“How Much Would You Pay for Three More Months of Life?” was the provocative title of an article in a recent issue of Newsweek.
It raised questions at a time when the extraordinary is becoming ordinary, as ethics keep up with technology.
The article dealt with what is known as “targeted therapies” — drugs that affect cancer cells only. As you would expect, they come at a high cost. It is called the price of time.
For example, one type of therapy costs $10,000 a month for a drug that would add about two months to the life of one suffering from lung cancer. The article contained other examples: $15,000 for a drug to extend the life of a pancreatic cancer patient by two weeks and $120,000 for extending the life of an advanced melanoma patient by four months. All time frames are median survival times, Newsweek pointed out.
Most end-of-life ethical questions have focused on the “don’t do” aspect — removing life support machines, withdrawing nutrition and hydration, euthanasia, proactive ending of life.
New technology brings new questions. This is not science fiction or abstract questions that an average person will never face. While it may be a good conversation starter, (“how much would you pay to live a month longer?”), it is a precursor to the type of ethical questions typical families will face more often.
Patients who are prospects for targeted therapies are pre-terminal, with no question that they will die within a matter of months. For Christians, once death appears imminent, isn’t a time of acceptance almost welcoming?
The Church has long taught that extraordinary means are not required. Treatment is considered “extraordinary” if it is determined to be futile, meaning that it is either not going to work to keep the person alive or to reverse the course of the disease, or if the burdens of that treatment are disproportionate to the benefits.
In 1957, Pope Pius XII wrote “Normally one is held to use only ordinary means … that is to say, means that do not involve any grave burden for oneself or another. A stricter obligation would be too burdensome for most people and would render the attainment of the higher, more important good too difficult. Life, health, all temporal activities are in fact subordinated to spiritual ends.”
Imagine a family sitting with a terminally ill relative trying to decide if is “worth it” to take out a second mortgage on the home or to use all of money saved for college to pay for weeks, a month more of life. This would create an unnecessary feeling of obligation to extend life.
Yes, insurance more than likely will bear the costs, but this leads to a larger social question: Is that a burden society should bear?
“Miracle drugs” was the term used in middle of last century to describe sulfa, penicillin, and other “wonder drugs.” They are now routine to the point that denying them to someone in illness would be ethically questionable.
The late Dominican Father Kevin D. O’Rourke, one of the leading Catholic voices in health care ethics, wrote on the evolution of Church teaching on prolonging life.
Ordinary means, he said, originally were those readily at hand and available to all. Extraordinary means were expensive, difficult to obtain or inconvenient to arrange for the average person. Over the years, they were used to signify whether particular means were morally obligatory (ordinary) or morally optional (extraordinary). Today the terms “proportionate-disproportionate” and “burden-benefit” have replaced “ordinary” and “extraordinary” to a great extent, said Father O’Rourke.
This is why values and ethics systems, whether faith-based or not, must have a place in any public policy discussion.
These are things to be thought about, deserving of more thought than the political pandering use of such labels as “death panels.”
Kent, now retired, was editor of archdiocesan newspapers in Omaha and Seattle. He can be contacted at: Considersk@gmail.com.