Heroic Medicine: How “sacred” is life itself? How heroic are we obligated to be in near-terminal conditions? A. How much money should be spent to attempt to keep alive a 2 month-premature infant? A 3-month premature infant? The limits of viability gradually are pushed down along with an exponential increase in cost and resources. Just because science can do something, it raises the question whether it should be done. B. Should we begin to consider rationing health care for the very old, those with senility? Again, a disproportionate amount of money is being spent for near-heroic procedures for those whose prognosis is guarded. C. What about liver transplants for alcoholics, drug abusers with Hepatitis C, etc? Expensive AIDS treatment for those whose lives were reckless? Lung transplants or other heroic treatments for inveterate smokers? Rehab, surgery, etc. for victims of reckless driving and motorcycling without helmets? Or should health care attempt to be blind and non-judgmental as to the source of illness (All this is related to item 1-B and 4-C.) D. Should we differentiate between mild and severe disability in considering the allocation of costs of help? Differences between prognosis–how likely that help will yield substantial changes in function? E. Do we need to re-negotiate our standards in times of significant economic constraints, recession, economic depression?
