American society is on a collision course between rising expectations for high-cost care at all ages and an apparent unwillingness to pay for such care. Logically, only two measures can prevent the collision: Spend more money or deny expected care. A third measure—wringing more care out of the present health-care expenditure level—is only a temporary fix. Even if more inefficient and/or unnecessary care can be found and eliminated, the increasing cost demands of new technology and labor-intensive care, combined with a growing number of senior citizens, will eventually outstrip even the current level of almost 11 percent of the GNP spent on health care.
Currently, the favored choice seems to be to deny care whenever possible, rather than to give more money to an already gluttonous system. This option is supported by two perceptions—both of which could be reversed in public thinking. One is the understandable human tendency not to want to pay for getting sick—and the consequent desire to have someone else (meaning government or employer) pay for our health care. The other is the understanding that we pay more for health care than other nations with similar values and health outcomes—suggesting that our health money is not being well spent. (That we pay more is an indisputable fact; that our money is not being well spent is a matter for debate.) However, as more members of our society are being denied actual care, or at least easy access to desired care, the debate about how to balance the spending of money and efforts to limit care will become more urgent. Barring international catastrophe or a major recession, I believe it will become the major political issue of the nineties. And the question Christians must ask is whether spiritual values have anything to contribute to the outcome of the debate.
I would suggest that there are two very important Judeo-Christian spiritual themes that speak intensely and provocatively to the current health-care debate, and that are seemingly contradictory. Only one of these values is widely held in our society, but the other may be increasingly needed to balance the debate.
A Time To Heal
The first theme, deeply ingrained in the American psyche, is that all human lives are of value. That theme clearly stems from Judeo-Christian teachings about the worth of each human life in the eyes of God. And even though the specific religious underpinnings for that belief have diminished in our society, the conviction is still widely held by current generations of adults. Translated into health-care policy, that belief drives us to provide at least basic health care to all our citizens, something we have always tried to do with either private charity or public insurance, and even to consider care that may not be logically called basic. For example, in a recent discussion on health-care policy, a doctor described the foolishness and wastefulness of the speech therapy being offered to his mother in a nursing home. He said, rightly, that his mother, who had suffered a severe stroke, was in no condition to benefit from this therapy, which was costing $50 an hour. But a rabbi in the audience got up to say that such therapy was evidence of our societal commitment to the dignity of even a woman in her condition—and we should therefore support the effort.
Clearly, however, our theoretical commitment to health care for all has never translated into a public policy of truly universal health insurance provided through federal guidelines and financed by general taxation. Instead, we have attempted a patchwork of private and public insurance that increasingly has left large holes in the health-care safety net. The biblical call for social justice, with special attention to the needs of the poor, leaves no doubt about the need for some form of national health insurance that will guarantee such needs will be met. I believe that by the end of this decade we will finally have such insurance, probably along the lines of the Canadian model in which federal and state money, as the sole source of health-care dollars, are parceled out to states and/or local governments to distribute according to local guidelines and negotiations. This model is far superior to a “national health service” that literally runs health care from Washington. That would be a bureaucratic nightmare of the highest order.
This spiritual/moral commitment to provide basic health care for all is the easy part, although translating it into reality and overcoming the political barriers to national health insurance will indeed take time—about ten more years in my judgment, possibly sooner if there is a change in political attitude in the White House. The much harder spiritual value to digest will be our second theme: that we should not blindly worship at the altar of physical existence. Specifically, this should cause us to look at what we spend money for and especially how much we spend for prolonging death or for rescuing life.
A Time To Die
At the heart of our Judeo-Christian tradition lies the belief that there is more to our ultimate pilgrimage than the physical life span of human existence. The familiar injunction of Ecclesiastes about “a time to die” often gets lost in the modern cultural worship of life at all costs. This concept is sharpened and provocatively enlarged by Jesus when he challenges his disciples to understand that “whoever loses his life for me will save it” (Luke 9:24). The apostle Paul carries this liberating concept to exquisite heights when he is able to write, “If we live, we live to the Lord; and if we die, we die to the Lord. So, whether we live or die, we belong to the Lord” (Rom. 14:8).
I am also reminded of Jesus’ question to his disciples as recorded in Luke 12:25: “Who of you by worrying can add a single hour to his life?” Obviously this rhetorical question was asked in the context of a lecture regarding foolish worry and anxiety about earthly sustenance. But perhaps some of our worry and effort to salvage or prolong physical existence falls into the category of “foolish” or even “sinful.” Put bluntly, when does the effort to rescue physical existence from the jaws of otherwise certain death—or at least certain vegetative existence—qualify as spiritually foolish?
Even to ask this question puts a different spin on the way the matter of medical rescue is usually approached. Typically, the question of whether to engage in extraordinary medical effort is approached by simply asking whether or not it is technically possible—or, today, by asking whether or not the effort is “cost effective” in terms of the quality of life expected. Also, today, the questions must always be asked in the context of the current local or state legal climate—an indication of just how secularized decisions about life and death have become. But if we are to ask about the spiritual value of our medical efforts, we are forced to bring the debate to a new level—one in which easy answers simply will not work. At best, we can only approach the questions in light of basic principles that can guide us to more spiritually sound decisions about how we should use our health-care resources.
First, it is spiritually sound to accept death as part of life. If the church taught and preached this concept more regularly—and discussed it more thoroughly—it would become a more natural and pervasive part of our medical decision making. We need to be reminded of this valid spiritual principle time and time again so that it automatically becomes part of the data in specific decision-making situations.
Second, it is spiritually sound to care as much about the quality as the quantity of life. That is clearly the message of Christ’s own life and teachings. During his ministry, he did not frantically attempt to salvage all the lives about him—though he did heal and restore life in many instances. By his own life example—a ministry of only three years and a very premature death—it would be hard to conclude that longevity in and of itself is the proper measure of meaning.
Third, it is spiritually sound to consider limits on the application of modem medical technology. Jesus’ teachings often ask us to question the value of and the concern for earthly existence or the comforts and idols thereof. He was not, of course, an ascetic in substance or style. But he was remarkably free of worry about how long he would live or even how well he would live.
Taken together, these three principles direct us to be willing to consider more limits on the use of present and future medical technology than is now the case. Specifically, I think they guide us not to:
• Rescue very young (very low birth weight) preemies where current medical skill cannot reasonably predict a nonvegetative life;
• Prolong the artificial physical functioning of a person who would otherwise clearly be dead;
• Prolong the natural physical functioning of a person who has no hope of human—that is, conscious—existence.
This means that when choices must be made, these principles compel us to use limited resources to provide for the basic medical needs of the living rather than to support heroic measures for the dying. In other words, I would not deny a liver transplant for an otherwise physically intact person on this basis but I would remove life-support measures—including food and water—for a person with no hope for conscious recovery. The secularization of health care has elevated physical existence to a near-idolatrous level, but this need not be a terminal condition. Health care that is infused with Judeo-Christian values will not only teach us to respect human life, but also to accept and respect the inevitable end of earthly existence.
