By Anne C. Woodlen

Five-point-two million dollars were spent on one 69-year-old retired prison guard who was in the Duke University Hospital Intensive Care Unit for 34 days. He was then discharged to death. His wife said, “I was just hoping it would save my husband’s life.” Who was thinking about the money? A bunch of doctors and administrators. They were keeping track of the money. They had a meeting about it—and didn’t put a cap on the spending.

When my roommate married a doctor thirty years ago, she told me with a great deal of discomfort that her husband could expect to earn more than a million dollars during his working years. Now, a physician will earn substantially more than a million dollars, and a gathering of these more-than-a-million-dollars people made the decision that it was okay to spend $5.2 million dollars on one man. What if the decisions were being made on a pay-as-you-go basis?

Take away Medicaid and Medicare, private insurance and university hospital money and look at this situation. We’re talking about $153,000 per day. On the third day in the ICU, somebody goes to the guy’s wife and says, “Tomorrow you have to move into an apartment. Your house has to be sold.” The wife gets upset, cries, and says, “Okay.” The kids look grim and talk to each other. They say, “This isn’t right. Mom and Dad worked their whole lives to pay for that house. They meant to have it as long as they live.”

“Yeah, but it’s just a house. Mom would rather live in an apartment with Dad than a house without him.”

“I know—but what if she ends up in apartment without him?”

A week later, somebody comes to the guy’s kids and says, “Now we need your houses. And the funds for your children’s college education.”

The kids look at each other and say, “Uh, no. Dad wouldn’t want us to do that. He and Mom worked and saved to get us through college. It really mattered to him that we go to college. He’d be sick if he knew we were giving up our kid’s future just to—maybe—give him a couple more years. When his mother died, he kept saying, ‘She had a good life.’ Well, Dad’s had a good life. It’s time we let him go.”

That is the nature of human reality. We weigh and balance our assets and liabilities. Income and outgo are budgeted and calculated. We make choices about what is valuable, but as a society we now have divorced our income from our outgo: the balance has been destroyed. It is not about one man’s life versus his children’s houses and grandchildren’s education; it is about one man’s life versus the houses and education of strangers. And the $5.2-million-man “told his doctors to spend the money on someone younger.”

Doctors and administrators who do not live in the real world are making the decisions. They live in enclaves of wealth. They live in three-bathroom houses, lease new cars every year, and send their kids to private schools. Discretionary income is about a ski vacation in Aspen versus taking the Concorde to Paris.

In the real world, a worker earns about $35,000 a year. That’s the woman in the ICU who changes the oxygen tubing on the $5.2 million man, and the guy who pulls the linen cart, and the woman who draws blood, and the guy who pushes the mop—and they are the people who should be participating in making the life or death decisions about how much of society’s resources are spent on one person’s care.

Duke University Hospital’s pharmacists “consulted colleagues . . . and scoured medical studies . . . ‘We found nothing that we could look to and say . . . here are the guidelines.’” Look to the real world. Don’t look at the medical studies: go sit in the cafeteria and listen to the workers who are talking about the cost of milk, sneakers and car mufflers.

We are a society, a single body. If one of the parts suffers, the whole suffers. It is time to put a cap on spending. A million taxpayers paid five dollars a year to keep one man alive. Let’s play Republican and return the money to the people paying it. Let’s let the individuals decide how they’ll spend their money. Let’s let individuals who are representative of the masses participate in making the decisions.

Let’s just look at the ICU and reconsider how money could be spent. Let’s do a survey of the outcome of the money that’s been spent. For every $100,000 bill from the ICU, follow up for five years at one-year intervals. Ask, “Where are they now?” The woman on whom we spent $250,000—is she at home in her kitchen baking cookies for somebody? Is she in elder care, reading to her grandchildren? Is she in a vegetative state in a nursing home? Is she in a cemetery? What about the man who got half a million dollars worth of care? Has he returned to teaching? Mowing the lawn? Worshipping God?

The woman upon whom society spent $86,700 in the ICU is now writing you this message.

If somebody is so sick that it costs half a million dollars to keep them alive in the ICU, do they ever again have a good life? Do their grandchildren? In the real world, you cannot divorce the quality of one person’s life from the quality of other people’s lives. It is not about judging the quality of one person’s life—for who can do that? It is about judging the quality of one society’s life—or one world’s. Five-point-two million dollars for one American man—and how much for a hundred El Salvadorian children? The women of India, the miners in Africa, the sweatshop workers in Bolivia? You are a citizen of the world. Should your father live while a child dies in Yugoslavia? You decide.

We need old people to be wise for us even though we, as a society, do not listen to them. We put them in residential enclaves where they are physically maintained and socially ignored; nevertheless, we save them at great cost. The age of the person in the ICU should be factored into the decision of how much to spend to keep the person alive.

Is this person, who is being treated so expensively, supposed to be dead? Does God have a plan for us? Is there a God? We should be asking these questions. Every important decision we make is determined by what we believe about death. If you are a doctor and believe death should be prevented at all cost then the cost will be very high. If you are a farmer and believe that death is necessary and inevitable, the cost will be low.

The question is not, “Should we let this person die?” because, ultimately, we have no control over whether the person will die. The question is “Should we let this person die now?”