The population is ageing and healthcare costs are rocketing. So how can we keep a lid on the costs of healthcare in the future? According to Marian Verkerk, Professor of Care Ethics at the University Medical Center Groningen, the question we should be asking ourselves is whether we want to be treated at all. ‘Is it really care to give a fragile 80-year-old chemotherapy to prolong his life by a few months?’
‘Do we increase the excess on healthcare insurance, or not? Do we cut back on care for the elderly, or not? Our politicians are clambering over themselves to find solutions to the rising costs of healthcare. They’re all talking the talk, but as yet, nobody seems able to walk the walk. I find it anything but inspiring, to put it mildly. I have déjà vu every time I hear a debate about healthcare. The solutions being put forward by our politicians have been around for years!’
‘It goes without saying that we should think seriously about the fairest way of distributing the funds available for healthcare. This is ultimately what all the political debate is about. But the discussions themselves don’t go far enough. In a recent report, former Minister Ab Klink came up with an interesting initiative to broaden the political horizon. We should not only look at the most cost-effective form of care, he suggested, but also whether care is worthwhile. Is it really necessary to order the complete battery of tests when we suspect heart problems? What is the added value? Asking ourselves questions like these could prevent a lot of wastage in the healthcare sector’
‘But even this perspective is too limited. We really need to broaden our horizons further. Rather than wondering how to treat an illness, we should ask ourselves whether we should treat that illness. In fact: we could even ask ourselves whether it is actually an illness at all. And whether care really is care. Without noticing, our notion of care is gradually changing. The word ‘illness’ is sometimes no more than a response to the latest medical-scientific developments. These days, someone who used to be called ‘sombre’ is labelled ‘depressed’ and prescribed drugs. A child that used to be ‘a handful’ now has ADHD and takes medicine for it. There seems to be no end to this process of medicalization; anyone with a heightened risk of a disease is seen as a patient.’
‘Medical science in the care sector is advancing at a rate of knots. Most of the findings are of great benefit to us and we should be grateful. However, we must be careful not get swept along. The question we must ask ourselves is When is care good care? Can we still refer to care when our primary aim is prolong the life of a fragile old person with lung cancer? And does feeding pills to the elderly to stop them feeling lonely constitute care? Does being pregnant really mean nine months of increased medical risks? Healthcare is not the only answer to living a good life.’
‘When considering the future of healthcare, one inevitably questions the meaning of life. Is life one big attempt to avoid as many medical risks as possible, for example? Does happiness mean living as healthily as possible? Questions like these are difficult to answer via political debate, but this doesn’t mean that we should ignore them. We all have a responsibility to think about these issues. We should not simply ask how much care we are entitled to; we should also think about how we want to organize our lives. And about what constitutes a good life.’
‘In some areas, we are witnessing a cultural shift, for example in terminal care, care for the dying. Not long ago, debate focused exclusively on how best to alleviate pain. We were medicalizing death. Nowadays, we are also paying attention to how patients themselves view dying. We are asking ourselves whether we should try to manage someone’s life until the very end, or whether our time would be better spent saying our goodbyes? Slowly but surely we are starting to realize that we might not have everything under control.’
Marian Verkerk studied philosophy in Utrecht and was awarded a PhD in 1985 for a thesis entitled 'Ethics and Welfare Policy'. She has been Professor of Care Ethics at the University Medical Center Groningen (UMCG) since 2001. Verkerk’s positions include being a member of the Health Council of the Netherlands. She is currently heading international research into ethics in the healthcare sector. More information about this research project is available at http://www.family-ethics.com.
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