Death and Debt for Diabetics

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Fending Diabetes With Compassion
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My father is a diabetic, and so is his three other siblings. Since 1997 he has been in and out of almost six hospitals for a total of 31 times for various lengths of confinement. He died almost a week ago when all our resources were already drained, having been discharged only a two days prior to his last bout of critical illness.

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We couldn’t have put him in the Intensive Care Unit because of the intense cost it requires. We barely have enough to put up front as “deposit” get him admitted. In the end I had to hold on to the Principle of Extraordinary Means.

As defined in the Catholic moral tradition, the principle holds that “one is obligated to preserve his or her own life by making use of ordinary means, but is under no obligation to use extraordinary means”. It is also called principle of proportionate/disproportionate means. Treatment has to be given and accepted when the means is proportionate. One is no longer obligated to undergo the treatment once it constitutes a disproportionate means.

To judge whether it is proportionate or not is a personal decision with consideration of the economic, familial and social circumstances of the patient. Realistically, this is not base on any convenient list of proportionate and disproportionate treatments.

Proportionate or ordinary means should not be confused with ordinary care. Ordinary care constitutes non-medical nursing interventions. Ordinary or proportionate means are treatment that offers a reasonable hope of benefit and is not too burdensome for the patient or others. Again, to consider it not too burdensome has to be taken in the light of the expected benefits the treatment can afford the patient in contrast to the financial, familial and social circumstances.

As much as I wanted to extend the life of my father, the circumstances played in to consider his mortality. I had to ask a theologian friend to affirm me that my decision was moral and valid. He said that it is not my fault to make this because in the end the system failed us. The principle of justice in health care, that Aristotle described as “giving to each that which is his due”, is all the more elusive; perhaps owing to modernity and its complexity.

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What Aristotle described is distributive justice. Oftentimes, the distribution of resources (confounding scarce at that) is oftentimes hinged on criteria that says nothing about noteworthy factors of the person or his/her needs. The question remains: Who has the right to healthcare? It is claimed by John Rawls that many of the inequalities we experience are a result of a “natural lottery” or “social lottery” for which the affected individual is not to blame. It is imperative then that society should treat this social malady for it to move healthily forward. Bono aptly writes that “where we live should not decide whether we live or whether we die”.