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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

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