Having someone else do that for you is indeed a slippery slope, but one you already stepped off one when you decided that healthcare is an entitlement to be paid for by others.

It is not and can never be a “right” because it is a service provided by people who are free beings and free to provide it or not–and who also like to eat. It is a commodity that can (and has been) with a resulting series of inevitable consequences, be made an entitlement.

Rights are not given by a public vote or governmental declaration, they are given by God and are a result of the inherent nature of man, of God, and their relationship. Governments, votes, laws, can trample on or recognize rights, not create them. They can also extend priveleges and entitlements.

The fact is that our society has already made up its mind. If a person walks into an ER with appendicitis, we do not have the right (not to say we should do this), to ask for that person to pay before he/she has surgery (By the way, this is what a dentist does, asks for payment upfront before an abscess is treated).

Because it already has been decided that healthcare is a right, we need to , as physicians, have a major role in deciding what to do now. We need to be paid fairly for the work we do. The days of a “safety net” are over.

I do not believe in rationing care, that is a slippery slope in and of itself. However, I think we should mount a massive public education project regarding futile and end of life care. Too often, an elderly patient does not want to talk about it while they are healthy. Also, the family does not want to be the ones to “pull the plug”, so as a result, futile care is performed, all with a hefty pricetag.

For example, we should videotape a “code”, put a black stripe over the patient’s eyes to protect identity, but show the patient, nude, tube down the throat, surrounded by people performing chest compressions, etc. I think when people really see how ugly a process this is, they may be more likely to not put grandma or grandpa through it.