18 December 2005

Morbidity and Mortality

While I was working at the office yesterday, the NPR radio program "Wait Wait Don't Tell Me" was playing. They interviewed Andrew Weil, a famous medical doctor with some pretty radical ideas about aging and medical care. He spent a good portion of his time talking about new ideas about mordidity (not being well) and mortality (being dead).

He draws his ideas from three axioms which are almost self-evident:

(1) You will get older.
(2) You will die.
(3) Being well is better than being sick.

Taken standing alone, these axioms lead you to an ideal life in which you get hit by a truck just before you get the illness which would have killed you, ideally as late as possible.

The problem is that this conclusion is wrong.

Yes, we want to maximize the number of healthy days in our lives. Yes, we will get older. And, yes we will eventually die. But, the axiom that the list above is missing is that, in all but the most dire situations, being sick is better than being dead.

Most of us, when we confront the issue face to face, would prefer to have six more months on this Earth dying of cancer, to being hit by a truck the day before the cancer that would otherwise have killed us would have started making us feel sick. While we want to maximize healthy days, the converse is not true, we do not want to minimize the number of mordidity days.

While this may seem trifling, it is important because it is the kind of misguided philosophy that someone might someday end up using to make policy.

The real hard question is how to balance mordidity with mortality. Most of us would be willing to give up a few days lived in excruciating pain in exchange for a day or two more of healthy life. Few of us would be willing to give up many days of life when the worst effects are some nauseau and moderate pain that pass after a few hours, in exchange for an additional day of healthy life. And, of course, there are some situations, where life is worse than death, for which we have living wills.

There aren't first principles that can easily tell us what the right answer to those balancing questions is, so we actually have to use intuition as well as logic to resolve those.

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