Thinking about ethics of our care
Ihad the great fortune to chat with my daughter’s preschool class last week about what I do as a health care ethicist — not the easiest thing to explain to 5-year-olds. I decided to talk with them about fairness and then play a game about resource allocation that seemed apropos of discussions we are having in the United States about health care.
When I asked the children what fairness was, they had a very clear understanding. The ideas of turn-taking, sharing and inclusiveness are hallmarks of what they talk about every day and echo in their daily interactions.
They had a harder time with the game. I had five of my daughter’s stuffed animals, which she introduced to her classmates as I set them on the table. I then gave the children the following scenario: I have five friends and five magical Band-Aids. Each Band-Aid will help protect an animal friend from getting sick. But Blue Dog is very sick. The only way to help him is to give him all five Band-Aids. What should we do?
Do we give each animal one to protect more friends or do we give them all to Blue Dog to make him well?
This was a tricky proposition. The children had many different answers, but they made three points. First, they rejected the main premise; they couldn’t get past the idea that we couldn’t get more Band-Aids. Second, they appealed to authority, suggesting we take the animals to the hospital, where they would know how to fix everything (and also might have more Band-Aids). Third, they appealed to democracy: One of the children suggested that they vote. So they did: 8-7, in favor of helping Blue Dog.
I was struck by how the children’s reactions mirrored those we all have. The idea of scarce resources in health care is not one that many of us consider and is one most reject. Though we might experience a delay in getting a medical appointment, we can always go to the emergency room if we need help immediately. The idea of access is paramount in every aspect of medical treatment, from the expectation of cardio-pulmonary resuscitation to the growing “right to try” movement, which allows patients with rare or treatment-resistant illnesses to request experimental and unproven treatments.
We also have a hard time thinking about trade-offs. We don’t feel comfortable letting Blue Dog stay sick, even if that means the other animals are less protected from getting sick. And we assume that the medical system will be able to handle the issue. We expect we will get whatever we need at the ER. But we shouldn’t be surprised if the hospital doesn’t have all the answers.
Health policy in this country is, in fact, really challenging, not simply because of all the systems involved, but also because of our conflicting principles and feelings. We are very worried about who is sick now and not always clear about how to keep others from getting sick.
As we consider health care policy, we would do well to think about how and why we allocate our resources the way we do. It is important to care for Blue Dog: He is sick right now. But it is also important to consider how we keep the other animals from getting sick, so that we don’t have to spend five Band-Aids per person to get them well. If we continue to ignore that we don’t have resources to care for everyone, we risk letting more people get sick and having to spend even more than we already do.
How to get from a system that focuses on immediate needs to one that helps us all stay healthy is perhaps the most important question to resolve. And sadly, there are no magic Band-Aids to help.