Should smokers and the obese be denied coronary artery bypass surgery?

No

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by Jon Dainty Sr.

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Reading this might be a temporary escape from reality. There are still people who believe that "personal responsibility" extends to every conceivable part of life, so long as that life is someone else's.

Coronary artery bypass surgery is a routine life-saving procedure that we perform thousands of times daily in the United States. Though the immediate aftercare regimen indicates that recovery is painful, the patient likely will survive years more than the likely prognosis without the surgery.

Who Is More Deserving?

There is a puzzling dichotomy here. Some people believe that, on some cosmic whiteboard, God or fate or karma keeps score when we threaten our own health. They are certain that more resources would be made available in our medical system, and to more "qualified" individuals, if only we made "the hard choices" about how Patient X got here.

Who is this Patient X? This is the 36-year-old father of three whose cholesterol and hypertension measures were off the chart last week. He experienced shortness of breath, pain in his left arm and jaw, and loss of consciousness at the dinner table. His family called 9-1-1, and he was saved through bypass surgery.

Patient X is overweight. He has been struggling with his weight for years, and recently he started both a sensible diet and an exercise program. His wife and his children were proud of his modest progress, and his physician advised that he keep it up.

Should Patient X have been denied this surgery? Was there no room for others "more deserving" because he was saved? The real head-banger question is this: who would play judge, jury, and executioner in such a situation?

Another patient (we'll call her "Y") is being brought in. She is a 78-year-old woman, a smoker when she can get cigarettes, who has been living on the street for the past four months, ever since her bank foreclosed on the home she shared with her late husband. They lived there for nearly forty years, and her life became hellish when her house was gone. Today she suffered a heart attack.

Patient Y has no family remaining; she and her husband could never have children. They were busy with the mechanics of simply living, and they did very well, at that. Their neighbors didn't know them well, but they were respected. Once Patient Y hit the street she became less than a statistic, because the census was not due for three more years, and few people knew.

Will YOU Decide?

Is it easier or more difficult in the case of Patient Y? Will anyone really miss her? Maybe she's not been an active, contributing member of the community in recent months; who can say?

The Slippery Slope Is Real

If the United States is a true community, we ought to care what happens to people. It ought to matter to someone when even one of us, let alone the present millions, falls through cracks in our social systems. Otherwise, there are scary days ahead for those who are not politically connected or wealthy.

Some will remember Charlton Heston starring in the movie "Soylent Green." It was a story of a rigidly-controlled society in which fresh food was very hard to find and very expensive. The populace had been introduced to a new "miracle" food, and they used it without a second thought; they were desperate.

Heston's character discovered alarming questions about this synthetic foodstuff, and he found too late that someone else should have cared about the answers. Soylent Green, he cried at the end of the picture, "It's people!"

Perhaps nothing this sinister will ever happen here, but neither should we appoint ourselves, for convenience or ideology, as judges over other common citizens. We must leave questions of life-and-death medical care to the families of those in need, and leave the self-righteous penalties to the movies.

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