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Unformatted text preview: ALLOCATING SCARE RESOURCES (by Alex John London) Bone Marrow Transplants for Advanced Breast Cancer: The Story of Christine Demeurers Christine deMeurers had stage 4 metastatic breast cancer, and was a mother of 2, had a husband, and was a teacher. She and her husband had health insurance, but had purchased the cheapest plan available – Health Net. She and her family exhausted all standard therapies available, but there was a new procedure available (high dose chemotherapy with autologous bone marrow transplant) that offered some hope, although it had no proven benefit at the time. Their insurance denied coverage for the procedure since it was “not uniformly accepted as proven and effective for the treatment of metastatic breast cancer.” The doctor who was going to give the treatment also happened to be a member of their insurance committee – conflict for the doctor between helping patient and upholding the policy he had a part in shaping. In the end, a third-party covered the costs (UCLA), and Christine had 4 disease-free months before succumbing to the cancer. Issues illustrated by this case: We embrace values of frugality and fiscal sensibility, which lead us to protest high health care costs. At the same time, we won’t accept any less than the latest and most sophisticated healthcare. Should we, the government, or insurance pay for procedures of this nature? Should we pay for procedures of unknown benefit when there are people struggling to get procedures of known benefit? Those with the resources and ability to articulate their compelling cases can receive access to these kinds of procedures while the less articulate and less well-off cannot. If we don’t draw the line on medical expenses here, where will we? What makes a procedure considered experimental? Towards a more just system Solution: If we give subscribers an active role in the formation of guidelines that govern their care (rather than deciding randomly what will be approved and why via people with money bringing their cases to court), insurance providers will give their subscribers a stake in making sure such guidelines are both fair and effective. It will ensure people are treated as ends in themselves and not as mere means. Christine’s insurance denied the HDC/ABMT procedure on the grounds that it was experimental. They can make a strong case for this via the following argument: There is only an obligation to pay for therapies that are proven to have some therapeutic benefit, since there are not even enough resources to cover everyone’s access to these proven therapies. Thus, saying the procedure is experimental seems more of a straightforward descriptive claim than a controversial normative judgment as to the monetary value of the quality and length of someone’s life....
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This note was uploaded on 11/19/2009 for the course PHL 325M taught by Professor Leon during the Spring '08 term at University of Texas.
- Spring '08