1) The market and this system in the US now is as ruthless a rationer of resources as any. Technologies available for rescusitation, such as ECMO-CPR which might (might) raise the response rate for a witnessed arrest to 25% (maybe higher for pediatrics) from its dismal response rate now is not available in most places, but will become increasingly available in urban centers. Rural and community hospitals have rationed resources in varied ways and as such this technology, skill, and expertise is unavailable in these environments. Also, neonatologists often fail to examine patients daily in remote, rural NICU’s and certainly are not available for emergencies. This is a common practice in the rural South, resulting in “less” care, a form of rationing. The army and its GMO system by which a physician only requires one year of residency training prior to practice is done for fiscal reasons. Less training=less expenses. This is another form of rationing. The US rations for care routinely. I include the market experiences above. Rationing of care is done thoughtlessly (without direct intent) in the US, but the absence of deliberate decisions for this system do not lessen the burden for the victims of this rationing or the community, state, or national responsibility for this matter.
2) Where am I on rationing? I am very different than most. I do not think a nation with such an inordinant number of Wii’s or Nintendo game systems or smart phones should have arrangements where a critically ill infant in a NICU shouldn’t see a doctor every day, or that HIV meds shouldn’t be available to all who need them. No child should be denied care even to 22 weeks of age or at the upper age limits of life. Hospitals in the rural areas should be able to provide the adequate immediate coronary care (which is routinely absent) for heart attacks for patients. We should have more care, not less. And the exclusiveness of this care and the weak infrastructure and pitiful capacity in some areas is should not be a matter of pride. It is a shame on our society and our faith.
3) However, discussions of this rationing should not be so dramatic. As I noted currently rationing occurs. I do not think the community or its representative is without say on the matter of resource allocation, and I keep in mind that currently, the US (with a chorus of Catholics) has said to this day that it is ok if the NICU infant doesn’t have a doctor examine the patient or a patient cannot receive HIV meds because of market demands. I think we could do better however. Such discussions should not be the occasion of histrionics and there currently is room in the Church’s bioethics to deliberate on this. That is another point. Just because we ration without deliberate intent does not lessen the fact we ration care. Markets do that. Markets ration scarce resources efficiently, but certainly not equally or even fairly. Just efficiently.
4) Along with that last point is that these discussions are not “secular” in nature. These discussions are important and again, different contexts have come up with different human solutions which are imperfect. The example of rural health care is one such example. Continued suggestion I am not religious nor pro-life is unjust and just not true.
5) I did not claim “quality of life” at any point. This is not at all my point, but within the discussion of end of life care, it is acceptable to consider “burdens.” Such is clear within conservative Catholic bioethics.
6) For Mr. Siekierski, I explicitly did not suggest a lessening of value for disabled children as an outcome of abuse. You misunderstood. I was responding to the comment of one poster that she had not known any parent who regretted the sacrifices required for their disabled child. I was noting that was not a uniform experience.
7) Comments that one would go into debt to save their child presumes that the money is available to the parent. Without property or even a car, then such debt is impossible to acquire for a poor parent if one is discussing hundreds of thousands. Or so the headlines over the past three years would suggest.
8) Equating socialism with single-payor, nationalized systems of health care is laughable. One poster noted Europe as a bastion of socialism. I hardly would consider Europe as equated with the economic system of Socialism, and its most recent experiment: the USSR. Its not the point of the post, but certainly indicative of the loss of any rational discussion possible on this point anymore. It is a certain consequence of the Hannitization of the right wing that once was the only intelligible group of discussants on the web.
9) Finally, the thought that no one other than the patient or his representative should or will make an end-of-life decision is a consequence of Americanism and reflects the role of the process of autonomy in ethical decisions. The bioethicians have posited a role for other factors other than autonomy to weigh in on end-of-life decisions. Currently, American bioethical decisions rests on autonomy as the prime directive. It is not the only priority in both secular or conservative Catholic bioethics.
A fellow Catholic is calling for more rationale discussion about complicated concerns.