Bioethicist Discusses Health Care Controversies

When do people have a right to health care that is being denied?

When do people have a right to reject health care that is being forced upon them?

Should we shift more resources into preventive care, knowing that more sick and elderly people will die from their ailments as a result?

Are these issues for the experts, or are ordinary citizens knowledgeable enough for majority rule to hold sway?

These were among the more provocative questions posed Sunday by bioethicist and Scarsdale High School graduate Jacob Appel, in a lecture at the Scarsdale Women's Club.

Bioethics is the study of the interstices of medicine, morality, and the law. Armed with a medical degree, a law degree and multiple PhDs, Appel is uniquely qualified to address these issues. Once an esoteric field of academia, bioethics is gaining relevance as the health-care debate rages from the chambers of Congress to our dining room tables and cable news channels.

"My challenge is to share what a layperson should know about bioethics," Appel said, adding that the goal of bioethicists is "to tell the same story from multiple points of view."

In his writings, which appear regularly on the Huffington Post and Opposing Views, Appel tends to champion libertarian views and the rights of individuals to make their own medical decisions.

On Sunday, however, he largely kept his opinions to himself while posing complicated questions and case studies for the audience to ponder.

One of the more compelling cases Appel described involves Slim Watson, a retired security guard from North Carolina. In 2000, Watson was diagnosed with a rare blood disease and admitted to Duke University Hospital. His treatment included a regimen of expensive drugs distilled from pigs' blood and flown to America daily from Europe. Over the course of a month, Watson ran up a $5.2 million bill. The costly treatment was not working, however, and he died after 34 days in the hospital.

"If he had lived a year, it could have bankrupted Duke," Appel said.

Duke's hands were tied by a federal law requiring hospitals to provide emergency care to anyone seeking it. Should Duke have been allowed to circumvent the law in this case? The dilemma reveals an important issue in both bioethics and the current debate over universal health care: rectifying economic interests with the ostensible responsibilities of the medical establishment to protect life at any cost.

Through what Appel called "the cold eye of a Dickensian law", Watson's life would likely be worth much less than $5 million, especially when that money could have been used to help younger people with curable ailments. But what cost would Watson's family place on his life? The line between human emotion and economic pragmatism lies at the core of bioethical debate.

"At what point do we choose between an individual's expressed act of will and a court's determination of public welfare that is purely economic," Appel asked, conjuring modern philosophers like J.S. Mill and Peter Singer.

Appel said that one type of case we will see more of in the near future involves patients being kept alive in a vegetative state, with little or no hope of recovering. Currently, he said, technological limits make these cases relatively rare. As life support becomes more widely available and less expensive, however, more people will be likely to keep loved ones alive regardless of their chances of recovering. Recent studies have shown that between one third and one half of all Americans would prefer to be kept alive, even if they would never be able to live without life support.

In addition to being a bioethicist, Appel practices health care law in New York and Rhode Island and is an acclaimed short story writer and dramatist.

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Appel gave his audience much to think about. Here are a few more ideas to ponder:

• If every American was given an MRI annually, it would save tens of thousands of lives, including cutting in half the number of deaths from brain aneurysms. The cost would be well over $1 trillion, meaning that resources would be drained from many other areas of health care and social services. Is it worth it?

• Current law allows people who adhere to religious beliefs to reject health care. However, parents may not reject medical care for their children on religious grounds. What's the difference?

• Recent breakthroughs in the field of in vitro fertilization allow specific genes to be removed from an embryo. An English baby girl was born last year without the gene that causes breast cancer, for example. Some parents are beginning to request such a procedure to the detriment of the child – one couple, both of whom are deaf and already have a deaf child, are requesting that their next baby be "engineered" to be deaf. Should this be allowed?