V Hidden Message
In all discussions of the cost of health care, the amount that is spent on one’s last illness always looms large. It’s a big number, looking like low-hanging fruit that we could really reduce costs with, if only…
Not that people bringing this up think that all of it is wasted. But it just smells like there’s a big hunk ‘o cash in there somewhere.
But the hidden statement is “We just spent a fortune on you Jasper, and you were going to croak anyway. If we hadn’t felt so darn obligated to keep you afloat, we could all have gone to Disney World on that money.” No, really. That’s what they mean whenever they say “We need to have an open and honest national discussion about end-of-life care.” Oh yeah, and it has seemed, in practice, to also mean “You Catholics are just gonna have to Get Over It.”
In addition to much of the savings evaporating quickly when you poke at the numbers – if you have something potentially fatal, treatment is likely to be expensive, after all – there are disquieting questions here. Let me tell you when similar large chunks of money are going in the mental health budget in your state: I can name a half-dozen women soaking up a million dollars of services every year at emergency rooms after repeated swallowings, cuttings, and overdosing. There is some volition, even manipulation in these acts – though the ultimate causes of their inner demons may not be entirely their fault. How is deciding against attempting care in a terminal person significantly different from the same in a suicidal (or parasuicidal) person? Or a head-injured adult, or a significantly disabled child? Those are very expensive services, and are essentially humanitarian, not rehabilitative care in the usual sense. That they might get a little job somewhere is deeply gratifying. But it costs much more to get them there than they will provide to society by being “productive.”
Not that such deterioration will necessarily occur. Perhaps none of it will. But cultures are funny, and can move in the direction of preserving our horror in one area while embracing the monster in another, barely different. Yet there is poison in the future whenever people in authority say we must have a frank discussion about something when their own word choices suggest the opposite. We’ve seen that happen in discussions about race and immigration already, where speaking truth to power has become the opposite: telling friendly audiences what they want to hear.
I feel the temptation because I share it. Who among us would impoverish their families when refusing treatment would preserve, not wealth and luxury, but merely modest lives for those who come after? The dystopic image of societies which teach the honor and even the duty of electing death runs through fantasy and sci-fi literature – the former often rather accurately tying it to pagan human sacrifice. It all makes sense at first, and then we find ourselves on the far side of some abandonment of Western Civilisation. (Perhaps most poignantly in Watership Down and The Giver.)