mid-1980s.
Baptist was still nonprofit and faith-based, but it had to compete in an increasingly
commercialized environment. Its doctors, and many across the country, feared being
told by accountants and other nonclinicians what tests and treatments they could give
to which patients.
As doctors began to rely more on machines and focus more on business,Baltz worked to remind his Baptist Hospital colleagues of the ethical tenets of their
profession. As medical staff president, he urged them to stay compassionate and be
selective about adopting new technologies. Baltz encouraged the establishment of an
ethics group at the hospital and participated in a discussion of groundbreaking cases,
including that of fifty-eight-year-oldClarence Herbert, a comatose patient whose doctors were tried for murder in Los Angeles
after they withdrew his life support and IV fluids. The investigation followed from
a nurse’s complaints, an indication that difficult end-of-life decisions could create
fissures between doctors and nurses. Family members also alleged that doctors had
misrepresented Herbert’s chances of recovery so they would agree to withdraw life
support. The charges against the doctors were ultimately dismissed.“The ways and means of dying must be carefully considered,” Baltz commented in the
newsletter.
Over the years, Baltz continued the dialogue with colleagues. LifeCare leased the
seventh floor of the main building in 1997, establishing the long-term acute care
hospital within the main hospital. A Medicare payment change created incentives for
these types of business arrangements, and they proliferated at hospitals around the
country. Baltz engaged in spirited debates over coffee with colleagues who believed
excessive resources were being poured into LifeCare’s typically elderly, infirm patient
population. “We spend too much on these turkeys,” one of them said. “We ought to let
them go.”
“You have no right to decide who lives and who dies,” Baltz would answer. Through
these conversations, he learned that some of his fellow doctors adhered to what Baltz
thought of as the “Governor Lamm philosophy.” In 1984, at a time of growing budget
deficits and ballooning medical costs, Colorado governor Richard Lamm criticized the
use of expensive, high-tech medicine to keep some patients alive almost indefinitely,
regardless of their age or prognosis. At a meeting of the Colorado Health Lawyers
Association, Lamm bolstered his argument by citing a recent critique of antiaging
research penned by the prominent Universityof Chicago bioethicist Dr. Leon R. Kass. “We’ve got a duty to die,” Lamm said, “and get out of the way with all of our machines
and artificial hearts and everything else like that and let the other society, our
kids, build a reasonable life.”
Lamm’s words were picked up by an attentive
Denver Post
reporter and caused a nationwide furor.With the appearance of crash carts and the expansion of intensive care medicine in
the 1960s and ’70s, hospitals had become adept at keeping sick people alive longer.
Medicare covered the new technologies regardless of cost, and by the 1980s some policymakers
worried about the projected growth in medical spending. Lamm’s comments awakened the
public to the problem and demonstrated the tension between the “business motive” and
medicine’s burgeoning end-of-life dilemmas.
Lamm’s rationing directive rankled for many reasons. To limit life-saving care would
be to deny the human impulse to rescue individuals in extremis. To handicap the race
for new treatments that might prolong life would be to call off the eternal search
for the elixir of immortality.
Plus it would be bad for capitalism. At the time, the US-Soviet war urge was sublimated
into battles for technological innovation. We were going to the moon. Why not also
cure cancer or raise the dead?
Also the relatively
Baptist was still nonprofit and faith-based, but it had to compete in an increasingly
commercialized environment. Its doctors, and many across the country, feared being
told by accountants and other nonclinicians what tests and treatments they could give
to which patients.
As doctors began to rely more on machines and focus more on business,Baltz worked to remind his Baptist Hospital colleagues of the ethical tenets of their
profession. As medical staff president, he urged them to stay compassionate and be
selective about adopting new technologies. Baltz encouraged the establishment of an
ethics group at the hospital and participated in a discussion of groundbreaking cases,
including that of fifty-eight-year-oldClarence Herbert, a comatose patient whose doctors were tried for murder in Los Angeles
after they withdrew his life support and IV fluids. The investigation followed from
a nurse’s complaints, an indication that difficult end-of-life decisions could create
fissures between doctors and nurses. Family members also alleged that doctors had
misrepresented Herbert’s chances of recovery so they would agree to withdraw life
support. The charges against the doctors were ultimately dismissed.“The ways and means of dying must be carefully considered,” Baltz commented in the
newsletter.
Over the years, Baltz continued the dialogue with colleagues. LifeCare leased the
seventh floor of the main building in 1997, establishing the long-term acute care
hospital within the main hospital. A Medicare payment change created incentives for
these types of business arrangements, and they proliferated at hospitals around the
country. Baltz engaged in spirited debates over coffee with colleagues who believed
excessive resources were being poured into LifeCare’s typically elderly, infirm patient
population. “We spend too much on these turkeys,” one of them said. “We ought to let
them go.”
“You have no right to decide who lives and who dies,” Baltz would answer. Through
these conversations, he learned that some of his fellow doctors adhered to what Baltz
thought of as the “Governor Lamm philosophy.” In 1984, at a time of growing budget
deficits and ballooning medical costs, Colorado governor Richard Lamm criticized the
use of expensive, high-tech medicine to keep some patients alive almost indefinitely,
regardless of their age or prognosis. At a meeting of the Colorado Health Lawyers
Association, Lamm bolstered his argument by citing a recent critique of antiaging
research penned by the prominent Universityof Chicago bioethicist Dr. Leon R. Kass. “We’ve got a duty to die,” Lamm said, “and get out of the way with all of our machines
and artificial hearts and everything else like that and let the other society, our
kids, build a reasonable life.”
Lamm’s words were picked up by an attentive
Denver Post
reporter and caused a nationwide furor.With the appearance of crash carts and the expansion of intensive care medicine in
the 1960s and ’70s, hospitals had become adept at keeping sick people alive longer.
Medicare covered the new technologies regardless of cost, and by the 1980s some policymakers
worried about the projected growth in medical spending. Lamm’s comments awakened the
public to the problem and demonstrated the tension between the “business motive” and
medicine’s burgeoning end-of-life dilemmas.
Lamm’s rationing directive rankled for many reasons. To limit life-saving care would
be to deny the human impulse to rescue individuals in extremis. To handicap the race
for new treatments that might prolong life would be to call off the eternal search
for the elixir of immortality.
Plus it would be bad for capitalism. At the time, the US-Soviet war urge was sublimated
into battles for technological innovation. We were going to the moon. Why not also
cure cancer or raise the dead?
Also the relatively