the line

I have always wondered about the line between when public health care should fund procedures and when it becomes the responsibility of the individual. Don't get me wrong I really do enjoy universal health care (provided the system is run correctly), but there are always some therapies that are questionable.

At our clinic, we do a procedure called a TheraSphere for clients with advanced hepatocellular carcinomas. Basically, tiny microspheres of radioactive glass are injected into liver capillaries via a catheter inserted into the hepatic artery. They lodge and embolize there, bathing the liver with beta emissions, providing a therapeutic effect. According to our resident nurse coordinator, these therapies provide most advanced patients with about 2 extra months to live on average. The therapy is unbelievably costly, and public health care is obviously very reluctant to offer this treatment out.

I would hate to be on an ethics board attempting to decide this case, but it does beg the question, when do you draw the line on helping someone? The Hippocratic Oath says, "I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone." The way I read that is that you should always help your patient, no matter what stage they're in. Two months is plenty to an individual - it can give the chance to say goodbye, to finally reach acceptance in the Kübler-Ross if they haven't done it already.

I always worry, however, that this is a costly last stage of therapy. They have probably undergone many surgeries and chemical treatments already; do we allow them to be ravaged by another invasive technique? Is 2 more months just prolonging the inevitable? Are we burdening health care if we are allowing these seemingly palliative techniques to anyone? After all, these operations are lucratively expensive, and these are taxpayer dollars at stake here - you and I both contribute. Would you want to make an investment that dies after 2 months?

Where is the line?