President Obama's Grandmother and the Ethics of Health Care Reform

[jody]

President Obama's Grandmother and the Ethics of Health Care Reform

So now she’s in the hospital, and the doctor says, Look, you’ve got about — maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that — you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible.

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I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.

...I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.

The President has done two key things here. First, he has started to discuss resource allocation and rationing in down-to-earth, personal terms. The question of whether to do a hip replacement is a truly challenging clinical as well as ethical decision. This wasn't a situation of "flogging" his grandmother with a chemotherapy that offered a small chance of minor extension of life but at the cost of major side effects and high expenditures. If the President's grandmother had nine months of life in store and the hip replacement went well, the operation could have contributed to a significant improvement in quality of life for many months, but her heart condition and the cancer made the procedure riskier. What to do was a tough question.