We're already rationing health care, Fordham University ethicist Charles C. Camosy argues in his book Too Expensive to Treat? Finitude, Tragedy, and the Neonatal ICU, so why not reconsider the resources expended on premature babies?
Camosy was a principal organizer of Open Hearts, Open Minds, and Fair Minded Words: A Conference on Life and Choice in the Abortion Debate at Princeton University last year and is working on a book about correlations between Christian Ethics and the controversial bioethics of philospher Peter Singer. I interviewed Camosy via email about his current book and its foundation in Catholic Moral Theology and the Social Quality of Life model of bioethics.
Christine A. Scheller: You say in the introduction that "Too Expensive to Treat?" is about "moral tragedy" that results from "two universal aspects of the human condition": 1. We have virtually unlimited health care needs 2. We have limited health care resources. You suggest that while we must live with this tragedy, "we need not live in an unjust situation." Why did you choose to focus on Neonatal Intensive Care as an example of this injustice?
Charles C. Camosy: My general argument could really apply to any kind of medicine. Many other bioethicists have explored rationing health care at the end of life, but I wanted to apply this argument in a new way. I also picked this topic because the very few who have looked at rationing care for newborns, like the philosopher Peter Singer, have challenged the moral worth of such babies. I insist on the full worth and personhood of even the most vulnerable newborn baby. No one should aim at the death of a patient in order to save money.
You argue that the most important issues of neonatal bioethics are primarily social, so the "social quality of life model" is the most helpful for decision making in the NICU context. What is the social quality of life model and why is it the most helpful?
Despite the secular culture's continued attempts to get us to worship the individual and "individual rights," Christian ethics affirms that no human choice exists in pure isolation. It is impossible to understand one person's claims except in a context of relationships with other persons. If we are going to ask whether and how to treat an individual patient, then we cannot pretend to do so in an isolated manner -- as if choices made about one patient do not affect other patients and our broader society.
You say "honest acknowledgement of the inescapable need to ration resources" and "rationing that has justice and the common good -- rather than politics and the ability to pay -- as its guiding principles" are two steps that should be taken in health care reform. How do you propose accomplishing these goals?
It is easy to point out that we are rationing resources already within Medicaid, Medicare, and even private insurance: certain necessary procedures and drugs are not covered, and almost nothing is paid in full. It is easy to point out that the way we currently ration care is unjust: politics and profitability drive most of it. But it is far more difficult to determine what to do instead. One thing we could do is give far more critical and public attention to the entities that are currently rationing care. What sort of people are making these decisions and how are they chosen? What is their training? Are they protecting vulnerable minorities over and against patients that might be big money-makers? How influenced are they by special interests and politics? I find it stunning that these practices still get very little attention even in our era of health care reform.
You say a broadly Roman Catholic understanding for reform according to the National Conference of U.S. Catholic Bishops would require: universal access to health care, priority concern for the poor, comprehensive benefits, pluralism, quality, cost containment and controls, and equitable financing. How does Catholic moral theology inform this list?
All people must have access to resources for meeting their basic needs, and the community is unjust when they are not made available. Indeed, the Church fathers and other great theologians like Thomas Aquinas teach that the poor and vulnerable may actually take what they need from others without it being "theft" because what they are owed to is being unjustly withheld. The bishops, therefore, start with the premise that all human beings are owed health care as necessary for their basic needs. Following in the example of Jesus, we must then have a special concern for the poor and given priority to their health care needs over those who are better off. The other aspects listed are a bit more complex and may even be in tension with each other. Yes, we should aim for comprehensive benefits, but that might be balanced by needs for quality and cost containment. The Catholic tradition takes a both/and approach to these and many other questions -- believing that we must live with the tension rather than abandoning important values.
You write in the conclusion: "Perhaps forgoing lifesaving treatment for babies in the NICU will be enough to give our culture the shock it needs to clear the conceptual space needed for this kind of systematic shift in thinking about health care?" Do you think any parent would be willing to make this tradeoff?
I would be shocked. It would take a selflessness and mental strength that is close to superhuman. However, many parents are already familiar with Medicaid and private insurance denying claims for health care for their children. Again, we are already rationing health care for our children (and other patients), and I'm simply arguing that we should be honest about this and that we should try to do it justly.
In a post about the debt ceiling debate at Catholic Moral Theology, you wrote: "Christians in particular should understand that the finitude of our natures and of our resources means that rationing health care is an inescapable feature of human existence," but research has shown that Christians often cling to artificial life extension as tenaciously, if not more tenaciously than others. What can be done about this disconnect between what Christians should understand and what they do?
Anyone gazing at a crucifix can see that preserving biological life at all costs is a failure not only to follow the example of Jesus, but of the early Christian martyrs as well. Following the commands of God to do justice to the most vulnerable, especially when it means meeting their basic health care needs, trumps whatever good can come from pumping huge amounts of money into an attempt to prolong the fate that awaits us all. Unfortunately, many self-described Christians have traded our tradition of justice for the most vulnerable and a belief in the kingdom of God for an understanding of secular individual rights which can envision no life but this one. But no one can serve two masters, and modern-day Christians should think hard about to what or whom they own their ultimate allegiance.
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