Warning: Some of you are not going to like this post.

Humans, currently tallying 6,700,000,000 are by far the most numerous large land/sea/air predator on the planet. No other species comes close. (Predators of a similar size usually number in the thousands, not billions). This would mean that for each tiger, say, there’s now about a million humans or at least a few hundred thousands and so if we gang up on Mr. Tiger, we can just sacrifice one of us (the bravest 😉 ) and then when Mr. Tiger takes a nap after eating him, we can just smother the ferocious feline with a quarterback sack. With a 999,999 humans coming in for the sack, that would obviously require some logistics and it would likely take several hours to pile on all the humans, but the tiger would certainly be done for, but I digress…

Now, thanks to our great skills in killing, it used to be that the only thing to take us out was various diseases, viruses and bacteria. This provided death system which kept the human population down by culling the weak. Today, medicine has has eliminated many such diseases and so people live longer. This is a good thing since age equals wisdom (hopefully) and experience which makes for a more complex and mature society.
However, as everybody dies (something I figured out was I was 19: Hey, I’m not going to live forever), people instead began to die of organ failure, like kidney failure or immune system failure (AIDS, cancer).

The medical ethic in our culture, as taught by religion, medical school, parents, and other strong influences is that one must do whatever it takes to keep people alive (even contrary to the wishes of the patient). This is even written into law. Thus with advancing technology, we have an increasing number of people who are being kept alive by drugs, machines, etc.

It is somewhat strange how this conflicts with our behavior where we expose ourselves to dangerous chemicals, eat crappy food, let our bodies decay due to physical inactivity, kill ourselves with cars, and so on… On one side, it is written into law that we must preserve life. On the other hand, we seem to be doing as much as we can to kill ourselves.

Insofar that they can not contribute net of the cost of this part of the medical infrastructure (very expensive stuff), this produces an economic drag on the system. (Most of the health care money is spent in the final five years of a persons life.) This means that something which could have been done (more teachers in school, fixing the roads, housing for everybody, starting new colonial wars, ending hunger, going to the moon, … or whatever suits your fancy) is not done in the name of extending life.

You see a similar drive to keep humans alive at the other end. In the past people had many children because many of these children would die due to weak constitutions, weak immune systems, or simply being born too early. Some cultures would even intentionally expose their newborn to hardships so as to keep only the most hardy alive. Today, we use technology to keep as many as possible alive, because we “must”. The downside is that many children grow up and pass on these weaker genes, which would have been mortal without the technology, to their children. This means that in order for their children to survive this medical infrastructure must remain in place. This means we are passing on the cost of our choices. It is a debt of bad genetics to future generations.

Do we place such a high value on the quantity of life that quality of life both for the individual and for the whole does not matter? In other words, is it preferable to spend a large amount of resources on keeping the very old or the very young alive. In more practical terms. Suppose you were 78 years old. Would you rather pay to live to 79 or would you rather pay for the education of four grand children? What if they were someone else’s children?

It is difficult question. Or maybe it isn’t.

In practical terms, this has strong implications for health insurance.
HDHP typically contains a lifetime ceiling of around $5,000,000 for all treatments and people often worry what will happen if they exceed them. Well, if we look at the “cold” economics. How many people will earn more than $5,000,000 over a lifetime? Not many. In conclusion, I think medicine should stick to treatable problems and not entertain heroic measures postponing the inevitable.

Originally posted 2009-12-01 10:27:21.