Major Moral Dilemma: It Started with Viagra

coberst

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Major Moral Dilemma: It Started with Viagra

It is obvious even to the most casual observer (no Critical Thinking required) that we must quickly deal with the problem that medical technology has left on our door step. As a result of the success of medical technology we can prolong life ever more, every day, than the day before. I claim that this constantly extending the prolongation of life must quickly cease; we can no longer afford such a foolish unreflective behavior.

Bruce Hardy, a British citizen and cancer victim, was refused the funds, by British health officials, for a drug that could likely prolong his life for 6 more months. The drug treatment cost was estimated to be $54,000. His distraught wife said “Everybody should be allowed to have as much life as they can”.

“British authorities, after a storm of protest, are reconsidering their decision on the cancer drug and others.”

The introduction of the drug Viagra, by Pfizer, in 1998, panicked British health officials. They figured it might bankrupt the government’s health budget and thus placed restrictions on its use. Pfizer sued and the British government instituted a standard program, with the acronym NICE, for rationing health drugs.

“Before NICE, hospitals and clinics often came to different decisions about which drugs to buy, creating geographic disparities in care that led to outrage.”

“British Balance Benefit vs. Cost of Latest Drugs” New York Times


I have stated many times before that I was convinced that we have created a technology that is too powerful for our intellectually unsophisticated citizens to deal with. It seems to me that this particular dilemma does not require a great deal of sophistication to understand. This might be a perfect place to begin a nationwide (USA) Internet discourse directed at getting our intellectual arms around this problem and helping our government officials in an attempt to resolve this terrible dilemma.

Incidentally I am 74 years old, which I think qualifies me to push this matter without appearing to be a hypocrite.
 

coberst

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I think I see the dilemma: Medical technology is very expensive. And yet it seem like we have a moral duty to prolong life as long a possible by using that technology, which in consequence to make us overuse our capacities.

How do you think it should be solved?

The only way to solve our problems is for the citizens to become sufficiently sophisticated to comprehend such problems. After the recognition of the problem then an even higher level of sophistication is demanded to solve those problems.

Our (USA) educational system is directed toward vocational training and not for a high level of intellectual
sophistication.

The only answer for us is that adults must begin a process of developing the sophistication required. That means that adults must begin to become self-actualizing self-learners when their school daze are over.
 
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coberst

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”A 70-year-old woman in India gave birth to her first child, a girl, after undergoing infertility treatment, according to a report in the Daily Mail.

The mother, Rajo Devi, had been trying for 50 years to get pregnant with her 72-year-old husband, who had failed to become a father in two prior marriages. It was undetermined whose egg and sperm were used in the treatment, the newspaper reported.”

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Rauffenburg

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Everyone should be allowed to have as much health as they can, at their own expense, not the taxpayers. Problem solved.

I sharply disagree with that. Culture is one of the most significant evolutionary adaptations of mankind. It helps a group of people to get an evolutionary advantage by cooperating, which means, redistributing survival risks among its members so that the group can cope with challenges no single individual could. And this is why taxpayers should be held accountable for the benefits they all share by being members of states and governments. On a species level the return to individual utility-maximization is a great loss. Public healthcare can be a good mechanism for risk-redistribution with an increase in overall utility.
 
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Eudaimonist

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Culture is one of the most significant evolutionary adaptations of mankind.

I agree.

It helps a group of people to get an evolutionary advantage by cooperating, which means, redistributing survival risks among its members so that the group can cope with challenges no single individual could.

Cooperation does not require taxation and government services. (Forced cooperation is a bit of an oxymoron anyway.) The free market is also a form of cooperation and culture.

Survival risks need not be "redistributed", as if one had to distribute pieces of pie of a fixed size, but reduced overall and in the long run through production and trade.

And this is why taxpayers should be held accountable for the benefits they all share by being members of states and governments.

Not only do taxation and government services not provide an evolutionary advantage, I don't see why evolutionary advantage should have anything to do with either politics or ethics.

On a species level the return to individual utility-maximization is a great loss. Public healthcare can be a good mechanism for risk-redistribution with an increase in overall utility.

I see no reason why I should judge society with an individual-nullifying utilitarianism or species collectivism.


eudaimonia,

Mark
 
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Rauffenburg

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Cooperation does not require taxation and government services. (Forced cooperation is a bit of an oxymoron anyway.) The free market is also a form of cooperation and culture.

More or less, yes. It is a special case of cooperation that arises out of individual maximizing of utility. Of course free markets also include collectivist elements - each corporation is one; things like loyalty towards the employer are good examples for collective organization of companies. Why are WalMart employees doing stuff like singing and yelling togehter? These tactics are used to create a collective feeling of identity, just like they do in the military. There are other ways of cooperating, ways that are not based on individual maximizing of utility, but on setting common goals beforehand. And my case is, that there are good reasons to have both kinds of cooperation and to choose between them based on the situation one wants to cope with. In a prisoners dilemma situation a totally free market is a bad thing, yet a market with certain additional limitations and rules may lead to a better overall outcome.

