US debates whether age or economics should be deciding factor for surgery

The debate on surgery for elderly patients has been highlighted by US doctors who carried out heart surgery on a 97-year-old physician who had refused an operation to repair a tear in the main artery of his heart, which could have killed him.

World-famous cardiovascular surgeon Michael DeBakey eventually underwent surgery after he fell into a coma and relatives consented for the operation to go ahead, according to a report by The Philadelphia Inquirer on Monday (06/07/09). The operation he underwent was one he had pioneered himself.

Before he died last July aged 99, Mr DeBakey agreed that it was appropriate for him to have had the surgery, despite his age. After surgery he had resumed a busy schedule until his death.

The case raises concerns in the US regarding extending free Medicare – federal health insurance for those aged over 64 – to the hundreds of thousands of patients who do not have health insurance. The Medicare programme is currently thought to be heading for insolvency – a report last month said it would run out of funds in seven years.

Pennsylvania Hospital's chief of cardiothoracic surgery, Charles Bridges, said that each patient should be treated individually.

‘You have to get out of the idea that there's a threshold age where we think about this surgery differently,’ he said.

‘With each patient, you have to lay out: What are the risks if I do this? What are the risks if I don't?’

However, Daniel Callahan – co-founder of bioethics research institute, the Hastings Center in Garrison, New York – said recently:

‘Under the best of circumstances, age should be irrelevant in the Medicare program. But so far, the cost of care has not been considered, and it can hardly remain irrelevant in a program strapped for money.’

In 2005, Alan Maynard – health-economics professor at the UK’s University of York – said that the US and UK attitudes towards dying might contribute to different approaches in surgery for very elderly patients. Writing the journal Health Affairs, he said:

‘Dying is an un-American activity! This accounts in part for Americans spending twice as much per capita on healthcare as the British do. The British reluctantly accept two facts of life. First, they are all suffering from a terminal, sexually transmitted disease called life. Second, with death inevitable and resources finite, healthcare rationing is inevitable.’

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