Skewed moral priorities


OUR MORAL priorities with respect to health care are -- not to put too fine a point on it -- stark, raving nuts. Two cases involving the care of elderly patients nicely illustrate this.

Helga Wanglie is an 87-year-old woman who suffered a stroke and a heart attack that left her comatose in a bed in the Hennepin County Medical Center in Minneapolis. Wanglie's family wants her care continued even though her doctors say she has no hope of recovery and it is absolutely futile to continue her care. The hospital is going to court to get permission to discontinue Wanglie's life-support.

The Wanglie case has nothing to do with money. Her care is being paid for in full by private insurance. In fact, the hospital is acting against its own financial interest in trying to end her treatment.

The prospect of stopping Wanglie's care against her family's wishes has evoked a storm of criticism. Even the outbreak of war has not dimmed the concern many Americans have expressed for her. Right-to-life groups have vowed to do whatever it takes to keep her care going. Advocates for the disabled have expressed grave concern about her fate. Many physicians and ethics committees have weighed in with advice, and newspapers have editorialized about her.

Now, consider the plight of a 75-year-old former merchant seaman, William Hart of San Diego, Calif. Three years ago, like Wanglie, he suffered a stroke and a heart attack. Unlike Wanglie, he was not rendered comatose. Hart was left partially paralyzed and his speech severely impaired. He is confined not to a bed but to a wheelchair.

Hart needs medicine to keep his heart going. While he is eligible for Medicare, this program does not pay for prescription drugs used outside a hospital. His medicine costs $75 a month, but he cannot afford it.

Recently, Hart rolled his wheelchair into one of the San Diego branches of the HomeFed Bank. He had a savings account there with $4 in it. He removed his $4 and demanded $71 from the clerk. He waved around a bottle that he said was filled with explosives.

Police arrested Hart at a nearby pharmacy as he tried to buy his medicine. They seized the bottle he had waved in the air; actually, it contained the last dose of his life-prolonging drug.

No one has rallied to Hart's cause. The nation has taken little interest in his case. Editorial writers are not agonizing about his fate. Right-to-life groups have made no vows to throw their bodies in the path of anyone who would deter Hart from getting his medicine.

Some say if we would stop paying for the treatment of the nation's Helga Wanglies, America would have enough money to pay for the medicine needed by its William Harts. But this is morally wrong. Wanglie and Hart should not be forced to compete with one another for scarce resources -- not in a nation that spends billions of dollars every year on vitamins, malpractice insurance and cosmetic surgery.

Wanglie and Hart do, however, compete with one another for our moral attention. The fact that the Wanglies always win reveals some sad truths about our priorities.

The Wanglies get our attention because, in our society, it is more acceptable to evince concern about the rights of the comatose than about the rights of the needy.

If police had shot Hart in the head and rendered him comatose, we would spend more time worrying about whether to continue his medical care than we do about why he cannot afford his heart medicine. Kind of wacky, don't you think?

Arthur Caplan is director of the Center for Biomedical Ethics at the University of Minnesota. He is a columnist for the St. Paul Pioneer Press.

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