The collective differences are freighted with even greater significance for everyone concerned. Dave's cancer lies on the far side of a cure. Like everyone else in a clinical trial, he is reminded that the course of his treatment is unlikely to alter the course of his own illness, but it will aid physicians in caring for the next generation of victims. But once his condition—or any other condition—has been conquered or controlled, the prospects change for everyone.

The practice of this kind of medicine is inherently expensive and wasteful—and necessarily so. The initial research, the funding for new medications and procedures, and the grinding, exploratory nature of the treatment takes its toll financially and physically—to say nothing of the spiritual and emotional costs.

But how do we measure waste? Do we measure the efforts we make now against the probable survival of current victims? Or do we measure the value of present-tense waste against the future-tense conquest of a disease—as well as freedom from the misery and deaths it might inflict on subsequent generations?

To be sure, there are trade-offs and subtleties to be observed and at any one moment, we are always dealing with finite resources. But these are not decisions that can be made beyond the context of the doctor-patient relationship, and global metrics imposed by a board populated by accountants, actuaries, and a small band of physicians would foreclose on the learning that a more open-ended process fosters. Granted that the potential for abuse and exploitation of the current system is possible and does exist, correctives are undoubtedly needed.

But fairness and equality of outcomes is a hollow victory if, in our rush to find simple solutions, we destroy our capacity for the practice of medicine. Illness itself is spread inequitably and, in large part, blindly across the human race. On that reading, life's outcomes are already unfair. The best possible response to that suffering does not lie alone in resolving issues of access. It also lies in preserving the effort to find an effective cure for the illnesses that threaten our lives. Without it, access will mean very little.

Note: The Reverend Dr. Frederick W. Schmidt serves as an ethics and patient safety consultant to the National Institutes of Health in Bethesda, MD. Widely published, he is in the process of writing The Dave Test: Caring for Ourselves and One Another when Life Sucks (Abingdon, Fall, 2013).