Modern technology has created the possibility of dramatic extensions of life. Prolonging life, however, is costly because the technology can be quite expensive.
In market-based societies, high prices for extending life often mean too many people are excluded from these technological benefits. Humanitarian concerns compel that this dilemma be dealt with adequately.
Free market critics, sensitive to the exclusion problem, look to the welfare states of Northern Europe for guidance. But the welfare states' experience with extending life is much less satisfactory than that of the market-based societies. A "culture of euthanasia" has taken hold in Northern Europe where life-extending technologies are increasingly out of fashion and terminating ill old people is extolled as humanitarian. According to the Dutch newspaper NRC Handelsblad, "humanitarian terminations" by doctors occur at the rate of ten thousand per year in Holland.
Economics plays an important role in motivating Europe’s culture of euthanasia. Faced with bloated fiscal deficits the welfare states are rationing the use of new technologies. Moreover, countries such as Holland that do not use prices to allocate heath care have taken the economic incentives for extending life away from physicians. Indeed, because extending the lives of ill old people can be costly, the economic incentives run in the opposite direction in the welfare state. In these budget-balancing times, the doctors at public nursing homes and hospitals are under severe pressures to keep costs down.
Patients are virtually helpless against this new culture of euthanasia. "Free" health care effectively disempowers them. Doctors are not gods but increasingly are forced to play such a role by refusing to use life-extending techniques for patients and families who want them. In Holland, there is no private medicine. The only recourse for dissatisfied patients is to leave the country or go to the courts.
Europe's welfare states face a serious dilemma. On the one hand, if Holland more fully exploited existing life-extending technologies for its people, substantial additional pressure on its health care budgets would result. On the other hand, the underutilization of life-extending techniques creates a moral crisis because ill patients are being prematurely terminated.
The solution to this dilemma is simple. The Dutch, like the British, must allow private medicine to coexist with public medicine. In a so-called mixed system, patients would have more power—and physicians less—over life-and-death decisions. If patients do not like the treatment at public facilities, they can switch to private ones. This is more moral then "trapping" patients in public institutions. Introducing private medicine also would take some pressure off public health budgets.
The lesson from the welfare state experience with life-extending technologies is clear. It is not enough for science to find new ways of extending life. If the benefits of the new technological revolution in health care are to be fully exploited by mankind, health care must be allocated through the private sector.
