Rationing: The New Healthcare App

In July, the American Society for Clinical Oncology (ASCO), the world’s leading oncology association, announced the development of a new mobile app for cancer patients. This app is not intended to ease people through the treatment process, but to create a standardized way of limiting patients’ access to innovative treatments based on costs rather than benefits to the patient.

Being sick is costly. However, being alive is also costly—even funerals are costly—but when did it become acceptable for costs to matter over the person?

At ASCO’s national conference, Dr. Lee Newcomer, the medical director of United Healthcare, stated, “Motives [of insurers] are viewed with suspicion when it comes to deciding whether a treatment is cost-effective. So having ASCO play a key role in establishing such guidelines would be crucial to their implementation.”

In other words, to take “suspicion” of rationing away we should allow the healthcare system to do determine what is cost-effective so people will be less likely to question it. The app will determine a person’s access to certain treatments based on an algorithm that insurance companies use to measures cost-effectiveness.

The New York Post even entitled its article on the new software as “The Death-Panel App.” Even this liberal newspaper is asking when did it become the business of the world’s leading oncology association to base patient treatment on costs rather than benefits.

Dr. Lowell Schnipper, who heads ASCO’s Value in Cancer Care Task Force, which is building the app, justified the claim by arguing that cancer treatments are going to bankrupt the healthcare system. But later on we find this has little do with just cancer treatments. Schnipper affirms that he sees limiting treatments as a step to making “the health-care system, not just the cancer system, more rational and just.”

Why would this system be more “rational” and “just”?

You may recall vice presidential candidate Sarah Palin’s mocked statement of Obama’s Death Panels. Soon afterwards, Peter Singer, Ira W. DeCamp Professor of Bioethics at Princeton University, authored an op-ed published in the New York Times entitled “Why We Must Ration Healthcare.”

Singer made the argument in the form of a joke. A man offered a woman $1,000,000 to have sex with him. She reluctantly agreed. Then the man asked if she would have sex for $50. Shocked she exclaimed, “What kind of woman do you think I am?” He answered, “Well, we already know what kind of woman you are, I’m just haggling over the price.” Singer argued that no matter how high the amount, a person who sells their body is still a prostitute. He then paralleled that if we believe that there should be any limit to the healthcare system, no matter how high, then we still be believe in rationing.

Is this true, or, is this a misplaced value system? Schnipper and Singer would argue that a person has a limited worth, and, once we accept that, the price can then be haggled. As Christians, we believe a person has an intrinsic worth that cannot be altered, limited, or denied. In Gen 1:26-27, God created humanity in His likeness: a worth built into the very framework of our humanity. Personhood is the legal recognition of that truth and our founding “self-evident” beliefs “that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

Singer and Schnipper are trying to implement a different type of philosophy into our society known as Utilitarianism. It is an ethic that attempts an almost mathematical view of morality. This type of thinking would marginalize the sick, the mentally and physically disabled, the elderly, the preborn, and many others.

The founder of Utilitarianism, Jeremy Bentham, termed it “the greatest happiness principle” or “the principle of utility.” He defines happiness as the presence of pleasure and the absence of pain. Therefore, what is morally obligatory is that which produces the greatest amount of happiness for the greatest number of people, which applies to “every action whatsoever.” Bentham writes that moral philosophy, or ethics, is “the art of directing men’s action to the production of the greatest possible quantity of happiness, on the part of those whose interest is in view.”

If the choice to keep that person alive does not contribute to the greatest amount of “happiness” or “pleasure” for everyone “in view,” then there is no moral obligation to them. As a result, the app does not take into account the individual person. It is a one-size-fits-all software ignoring genetic variations between patients and the patients success with past treatments.

This line of thinking attacks and compromises the very foundation of healthcare. The Hippocratic Oath defines the first obligation of doctors “to apply for the benefit of the sick, all measures that are required.” Instead, Schnipper believes three months of added life “is not a large enough benefit to trump the greater benefits to many that would have to be foregone to provide it.”

One of the most twisted concepts in Singer's comparison of the prostitute to the healthcare system is that she still had a choice. But the reality of this “death-panel app” is that there is no autonomy for the patient to choose, just to accept.

Sources: nypost.com; nytimes.com; washingtonpost.com

Bethany Burrell
Director of Bioethics and Emerging Technology