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Putting a Price on Quality of Life

Abraham Schwab, PhD

My uncle needs a new heart. His medical history is rich in detail, but the only thing that matters to us is that he needs a heart transplant. 

And he’s not sure he wants it. He doesn’t use the terminology I do, but he’s not sure his quality of life is worth it. He doesn’t seem to want to continue living like he has, and he’s not sure he wants to live like he would have to after the transplant. His judgment about his quality of life remains unsettled, but last I heard, he was leaning against getting the transplant. 

Of course this is upsetting. My mom wants him to get a transplant. And my aunts too. But whether the quality of life is good enough, and makes his life worth living, is his call.

He could, as many do, set aside his judgment in favor of other considerations. He might judge that his quality of life isn’t worth it, but defer to his sisters’ pleas, or his friends’ requests, or his religious leader’s directives. The quality of life judgment would remain, but it would be set aside for other considerations.

For my uncle’s case, we talk about this in terms of his judgment, in terms of what he wants. What I began to wonder, though, is if there comes a point where his judgment will be set aside entirely. 

Imagine, for example, that my uncle decides he wants the transplant. Suppose he decides the quality of life is worth it. With a cost of $1 million for the transplant and the first year of related expenses, we, as a group, are going to cover those costs. Whether through insurance premiums or taxes or other fees, the costs of such a transplant will be spread around for the rest of us to cover.

And if things go poorly, it’s possible he’d need another heart transplant and we’d be paying for that, too.

But, of course, this isn’t just about my uncle’s heart. It’s about liver, kidney, and lung transplants. It’s about dialysis and hip replacements. It’s about chemotherapy and radiation. Most of us can’t afford any of these things on our own. If we think it will be worth it, if we think the quality of life is one we want, and we need these things, we often get them. But should we? 

Up until recently, we in the United States let the brutality of the market and the vagaries of employment make some of these decisions for us. But now that we’re covering a higher percentage of the population, and we’re requiring insurance companies to cover more costs for more people, there may come a day when we have to decide whether it matters if I or you or my uncle thinks the quality of life is good enough. We have to decide when it’s worth the cost. 

Abraham Schwab, PhD
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