A Healthcare Conundrum? Hip Replacements for the Terminally Ill

What do you do? You are a healthcare administrator and you have to make a decision. You have a patient with terminal cancer who needs a hip replacement. While the hip replacement would increase mobility, the operation would cost untold thousands of dollars. There is also the fear of complications that can result for patients with terminal illnesses. Here’s what one study said about a few of the challenges,

Advanced cancer, severe cardiac and pulmonary disease, and other disorders that threaten overall survival have long been regarded as contraindications to total joint replacement… The reluctance to operate in these settings may stem from concern about a higher risk of perioperative complications in patients with terminal disease or from discomfort with using an expensive procedure for patients with limited life expectancy.

Do you decide to authorize the operation or determine to give the patient enough medication to endure the pain until death? What do you make of the patient’s desire to experience as high a quality of life as possible in the time of life remaining? Would your decision vary based on whether or not you sensed the patient would live only six months, a year, or up to two years? Would you also account for the possibility that if money goes to a hip replacement for this terminally sick patient there may not be enough money to attend to patients with other pressing needs? Most people would imagine that health insurance would cover the hip replacement, so who cares? But the patient in question doesn’t have insurance or the insurance the patient has would cover the hip replacement.

For the Christian, other consideraions will likely come into play. Someone might say that Jesus would leave the ninety-nine patients to go after the one who was in desperate need. Someone else might respond: Jesus would also make sure the ninety-nine were attended to until he returned; and what if it were not one who is in crisis, but ten or twenty in desperate need? Another person might counter: who said anything about desperate-hip replacement does not rise to the level of a lost sheep’s soul needing to be saved! Prepare yourself for still another line of thought: the Bible doesn’t belong in the discussion since it is an ancient book and we are dealing with modern realities. If that is true, perhaps some hospitals will need to consider more than replacing hips to changing names, abandoning “Good Shepherd” and “Providence” for something more contemporary.

For all the differences in the debate over healthcare reform in our country, people on various sides would agree that we are facing huge challenges; there is a need for reform, whatever it may be. Rigid ideology of one sort or another straightjackets complexity and brings about short-sighted and ill-fated solutions. Complexity for complexity sake can lead to an affirmation of the status quo and paralysis. We have to engage in healthy conversations for the sake of advancing public health.

Easy answers are hard to find. Tough questions and nice names come more readily. We will be addressing such issues as these at The Institute for the Theology of Culture’s: New Wine, New Wineskins’ conference on healthcare Saturday, October 19th. We hope you will join us.

This piece is cross-posted at The Institute for the Theology of Culture: New Wine, New Wineskins and at The Christian Post.

About Paul Louis Metzger

Dr. Paul Louis Metzger is the Founder and Director of The Institute for the Theology of Culture: New Wine, New Wineskins and Professor at Multnomah Biblical Seminary/Multnomah University. He is the author of numerous works, including "Connecting Christ: How to Discuss Jesus in a World of Diverse Paths" and "Consuming Jesus: Beyond Race and Class Divisions in a Consumer Church." These volumes and his others can be found wherever fine books are sold.

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  • Allison Wood Hinz

    I think the decision whether to provide surgery for a hip fracture to a patient with a terminal illness needs to be made on a case by case basis. A key question that must first be asked is what their functional capacity was prior to obtaining the fracture. If they were up walking, able to participate in activities and enjoy life in a way that would be unthinkable now without repair of the fracture it seems cruel to deny them these things if a surgery had a good chance to return them to these previous activities for the remaining months to sometimes years of their life. (As Drs we are invariably bad at making estimates as to life expectancy). On the other hand, if the individual is already essentially bed bound at the time the fracture occurs, and their quality of life is already very poor, the hip fracture could be treated with pain medications and their quality of life would remain unchanged. It would not be worth the risk of surgery nor the expense to repair the fracture in such cases because there is little to be gained.


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