Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, August 29, 1993 TAG: 9308260053
SECTION: EXTRA PAGE: 1 EDITION: METRO
SOURCE: Cody Lowe
DATELINE: LENGTH: Medium
An astute Bosnian physician pointed the world's cameras at a little girl suffering brain damage - but otherwise treatable wounds - in a hospital that couldn't care for her.
That image woke the consciences, the compassion and the rage of millions of Americans, hundreds of millions around the world. Within 24 hours, that child was on her way to receiving the best care available.
In the last couple of weeks, we've watched the story of two little Siamese twins - one of whom had to die in order for the other to have even a 1 percent chance of survival.
We cried again. Amy and Angela Lakeberg became household names overnight. When they heard the Lakebergs had no health insurance, many offered financial help. The Children's Hospital of Philadelphia was willing to attempt to separate the girls despite the lack of insurance.
And, at mid-week when this was written, Angela seemed to be faring much better than any of us had any right to expect.
We can sit back and feel a warm glow in our bellies when we think about these little survivors and how human goodness has helped them overcome humans' enmity and nature's indifference. Yet these cases also force us to reconsider how we decide who lives and dies.
It has become a cliche to challenge those who would ever say "no" to a sufferer by asking "would you play God?"
The truth, of course, is that we - individuals and society - do "play God" all the time in the sense that we are capable of altering the course of Nature and sometimes choose to do so. It is only when we are specifically dealing with human lives that we become especially sensitive to the charge.
No one disputes that there are probably hundreds of other children - not to mention the thousands of adults - remaining in Bosnia who will die or be permanently disabled if they are not moved to hospitals where simply routine care is available.
Was it right to help that little girl whose eyes we could not look into without our hearts breaking? Of course. Is it right to do nothing about the others? No, of course not when we are capable of helping.
Helping Angela Lakeberg raises even more disturbing questions. The technology certainly was available to attempt her separation from her sister. The question is whether this case justified its use.
It is easy from the perspective of a successful operation to say, "Of course, it was worth it. Where both of the twins surely would have died, one has survived."
What if she had not survived? You can be sure the recriminations would have been flying fast and furious. Remember, her doctors gave her only a 1 percent chance of survival of a procedure that cost hundreds of thousands of dollars.
The Children's Hospital of Philadelphia will absorb some of the cost, other patients - and their insurance companies - will pay some of it through fees that are higher than the cost of their care. We taxpayers will likely pay some of the bill as well.
Can we place a monetary value on life? In a narrow sense, no we cannot. Every day, however, physicians and patients struggle to define what is reasonable care. A far-reaching debate is heating up over how we are to make decisions on who gets access to limited medical care.
One specific discussion revolves around whether physicians have an obligation or responsibility to provide life-sustaining care when the odds are great that the effort will be futile in the short term.
Angela Lakeberg's case is likely to be a topic of discussion at a seminar on the subject of "medical futility" in Roanoke next month.
Even those not inclined to get caught up in the finer points of the ethical debate are likely to admit that it's time to talk when the chance of survival is only 1 percent and the cost is so high.
I suspect that as a society we probably would have been hesitant to provide the level of care Angela has received - if we had been given a vote. In light of her survival, that cuts to the heart of the debate.
We're not so concerned, I think, about wasted resources. We believe most of us will make rational choices about when the medical community has done all that is reasonable and death becomes the best choice.
What we really worry about is who gets to make the decision. We readily concede that right to competent patients. The sticky situations arise when family, friends or doctors need to make the decision for a patient who is not capable of choosing.
Individually, I couldn't have made the decision for the Lakebergs. As a society, though, at some point we will have to make some decisions about how far we're willing to go to help the Angelas who will continue to be born among us.
by CNB