Blog | Friday, July 18, 2008

Pacemakers for centenarians

An article in today's New York Times discusses a now-104-year-old woman who received a biventricular defibrillator when she was 99 (after being rejected by one cardiologist for the operation). We've covered the ethical debate over dialysis for the very elderly, but the general dilemma of interventions for the oldest patients seems likely to become a bigger issue as more people enter that age range. How do you make determinations about their likely quality of life? (The woman in the story's very happy just to be alive, but lots of people wouldn't feel that way about being so incapacitated.) Can you apply a standard of cost-effectiveness to these decisions? (There are certainly many ways that the $35,000 Medicare spent on her operation could have been used to sustain more healthy life-years.) Who should decide this--patients, docs, insurers?