Retired neurosurgeon and Republican presidential candidate Ben Carson has, in two of his books, proposed national guidelines on end-of-life care for the elderly in order to prevent skyrocketing medical costs from bankrupting society.
In his 2000 book, The Big Picture, Carson laid out a simple question on keeping the sick and elderly alive past their 100th birthday: "Should we do it simply because we can?"
Carson, whose views on health care policy have varied over the years, argued a basic staple of his then-plan for the government to take over catastrophic coverage would be a rational discussion of end-of-life treatment the country had been lacking.
"The government's assumption of catastrophic health care would almost certainly and immediately prompt a national debate on what catastrophic conditions should be treated— and to what extent," he wrote. "We might even hope for some reasoned discussion on some difficult choices we will all face with the aging of our baby-boomer generation."
Medical treatment's advanced capabilities, Carson said, would soon mean the medical community could significantly extend the life of the elderly.
"As our medical knowledge increases and our technical abilities advance, the modern medical community finds itself capable of successfully performing procedures never before considered— such as quadruple bypasses on eighty-five-year-old patients or extensive resections of malignancies in very elderly individuals who also have a host of other serious medical problems," Carson wrote. "As America's general population ages and our medical capabilities continue to expand, we will face more and more such scenarios. In fact, we may soon find it possible to keep most people alive, albeit at varying levels of activity, well beyond their hundredth birthday. The question is: Should we do it simply because we can?"
Carson noted most health care costs incurred for people take place in the last few months of their life. He argued this was because unlike over advanced nations, Americans had yet to accept the inevitability of death and how to treat it when it comes.
"One reason for this is that, unlike many other advanced nations, American society has not yet accepted the idea of keeping someone suffering terminal or catastrophic illnesses comfortable at home rather than in a hospital," he wrote. "Our mind-set is to automatically pull out all medical stops— even if that means literally torturing loved ones during their last few months of life."
Carson said basic national guidelines should put in place, with allowance for flexibility and consideration of treatment on end-of-life care:
"What if rather than always putting terminally ill patients in intensive care units— where we poke, prod, test, and operate ad nausea— we allowed most people the dignity of dying in relative peace and comfort, at home, surrounded by loved ones, with hospice care or some other medical attendant if necessary? Agreement on who should be treated and who should not be treated would require an extensive national discussion that could hopefully result in some helpful basic guidelines. Obviously any such guidelines should allow for flexibility and choice. And decisions should be based not merely on age but on the viability of the patient. I have seen ninety-year-olds who are healthier than some forty- or fifty-year-olds. So I would argue that medical treatment should not be withheld any time there is a reasonable chance of recovery and a resumption of a quality lifestyle. If any patient insisted on having everything done, I think consideration of more aggressive treatment should be given. I also believe, however, that most reasonable, terminally ill patients would much prefer to die in comfort and dignity at home than be tormented until the end in a hospital setting. Especially if we can freely and honestly talk these issues out in a national discussion that would help us all rethink our culture's mind-set about death, dying, and terminal illness."
Carson noted he was not calling for euthanasia and mercy-killing but believed our culture around end-of-life procedures was out of whack.
"But I think too often in the face of terminal illness our attitudes and actions are colored more by a fear of physical death than by a belief in the spiritual nature and the sanctity of human life. This is true even for a lot of my fellow Christians," he added
In his 2012 book, America the Beautiful perhaps aware of the political ramifications, Carson made clear -- and even attacked -- those who might call such an approach "death panels."
"Again, I can hear some people screaming after reading this that I am advocating for 'death panels.' Some people like to put forth terms like this because they stir up emotional responses rather than encouraging people to engage in rational dialogue aimed at resolving issues," Carson wrote. "Obviously, as our population ages and as our medical technology becomes more sophisticated and expensive, the potential for bankrupting our society with medical costs skyrockets."
Andrew Kaczynski is a political reporter for BuzzFeed News and is based in New York.
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