The ambulance announces the arrival of another patient from the local nursing home. The patient is an 82 y/o male with a fever. He has not spoken to anyone in over 5 years. He cannot walk, communicate, eat or urinate on his own. His family in New York has not visited him in over 2 years, but they insist that “everything be done”. The extensive work-up for the fever source begins. A small aspiration pneumonia is found, and the patient is admitted for IV fluids and wide-spectrum antibiotics. After a few days, and thousands of dollars, hopefully, he will be well enough to return to the nursing home. He will probably repeat this process again in a few weeks. This will continue until he expires.
The question that comes to mind is the cost for all this care. In a perfect world, there would be unlimited healthcare dollars and the cost would not be an issue. This is not a perfect world and there are many pediatric patients competing for the limited healthcare funds. The question then changes to – where would you like to spend the money? On pediatric patients or to prolong the life of those who have no quality of life left. I do not wish to play God and make these decisions on my own, but I believe that we as a society must discuss these issues and make these very difficult and important decisions. I explore this and many other issues in my recent book – “A License to Heal”.