Power-Up Friday: A Staggering Question of Health Care Ethics

In the latest issue of Health Affairs, medical technology is highlighted and many questions are raised. A study from Stanford reports that even though the use and cost of MRI and CT scans have increased dramatically since 1995, there is little evidence to suggest that there has been an impact on overall health care or mortality outcomes.

The explosion of medical imaging technology since my medical school days is absolutely staggering. Nevertheless, our infatuation with the latest and greatest machines sometimes keeps us from critically examining just how useful they are in the larger scheme of things. With increasingly tough economic questions being asked, these types of studies will put our health care practices under greater scrutiny in the days to come.

Nowhere is this more important than in the care of older adults. Changing medical conditions and life expectancy put even further constraints on the usefulness of diagnostic testing, as comfort and quality of life concerns begin to overshadow the ability to cure disease. A recent task force on colon cancer screening, for example, has recommended it not be done routinely in people over 75, and similar guidelines for prostate cancer suggest that people with a life expectancy of fewer than ten years not be screened.

The point is that we need to look at each individual in terms of their own situation, their prognosis and life goals, before blindly walking through the available diagnosis and treatment options. This requires practitioners to know their patients well and to initiate values-based discussions with each person before deciding how to proceed. These conversations alone may serve to cut the cost of health care dramatically.

Here's a great quote from A. L. Caplan (speaking about nursing homes), which is even more true 18 years after it was written:

"...ethics concerns not only questions of life and death but how one ought to live with and interact with others on a daily basis. The ethics of the ordinary is just as much a part of health care ethics as the ethics of the extraordinary. For the resident, the small decisions of daily life set the boundaries of his or her moral universe."

-- Al Power