By Jonathan B. Wight

“We have invented more health care than we can afford to deliver….We already ration. The United States denies more health care to more people than any other developed country in the world. We did that by leaving 50 million people out of the system (before the Affordable Care Act).”

“[For example] I don't believe you should give any extensive operations to anybody over 85. You should make sure that they're clean, they're loved, they're comfortable, they're pain-free, but we shouldn't be doing high-technology medicine on people over 85.”

--Richard D. Lamm, former Governor of Colorado

I’m not sure what Dick Lamm means by “give” extensive operations.  Perhaps better to clarify: we should not be spending public health dollars to do heroic medicine, given that we have millions of people still without access to basic care. But individuals should be free to spend their own private money on any frivolous medical interventions they want--including cryogenics, a solid-gold casket, and so on. People should have the right to do so, even if they don't have the right to my respect for such behavior.

There is something virtuous, I think, in being prudent—in showing proper regard for our future selves.  And that means taking care of ourselves, including with medical interventions.  But at what point should we (as people who aspire to live a life of meaning) step back and follow Adam Smith’s conception of “superior” prudence. Do we have a duty to others to die gracefully—and not, for example, rack up hundreds of thousands of dollars in debt to prolong our own lives by a few weeks or months? 

Along this line, consider this post from John Kay:

“A rising proportion of medical expenditure is now devoted to prolonging the lives of the very old and the terminally ill. The costs of this are potentially unlimited.

“We should pause to ask ourselves the questions raised by the surgeon Atul Gawande in his book, Being Mortal. Perhaps the greatest challenges in modern healthcare are not those of meeting the spiraling cost of advanced medical technologies. They lie in accepting that we are all going to die, and learning to do so with dignity.”

--John Kay, in the Financial Times.