Whether forced cooperation is an oxymoron or not is an interesting question. I do not believe it is. In fact every type of cooperation faces the free-rider problem and every type of cooperation therefore needs force to guarantee that cooperation continues to work. This is the case for free markets as well; private property can only be sustained by force because otherwise a strong competitor would not want to respect it.

The question not addressed here is: What is legitimate force?

Survival risks need not be "redistributed", as if one had to distribute pieces of pie of a fixed size, but reduced overall and in the long run through production and trade.

In times of crises, private property is commonly restricted. This is in fact a thing that our modern societies and indigenous societies have in common. And there are good reasons to do this; a crisis normally effects large parts of the society, not only small groups of individuals. In such cases it can be detrimental to the overall utility of all or a large part of the members of a society to allow certain privileged groups (that is privileged in their possession of resources) an exclusive right on resources they do not need for survival.

The fixed-pie model is indeed inadequate. It is a common strategy of societies to limit individualism in times of crisis, because in such times individualism shrinks the pie. In such situation certain ways of redistribution of risks maximize the size of the pie.

Not only do taxation and government services not provide an evolutionary advantage, I don't see why evolutionary advantage should have anything to do with either politics or ethics.

You are right in one thing. Taxation and government services do not per se provide any advantage - nor any disadvantage. In depends on how resources are redistributed and on how they are allocated and used. I also agree that evolution does not provide arguments for normative claims. Yet it is imperative to know which ways of organizing society are stable and which are not. And evolutionary theory teaches us that stability is a relative notion. More or less total individualism is only stable for a society without large external threats such as war, catastrophes etc. or for a society that does not expect such threats in the immediate future.

I see no reason why I should judge society with an individual-nullifying utilitarianism or species collectivism.

What is the value of individuality when one faces an epidemic, an eruption of a volcano, global warming or other things comparable? I have some sympathies for your heroic individualism. But in certain types of situations it is inadequate to be an individualist - it is irrational from the point of view of most individuals (not necessarily of all individuals!). And in such a situation the rules that protect individualism in normal times, will inevitably become more and more unstable as it is nothing more than the rationality of the people that stabilizes these rules. Individualism is fragile. Take the example of an epidemic. Which society is better equipped to cope with an epidemic? a) A society with a more or less government-based public health care system that allows for treatment of larger quantities of the population; or b) a private health care system with many people that aren't even insured either because they do not want to or because they lack the resources. To cope with an epidemic you will need all kinds of force, regardless whether they may conflict with individualism or not.
 
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Jade Margery

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The thing about tax-payers paying for expensive medical treatments that only delay an inevitable outcome is that the money could be used for something that helps many people live well instead of helping one person live uncomfortably for a very short amount of time. $54,000 is almost twice the average annual income of a lower class family here in America ($28,000 at minimum wage, from probably two jobs). If we assume even half of that is spent on food (it is likely much less in reality), then the cost for keeping a dying man around for six months is enough to feed four hungry families for a year. It could repair a crumbling school, or provide vaccinations to underprivileged children, or go to medical research. It could put a young person through college, making them a greater contributor to society for many years.

I'm not saying the state shouldn't fund some health care, or that they shouldn't help with the overall cost of the treatment, but rather that they need to evaluate better where our tax dollars are spent to provide the greatest assistance to the most people. Of course the wife is going to be distraught and angry, because she is one person losing what is most important to her, but others need help too.
 
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jayem

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Actually, it started well before Viagra.

I think the first time where we faced a thorny issue of how to allocate an expensive medical technology was with renal dialysis back in the 50s. Transplants were still highly experimental (and worked well only between identical twins.) Kidney failure used be terminal within 6-12 months. Lives could be prolonged with these new machines, but they still weren't available everywhere and the costs were exorbitant. Hospitals had dialysis committees to determine who would qualify for treatment. They use factors such as younger age and family responsibilities as criteria as well as medical need. This was obviated in the early 70s, when Medicare assumed payment for all renal dialysis. So now everyone with end stage renal failure automatically qualifies for Medicare coverage. Dialysis is available to all. But it costs us about $70,000 per patient per year.
 
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coberst

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Perhaps the greatest problem the USA faces in the next decade or two is our cost of medical care. We are presently committed to medicare payments that are far beyond what we can pay. We must face with moral courage this problem and make decisions that will allow future generations to survie. Our delay in tackling this problem is a measure of our irresponsibility that might properly be compared with the irresponsibility of our financial leaders when they put us into the financial fix we are now in.
 
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billwald

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The one who pays the piper names the tune. If the government is required to pay for all medical treatments then the government is obligated to limit its liability by limiting unhealthy activity . . . fat burgers, beer, mountain climbing, ice cream, motor cycles, ski boats . . . .
 
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Eudaimonist

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The one who pays the piper names the tune. If the government is required to pay for all medical treatments then the government is obligated to limit its liability by limiting unhealthy activity . . . fat burgers, beer, mountain climbing, ice cream, motor cycles, ski boats . . . .

And this shows how even the most well-intentioned government programs can become a threat to personal freedom.


eudaimonia,

Mark
 
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