Death, Ethics, And Education

Triaging has been a feature of medical care for a long time. It's a method for sorting patients so as to make the best use of limited resources. According to the usual pattern, patients are sorted according to the following plan:

           Those who are likely to live, regardless of what care they receive;

           Those who are unlikely to live, regardless of what care they receive;

           Those for whom immediate care might make a positive difference in outcome.

Medical attention is initially addressed to those in the third group. They're likely to be the most “productive” recipients of the limited resources.

Ethicists have discussed the proper husbanding of medical resources in view of the costs that have a significant effect on society. Sarah Palin, on her Facebook page, raised a sensitive issue, fearing that the Affordable Care Act would lead to “death panels” which would decide where limited funds would be used, and deny care to some elderly patients. Denials followed immediately, but the issue, once raised, concerned a lot of people. The patients, especially the grandmas, for whom most of the fear existed, were often those who would best fit into the third category: immediate care might make a positive difference. Whether true or not, it raises serious questions about our use of funds.

I'm 78. I have no school-aged children. But I pay school tax. Long ago I had such children and paid the Day School where they were educated. And I paid the school tax in addition to the tuition. And I've paid ever since although I've never had children in public schools. That allows schools to collect money from all of us for students it doesn't educate. (Actually, international statistics suggests that it doesn't do a very good job for those it does try to educate.) Attempts to get “vouchers” authorized, so those who wished to send their children to private schools would not have to pay twice to improve the quality of the learning in general, and in particular areas, were always opposed by teachers' unions, and always failed to get approval. It was maintained that they'd take funds away from public education. (As does the Department of Education – bureaucrats who supervise the states.) That's true, but vouchers would probably allow children to get a better education – rich and poor alike – if they could choose the school they attended. But besides acting as a prod for professional improvement, such a system would also cost the jobs of some union members, and this would be intolerable, despite the fact that some teachers were not up to the job.

The complaint was also made that vouchers would aid parochial schools and thus constituted a violation of the first amendment by destroying the separation of church. The Constitution, of course, has no such mandate – only against the establishment of a state religion. That, however, doesn't stop opponents of vouchers from protesting. And it doesn't stop them from bowing before the god of public education.

(The ante has been raised. Because those with college degrees earn more, and there is a history of free municipal colleges, there is a movement to once again offer free education for almost everyone. Who pays for that? And do we need more cabbies with college degrees? )

Suppose the ethics panel considered the use of public money for an educational system that was functioning poorly. Would they approve the use of limited resources for a failing system when other options existed? Would they pay for the education of all comers, irrespective of qualifications or interest?

Another question that comes to mind is based on the reality that there seems to be no limit on the resources used to save a preemie or an otherwise damaged newborn. No expense is spared and publicity is extensively lavished upon successes. Thousands, or even hundreds of thousands of dollars may be expended. An additional result may be the markedly increased expenses required to educate these children, which come from the costs of educating others – including the disabled. Do panels of ethicists ever ponder the morality and the wisdom of using limited medical and educational resources this way? I don't mean to suggest that we should withhold care from those who need it – preemies, the disabled, or grandmothers – only to raise the question of how we choose to use our limited resources.

It's basically a political issue. There are repeated and angry demands from all interest groups for the funding of their needs. Where do the funds come from? The treasury that contains our tax money. And the two opposing views of what funding should take place are those of ideologues.

Liberals: We are obliged as a society to care for our most vulnerable citizens, if that is possible. If it's not possible our ethicists will tell us what to do.

The costs should be born by the rich.

Conservatives: You get what you pay for.

They get what we pay for.

Perhaps we should reconsider, or even triage, taxpayer expenses with the aid of ethicists who consider all our problems, and all aspects of each of them.