Buying Time: the Cost of Prolonging Heart Patients' Lives
May 9, 2003
In the United States, more than five million patients have heart failure and half a million new cases are diagnosed each year. A few years ago, people suffering from heart failure had few options other than hospice care. Today, these people have choices, including heart transplants and devices designed to help failing hearts.
- One of them is a biventricular pacemaker, which helps to coordinate the contractions of a failing heart -- one study suggests they may even prolong life but the devices cost about $20,000 each.
- Implanted defibrillators are beeper-size devices that monitor the heartbeat and apply an electrical shock if the rhythm degenerates into something dangerous -- millions of Americans could potentially benefit from the $30,000 devices.
- Mechanical pumps (left-ventricular assist devices) costing about $250,000 prolong life by an average of eight months in patients with advanced heart failure, but those who lived longer spend much of their extra time in the hospital.
All these options force doctors to make individual judgments about who should get a device and who should die without one. However, a physician's first responsibility is to the patient, not to some abstract notion of social justice.
Most of these patients will not live very long, with or without devices. But policy makers should enter this debate. Some of the questions they must answer include: Does it makes sense to implant such a device in the chest of a 70-year-old debilitated by heart failure and living in a nursing home? How much should society pay for those few extra months?
Should society invest its limited resources in such patients?
Source: Sandeep Jauhar, "Buying Time: Doctors Debate the Ethics of Care and Cost," New York Times, May 6, 2003.
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