This is the story of a 95-year-old man who was born in Germany in 1927, immigrated to the US in 1939, and has lived a long and full life. His experience is a testament to the opportunities and benefits of living in the US in the 20th century, in a society and family that valued education and hard work, and who benefited from advances in healthcare throughout his long life. At the time of his birth, insulin had just been discovered, and antibiotics were not yet in common use. This man's experience included the GI Bill, college and graduate school, marriage, family, and a long career as an engineer. His and his wife’s three children, seven grandchildren, and five (+1 on the way) great-grandchildren, is evidence of the American dream. Recently, due to a variety of factors, his health deteriorated due to increasing congestive heart failure causing shortness of breath, lower extremity edema, and general fatigue. A cardiology workup was done with recommendations including pacemaker placement prior to a TAVR (transcatheter aortic valve replacement). Cognitive function is intact, no dementia. There are no mobility or other limiting factors. The distribution of healthcare resources in the elderly, specifically in the case of a heart valve replacement, raises important ethical concerns.
On one hand, this individual has lived a long and fulfilling life, and it may be tempting to question the allocation of healthcare resources to someone who has already had so much time on this earth. Furthermore, with limited healthcare resources, it is important to consider the overall cost-effectiveness of medical interventions and to prioritize those that provide the greatest benefit to the most people. On the other hand, it is important to consider the value of life, regardless of age. This individual still has much to offer their community and loved ones, and has personal goals and aspirations that they wish to achieve. Additionally, the value of a few more good years should not be discounted. These years could be filled with joy, love, and meaningful experiences for the individual and their loved ones.
It is important to recognize that this man's access to healthcare and excellent health throughout his age is partially due to genetics, of course, but also to circumstances, education, habits, and opportunities available to him. He worked at a ‘desk job’ most of his life, never smoked, had moderate alcohol intake, and always maintained a healthy weight. Additionally, lifelong health benefits have been provided by his wife's state employment as a school administrator for 40+ years, affording the family excellent retirement and healthcare benefits beyond actuarial predictions. This is a fortunate circumstance, and not all elderly individuals have access to such comprehensive coverage.
Ultimately, the decision to undergo a heart valve replacement or any procedure, should be made with informed consent, taking into account the risks and benefits of the procedure. Quality of life is an important consideration, and the individual's goals, values, and preferences should be taken into account. Two things can be true at the same time: The allocation of healthcare resources is a complex issue AND it is important to prioritize the value of life and the autonomy of the individual.
In conclusion, the story of this 95-year-old man, who has lived a long and fulfilling life, and who recently had a pacemaker and heart valve replacement, raises important ethical concerns about the allocation of healthcare resources in the elderly. While it is understandable to question the allocation of resources for those who have already lived a long life, it is also important to prioritize the value of life, the autonomy of the individual, and the quality of life.