNA floating around in my cells has endowed me with hypertension, or high blood pressure.  Strike two.  I ride a motorcycle to work.  Red flag there; strike three.

You get the idea...

Sure, this story is currently unfolding in Europe, but I predict that in a matter of a few years, the United States will be knee deep in exactly the same controversy.

Is this the future of medicine?  Is this what humanity was destined to accomplish?  With all the public funding available to the various medical sciences, is our society willing to accept a workforce of physicians that only provides the peak of modern medicine to people that are low risk?  Or people that can pay?  Are we ready to define ourselves - as Americans - as a society that in one breath fights for the right to life of a blastula, and in the other condemns a living, breathing human being to certain death because they're too fat?

As I think about the next 30 years of my life and project myself at 70 years old, I wonder...

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