A couple of years ago, I tried to make an informed decision about whether to give consent for organ donation. There was information available, certainly. It came in the form of pamphlets telling me about the benefits to those who received transplants, and the steps taken to maximize transplant success.
What they didn't tell me was the cost.
Why should I care? We have Medicare, and even if we didn't, obviously my estate wouldn't be picking up the tab for my generous act.
I care because a cost to the health system is a cost to my neighbours, my community, and my world.
Yes, but it saves a life!
Sorry, that's not a good enough argument. Fixing a highway embankment saves lives too, and if it does so at a lower cost, then it should have priority over the transplant program.
Well, okay, but that's easy to say if you're not the one on the waiting list for the transplant.
True, and I don't know how I would act in that situation. But I kept looking for information on costs and benefits of transplants, and as I looked, my thinking evolved. The more I looked (without success), the more convinced I became that I wanted healthcare cost information so that I could make advance decisions and directives, not for the fate of my organs after my death, but for the responsible treatment of my body while I live.
For example, I couldn't find any straightforward information on the full cost of having a kidney transplant, versus managing the disease in other ways, or accepting an earlier death. I did find out that transplant patients would face ongoing health costs associated with immune suppression to prevent rejection of the transplanted organ.
Now in case you're thinking I'm being incredibly callous, remember, I was thinking about what I would want to have happen if I myself should develop kidney disease.
I told Garth about these thoughts, and the idea of refusing a kidney transplant because the long-term cost of such medical intervention seemed irresponsibly high.
He told me I was being selfish.
I mentioned the discussion to a friend, and he agreed with Garth.
Here is an analogy. Suppose I was adrift in a lifeboat with two plump people. I myself am on the scrawny side. We have a water purifier, but a limited supply of food. Our best estimate is that there is not enough food for all three of us to last until we reach land. My suspicion is that the two of them could survive together, but there is only enough food for one of me.
Now let's say that all three of us have spouses and children waiting back home.
If I don't drown those other two people to make sure I get home to my family, am I being selfish?
revisit: Littling Along
3 days ago