A Kind-hearted Physician sitting at the bedside of a patient afflicted with an incurable and painful disease, heard a noise behind him, and turning saw a cat laughing at the feeble efforts of a wounded mouse to drag itself out of the room.

“You cruel beast!” cried he.  “Why don’t you kill it at once, like a lady?”

Rising, he kicked the cat out of the door, and picking up the mouse compassionately put it out of its misery by pulling off its head.  Recalled to the bedside by the moans of his patient, the Kind-hearted Physician administered a stimulant, a tonic, and a nutrient, and went away. 

The above is from Fantastic Fables, a book written by Ambrose Bierce and first published in 1898 over one hundred years before Sarah Palin stumbled into the end-of-life conversation.  Mrs. Palin’s contribution was to fan the fears of those worried about death panels.  Mr. Bierce calmly asked us to define humane. 

This post marks the four year anniversary of Health Insurance Issues With Dave.  The very first edition dealt with a very, very unhealthy gentleman in his late 70’s who was in line to get a new kidney.

• Did it make sense to place a healthy kidney into the body of someone that old and that unhealthy?
• Should the kidney go to someone younger or in better overall health?
• Should society, in this case Medicare, pay for this quixotic procedure?

I didn’t pretend to have the answers in 2009.  I’m no closer today.  Worse, this is a conversation that we as a country have managed to avoid.  But as we change our system of health care financing through the implementation of the Patient Protection and Affordable Care Act (PPACA), we are going to have to discuss this whether we want to or not. 

It isn’t always life and death.  An eighty-eight year old woman visited the Cleveland Clinic last week.  After examinations and tests by several doctors, nurses, and technicians, it was determined that yes, she did have a cataract, but no, she did not require immediate surgery.  Still, if she wanted to have the procedure, they were prepared.  Money was not a consideration.  Medicare and her Medicare supplement would have covered the entire cost.  She elected to wait until she had no choice. 

Is it great that our elderly have such wonderful, comprehensive health coverage?  I don’t know.  It FEELS great.  But is there a line and where is it?  If we agree that all Americans have a right to unlimited care, then we must begin the process to collect the funds (taxes) necessary to pay the bill.  If we want to set limits, then now is the time to start that conversation. 

The subject of that first post never received the new kidney and died from one of his many ailments.  I learned a lot about death this year as I watched a friend struggle with cancer.  He lost that battle.  I don’t know if he ever fully grasped the value of Hospice and palliative care or how much help and comfort he received in his final days.  I, however, now have a much greater appreciation for Hospice and the doctors, nurses, and technicians who staff these units and facilities.  

And we are left with the questions – How much medical care is needed and how much is too much?  And of equal importance – Who gets to decide?

Are we ready to define compassion?

DAVE