It is an issue that plays out daily at medical offices and hospitals across the country. It may be one of the most important issues in our country’s future because every discussion of health care reform tiptoes around it.

The issue is this: At what point should patients, families, providers and society simply say that technology has run its course?   When do we calmly and collectively say that prolonging human life at the expense of simple dignity is no longer advisable?

One patient, for example, is a 90-year old man with advanced Alzheimer’s disease who lives in an assisted living center. He no longer recognizes his family. He is bed-bound. He has to be fed, bathed and cleaned daily.

Whether to proceed

He had two pacemakers inserted when he was younger and now his last one is wearing out. Does the family ask to proceed with a battery replacement so that their father can continue to live another six or seven years?

If so, society pays for it through Medicare. To refuse this procedure would be considered by some to be immoral; by others, illegal.   

A second case is an 85-year-old patient who develops kidney failure. Already an amputee, she is bedridden.

She is reasonably alert and her family enjoys her presence. Without dialysis, she will die within weeks. Committing her to dialysis carries enormous risks and the grim reality of ongoing weekly treatments that take a toll. 

Dialysis is a federally funded and mandated procedure. This means that if families demand it, there is no choice but to proceed. But no one is asking what the ultimate cost of the treatment might be. 

 These cases raise fundamental political and spiritual questions.

As a society, do we put a premium on preservation of life at all costs?  If so, there are no limitations on what society should do or fund.

I feel this places life itself on an idolatrous altar and replaces compassion, dignity — and even God — with technology. Extension of life at all costs should not be our ultimate goal.

Technology over judgment

A wise physician said this would be a triumph of technology over judgment. Compassionate, competent and loving health care should be our goal. Life is not the ultimate virtue.

A humble admission of our finitude and allowing death with dignity to occur seems to be something that most of could agree might be a good thing.

It is actually something that most religious traditions hold in common. But living up that reality becomes hard for families and physicians in times of crisis when emotions are running high.  

So, how do we allocate our resources? 

Michael Leavitt, head of Health and Human Services under President George W. Bush, thought, correctly, that government had every right to ask questions about the appropriate treatment for which government was paying.

If we don’t want to pay $2,000 for a hammer for the military, we should demand the same sort of fiscal accountability of our health care system.

He did this out of a real concern that government should be fiscally prudent and conservative in its spending of federal dollars.

But when the current administration raises the same concerns, there is outrage and unfounded allegations about death panels and government takeover of medicine. 

I find this to be moral hypocrisy at its worse and an example of the political intolerance and half-truths rampant in our society. We simply must have a calm, civilized discussion about rationing health care. 

We spend up to 15 percent of our total federal health dollars on end-of-life treatments that are usually futile because they are for patients who are terminal.

Available resources

We have the resources to provide a reasonable, fundamental quality of health care for all our citizens.  It does not require new programs or higher taxes.

It does require that we be honest about the values we hold. As taxpayers, we have the right to demand that our dollars are well spent.

As people of faith, we also have to believe in God when he tells us that that death will not have the final word. And that a life well-lived and a death that occurs with dignity and grace is perhaps all any of us could ask for.  

Michael Attas is a local doctor, a medical humanities professor and an Episcopal priest. E-mail him at Michael_Attas@baylor.edu.