Socialized Medicine-One Size Fits None

By Selick, Karen | Freeman, August 1999 | Go to article overview

Socialized Medicine-One Size Fits None


Selick, Karen, Freeman


ONTARIO, CANADA-Andrew Sawatzky, an elderly Manitoba man whose wife went to court to fight the "Do Not Resuscitate" order placed on his hospital chart, is probably part of a fairly small minority. His wife says he wants resuscitation if he has another stroke, even though the attempt might fail or leave him permanently unconscious.

I discuss these life-and-death issues frequently with clients when preparing powers of attorney. The vast majority recoil from the thought of becoming brain-dead husks on permanent life support. Most say that if their doctors pronounce further treatment futile, they would rather accept the verdict and "die with dignity."

But what's right or wrong in cases like this can't be determined by public opinion poll. It doesn't matter what 99 people would choose, if the 100th person wants something different. The question remains: what should be done about Mr. Sawatzky?

To me, the ethical principles that should be applied are simple. Everyone should be free to conduct his life however he pleases, so long as he leaves others free to do the same. It's wrong to use force-including the force behind our court system-to bend someone to your will, except to enforce a contract the other person previously agreed to.

The Sawatzkys, if they want heroic and possibly futile measures taken, have the right to try and procure such services. But they don't have a right to force any particular doctor, using the court as their big stick, to render those services. If their current doctors and hospital genuinely believe it's unethical to provide them, all the Sawatzkys can do is look for someone who believes otherwise.

The doctors and the hospital, on the other hand, have no right to impose their will by force on Mr. Sawatzky. For example, they can't refuse to let him leave if he finds an alternative treatment center that is willing to comply with his wishes.

The Money Issue

But there's a good chance he won't be able to find one. Now the secret, unmentionable side of the problem must finally be broached: money.

The hospital couched its objections to further treatment in humanitarian terms, but they rang hollow to me. So what if resuscitation attempts might fail? Why not just try and see? And how can it be "cruel" to treat someone when he understands the risks and still wants the treatment? People make decisions to undergo risky medical procedures every day, and hospitals don't overrule them because the operation might fail or the outcome might be tragic.

If life-support machines grew on trees, and an infinite amount of money earmarked for paying doctors' salaries and hospital expenses fell like manna from heaven, we would not be having this debate. …

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