Occasional reflections on Life, the World, and Mathematics

Posts tagged ‘ethics’

The sins of the fathers

I was just reading Kevin Drum’s article on the fallout from the hapless US military raid in Yemen last week. He lists the costs:

Our adventure in Yemen last week failed to kill its target; caused the death of numerous Yemeni civilians; resulted in one dead American sailor; and ended with the loss of a $70 million helicopter.

This is not unusual of the commentary, and I find it weird that it fails to mention that a US civilian was among those killed: the eight-year-old daughter of American renegade Anwar Al-Awlaki, given that the sanctity of American life is the bedrock of American antiterror policies. I suspect this reflects the atavistic sense that the child of an evildoer is tainted, and somehow deserves to be punished for his crimes. Of course, the new president famously vowed to “take out their families”.

Why don’t we throw people out of emergency rooms?

In discussions of market forces in health care, someone always points out that we don’t allow people to just die in the streets. Anyone who shows up in an emergency room must be treated (in the US this has been true since the Emergency Medical Treatment and Active Labor Act of 1986, I believe). Among the many other reasons why medical care does not respond to free market incentives, then, is the fact that the providers are not able to turn away customers who are unwilling or unable to pay.

But here’s what I’m wondering: This is always presented as an issue of basic humanity, or altruism. We can’t let the poor die of treatable injuries or illnesses because that seems too brutal. But is that the whole story, or even most of the story? My suspicion — and I’d have to go back to the debates on EMTALA to develop any clarity on this — is that the real reason we have a no-exceptions requirement that hospitals provide urgent care to the poor is that there’s a significant danger that the non-poor might be confused with the poor, particularly in times of medical emergency. Someone who has been hit by a car or has suffered a stroke and is disoriented is likely incapable of quickly identifying herself as an upstanding creditworthy citizen with health insurance. So the hospital is required to try to keep them alive long enough to allow them (or their relatives) to demonstrate that they are worth saving.

Which leads to a question: Supposing biometric databases become universal, and the hospitals are able to immediately ID anyone who comes through the door. Will we then relax the rules, and allow them to turn away the indigent, perhaps sending them off to some primitive alternative hospital for the poor?

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