Abstract
Let us start with a scene that I ask the reader to imagine. I am fishing in a boat with a 90-year-old acquaintance. He stands up in the boat, is a bit unsteady, and falls into the water. He used to be a very good swimmer, but he is afflicted with arthritis, which makes it impossible to swim to save his life. I have a lifesaver at hand. Am I morally obligated to throw it to him? Or is it his time to die? I have to imagine that anyone reading this essay would instantly assert that I had a moral obligation to throw that lifesaver to him. Now imagine a 90-year-old with late-stage heart failure in our clinic or in our health plan. Apart from the heart failure, he is in reasonably good health. He loves life; he is not ready to die. He is aware of the fact that we now have a totally implantable artificial heart [TIAH]. These devices cost $300,000 with the surgery and hospitalization (SynCardia, FDA approves the SynCardia total artificial heart for destination therapy study, http://3blmedia.com/News/FDA-Approves-SynCardia-Total-Artificial-Heart-Destination-Therapy-Study, 2015). He asks his cardiologist to get access to this device for himself through his health plan. He can reasonably expect five extra years of life of good enough quality from this device. This would be a lifesaver for him. Is his health plan morally obligated to provide the TIAH to him? Or is it his time to die because he has had his “fair innings”? How is his situation ethically like or unlike the situation of our 90-year-old at risk of drowning? We are not talking about a scarce resource; no one else is competing for this resource with him (as would be the case if we were talking about absolutely scarce natural hearts for transplantation). What would justify his health plan not providing this lifesaving TIAH to him?
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Fleck, L.M. (2016). Just Caring: Fair Innings and Priority Setting. In: Nagel, E., Lauerer, M. (eds) Prioritization in Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-21112-1_15
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