GESTIÓN EN SALUD PÚBLICA: BioEdge: Ezekiel Emanuel: intimations of mortality

domingo, 15 de septiembre de 2019

BioEdge: Ezekiel Emanuel: intimations of mortality

BioEdge: Ezekiel Emanuel: intimations of mortality

Bioedge

Ezekiel Emanuel: intimations of mortality

by Michael Cook | 15 Sep 2019 |

Sixty-two-year-old Ezekiel Emanuel, chair of the University of Pennsylvania’s department of medical ethics and health policy, as well as a chief architect of Obamacare, spoke to the MIT Technology Review recently. The topic was “the social implications of longevity research and why he isn’t a fan of extending life spans.” He made some interesting comments about extending life expectancy, “healthspan”, and anti-ageing research.

As he had already explained in a widely-read article in The Atlantic in 2014, he believes that “living too long is a loss”, with declining health, strength and alertness in the twilight years: “I think this manic desperation to endlessly extend life is misguided and potentially destructive.” He maintains that after he reaches 75, he will “stop taking medications with the sole justification that the medication or intervention is to prolong my life.”

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Over-investment in the elderly: “Lots of presidents and lots of politicians say, “Children are our most valuable resource.” But we as a country don’t behave like that. We don’t invest in children the way we invest in adults, especially older adults. One of the statistics I like to point out is if you look at the federal budget, $7 goes to people over 65 for every dollar for people under 18.

Immortality research. “You listen to these people and their lingo is not “We’re just trying to get rid of problems.” Right? It’s “We want to live longer.” I notice that almost all of these things—not all of them, but many of them—are based out in California, because God forbid the world should continue to exist and I’m not part of it! The world will exist fine if you happen to die. Great people, maybe even people greater than you, like Newton and Shakespeare and Euler—they died. And guess what? The world’s still there.”

Quality of life is what matters: It’s very funny—every time I talk to people, it’s like, “Oh, yeah, definitely quality of life over quantity of life.” But when push comes to shove, it’s really quantity of life. “I might be a little more confused, but I’ll take that extra year!”

Silicon Valley: No, no—they’re fascinated by their life extension! This idea that they’re fascinated with life extension [in general]? Naw, they’re fascinated by their life extension. They find it hard to even contemplate the idea that they are going to die and the world is going to be fine without them.

Michael Cook is editor of BioEdge

Conscientious objection to procedures like abortion and euthanasia often features in BioEdge. There is a growing consensus that CO has no place in modern medicine. It’s often argued nowadays that a doctor’s duty is to carry out the wishes of patients, regardless of whether they agree with them or not.

I stumbled across an interesting hypothetical on the American Medical Association Journal of Ethics which makes me question this consensus. In it, three bioethicists analyse a situation involving a difficult patient with deep Christian convictions. He is refusing post-operative pain medication because he believes that he needs to suffer in order to atone for his life as an alcoholic. What should the physician do?

The bioethicists conclude that he should neither acquiesce nor refer the patient to another doctor who will acquiesce. Instead, the physician should “refuse to offer this course of action, regardless of the religious rationale for such a request”.

They go on to assert that “Indeed, as part of their professional commitment to the patient’s health, physicians have some obligation to respectfully challenge patients' refusals of medical care that the physician believes is needed. A sincere discussion—even a respectful debate—in no way denigrates [his] religious beliefs.”

Indeed, this makes good sense. But, viewed from another angle, the bioethicists are advising the physician to conscientiously object to a course of action determined by a lucid patient after serious consideration. They even counsel him to argue (respectfully) with the patient to convince him that he is wrong.

If this is so obviously the case, why is it wrong for a doctor to refuse to perform an abortion? I’m having trouble reconciling the ethical reasoning of the two situations. Can anyone help?