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Harris Sherline: Deciding Who Lives and Who Dies, Part II

We stand to lose people with great potential under a system that rations health care based on cost

In a society that bases life and death decisions on cost, such as the QALY (quality-adjusted life year) system in Great Britain, it’s easy to see how it’s possible to deny health care to people who have the potential for great accomplishments.

Harris Sherline
Harris Sherline

For example, Helen Keller, who was born blind, deaf and mute, through the patience and perseverance of her nurse and companion, ultimately became a world-renowned figure for her accomplishments in helping those with disabilities. However, my guess is that if she had been born at a time when the health-care industry was making cost-based decisions about who should live or die, she would not have been spared.

She has been quoted as saying, “I dreamt of heaven the other night, and the pearly gates swung wide. An angel with halo bright, ushered me inside. And there to my astonishment, stood folks I’d judged and labeled as quite ‘unfit,’ of ‘little worth’ and ‘spiritually disabled.’ Indignant words rose to my lips, but never were set free, for every face showed stunned surprise, not one expected me!”

Another person who probably wouldn’t be with us today under a health-care system that restricts access on the basis of cost is one of world’s greatest physicists, Stephen Hawking.

Hawking, born in 1942, has suffered for about 40 years with ALS (amyotrophic lateral sclerosis), more commonly known as Lou Gehrig’s disease. The list of his accomplishments is too long to detail here, but he has authored a number of important contributions to the fields of cosmology and quantum gravity, including “black holes.”

Hawking developed ALS in his youth, while attending Cambridge, and has become increasingly paralyzed over the years, to the point that today he is almost completely immobile and can no longer speak. He has been quoted as saying, “It is a waste of time to be angry about my disability. One has to get on with life, and I haven’t done badly. People won’t have time for you if you are always angry or complaining.”

If the British QALY system for evaluating the worth of individuals had existed at the time Hawking became paralyzed, would he have received the care and support that have kept him alive for the past 40 to 50 years, or would the cost of his care resulted in the conclusion that it was simply too expensive?

There is a long list of people who have made significant contributions to society and who might well have been denied health care on the basis of cost under the British QALY system or a similar policy that could potentially become the method for health-care decision-making in the United States under the type of health-care reform that the Obama administration has been pushing. The following are just some examples:

» Christopher Reeve (1952-2004), actor: He was paralyzed as a result of a horse-riding injury and dedicated the remaining years of his life attempting to harness the power of medical research to enable people with spinal cord injuries to recover and walk again.

» Ray Charles (1930-2004), musician: He became blind at age 7, learned to play the piano and went on to become one of America’s greatest entertainers.

» Jose Feliciano (1950-), Stevie Wonder (1950-) and Ronnie Milsap (1945-), composers and musicians: All were born blind and overcame their disabilities to become leading songwriters and entertainers.

» Franklin Delano Roosevelt (1882-1945), U.S. president from 1933-45: He suffered from polio, which he contracted in 1921.

» Louis Braille (1809-1852), inventor of the Braille system of reading and writing: He became blind at age 3 as a result of an accident.

» Anne McDonald (1961-), Australian author and activist for the rights of people with communication disabilities: She developed cerebral palsy as a result of a birth injury. Diagnosed as having severe intellectual disability at age 3, she was placed in an Australian government institution for people with severe disabilities and lived there without education or therapy for 11 years. McDonald wrote her story in Annie’s Coming Out, a book she co-authored with Rosemary Crossley in 1980 (the film Annie’s Coming Out based on the book won several Australian Film Institute awards and was released in the United States under the title Test of Love).

» Hubert H. Humphrey (1911-78), two-term U.S. vice president and senator: He is credited with saying, “The moral test of government is how it treats those who are in the dawn of life ... the children; those who are in the twilight of life ... the elderly; and those who are in the shadow of life ... the sick ... the needy ... and the disabled.”

Those are important words everyone should keep in mind during the debate about reforming America’s health-care system. If the changes lead to health-care rationing and decision-making about who lives and who dies based on monetary considerations, we will not have moved forward but backward in our quest for fairness and equity.

— Harris R. Sherline is a retired CPA and former chairman and CEO of Santa Ynez Valley Hospital who has lived in Santa Barbara County for more than 30 years. He stays active writing opinion columns and his blog, Opinionfest.com.

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