Sometimes you just don’t want to be right.  Over the past 5 years, I have seen an alarming pattern arise in my profession.  Many of my patients have heard me talk about Soylent Green, an old Charleton Heston movie.  The premise of the movie seems absurd.  Can you imagine the government of the United States providing for all the needs of its people including healthcare, food, clothing, and even death?

David Brooks’ recent opinion piece in the New York Times makes my fear of a “Soylent Green” society frightenly real.  While I recommend you read the entire piece, for the purpose of this blog, I want to highlight the following.

Mr. Brooks writes, “This fiscal crisis is about many things, but one of them is our inability to face death … our willingness to spend our nation into bankruptcy to extend life for a few more sickly months.”

He quotes S. Jay Olshansky as saying, “our main achievement today consist of devising ways to marginally extend the lives of the very sick.”   He then closes his piece with “we think the budget mess is a squabble between partisans in Washington.  But in large measure it’s about our inability to face death and our willingness as a nation to spend whatever it takes to push it just slightly over the horizon.”

In Soylent Green, the citizens dutifully walked into the death chamber when it was their time.  Mr. Brooks would be proud of how those brave souls faced their demise for the good of society.  Rather than marginally live another month or two, costing society a fortune and threatening a budgetary crisis, the citizens of Soylent Green did as prescribed, they follow the protocol created to save society.

My question for Mr. Brooks is who defines what “marginally extends the lives of the very sick” is?  Who decides who shall live and who shall die?  I can’t.  Not long ago, I met a very sick patient in the emergency room.  He was critically ill having had a catastrophic event.  He was comatose with signs of profound damage.  The neurologist told the family he was brain dead.  While Mr. Brooks believes that medical science has made very little progress in extending life, my patient benefited from a remarkable new invention, the Arctic Sun Hypothermic Unit, and fully recovered.

The procedure and hospitalization cost in excess of $300,000.  Saving this one life cost a fortune!  In Mr. Brooks’ world, should we have forgone this patient’s treatment and helped his family face death?  Are we “spending our nation into bankruptcy” by working hard to save lives?  Maybe so.  But who are we if we don’t care for our ill?  What do we become when we arbitrarily decide what a life’s value is?

Mr. Brooks obviously doesn’t practice medicine.  If he did, he would know that an individual life is worth everything to that person and his family.  Mr. Brooks would know that patients survive against all odds and recover to enjoy meaningful lives.  He would know that statistics lie.  A patient with a life ending cancer is told he has three months to live without treatment and six months with treatment.  Despite the tremendous expense both financially and physically, he accepts treatment.  Seven years later he is thriving.

Respectfully, Mr. Brooks doesn’t know what he is talking about.  The problem is the policy makers aren’t doctors.  Soylent Green, here we come.

Stewart Segal is a family physician who blogs at Livewellthy.org.

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