Sunday, January 8, 2012

Living forever

I suppose that in time science will find a way to let us live forever. Perhaps that is what motivates space exploration: finding a place to put us when we have no more room on this planet. But frankly, I’m not interested in waiting for that, nor do I think it is right.

Somewhere along the way in the current health care debate, opponents have asserted that there will be "death panels," that will essentially determine "who shall live and who shall die." That was the title, by the way, of a television documentary in the 1950s. The subject then was kidney dialysis and the lack of sufficient machines to provide the service to all who might benefit from it. The same question arises whenever there is a shortage of an advanced medical intervention, and it goes away as the health care industry reaches a point where resources equal need. Of course that doesn’t mean all who need it will get it, or all who get it will want it. Some will be denied because they don’t have a way to pay for life. Some will not get it because they don’t want it.

For a number of years I wrote and produced medical teaching films, translating the latest advances in the specialized sphere loosely identified as "combat medicine." I was associated with a highly specialized medical research institute whose mission was briefly stated in the motto: "Research for the Soldier." The goal was to identify the threats and develop the countermeasures against those which could render a soldier ineffective. That’s a very simplistic description, but it is generally accurate. I mention this because it relates to a personal philosophy, and it is relevant to some of the emotional and perhaps intentional misreading of the legislation designed to provide comprehensive health care to a significant number of Americans who have, at best, inadequate protection from incredibly expensive health care today.

When I made those films I was between my mid-thirties and mid-fifties, and life was good. (I’m well past that now, and life is still good!) I had no doubts about the work I was doing, or the work being done by my colleagues in military medical research. After all, we were asking our youngest and best to expose themselves willingly to the possibility of pain, suffering, dismemberment, disfigurement and death. We owed (and still owe) every one of our soldiers, sailors, airmen and marines the very best opportunity to recover and live full lives when war takes its inevitable payment. Anything we have to spend to provide the knowledge and tools necessary to repair and replace is just and righteous, no matter who started the war, or how unwise our involvement. The men and women who face the dangers don’t start the wars, don’t vote for them, don’t get paid enough to make the risk worthwhile.

But what about the rest of us? Don’t we have a little more responsibility for how our lives are lived? Don’t we as individuals control a lot of the potential exposure to threats? We know how to minimize the spread of disease, we learn early that alcohol and drugs (illegal and legal) can affect our abilities. Today we certainly have some idea of foods that help us and those that can kill us. We have choices that we make, and there are choices our bodies make for us.

I’ve already convened my death panel.  I have a "living will," that says I want no "heroic" measures taken in the event that routine procedures will not work. I don’t want to come back from the dead missing half my body or my brain. I cannot imagine a worse death than the one in which I would be able to hear you and maybe see you, and not be able to communicate; to know where my arms and legs are but unable to make them function. Life in which I could only communicate with eye-blinks would not be living, to me.

I just don't want the decisions in my life to be made because I can't afford any other choices.

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