There Is No Sanctuary!

by Julian Sanchez

One thing I find puzzling about the Michael Steele ad Patrick links below is that we've apparently decided "rationing care by age" is some kind of ghoulish form of discrimination. But it seems like an inevitable side effect of applying any sort of cost-benefit analysis to treatments covered. The benefit of any particular medical procedure will be either some finite number of additional years of life, or some improvement in quality of life over some finite number of years. (Bioethicists talk about "QALYs" or "Quality Adjusted Life Years.") And life expectancy creates an upper bound on that expected benefit for even the most successful treatments.

You don't need to explicitly ration by agethere need not be some one-size-fits all limit past which this or that treatment won't be providedbut if you take life expectancy into account at all when calculating when benefit a treatment confers, that's what you'll effectively end up doing. We seem to be OK with taking into account whether advanced age means a treatment is less likely to provide its intended benefit, or that the benefit will be qualitatively smaller. Is it somehow more unfair to factor in the expected quantity? I suspect the true basis for resistance to the idea is simply that we don't like to be reminded that, even with the best doctor, none of us actually get to live forever.