Enough of this discussion about a massive healthcare overhaul - let's talk about something more fun. After all, this is the month for Halloween and...But wait a minute! There is something pretty spooky going on behind the scenes in Washington - something you might not have heard much about.

Consider this: How much would you say your life is worth?

OK, so you want to be humble. Well, how about the life of your mother? Or wife? Or daughter? What kind of dollar sign would you put on that one?

Not an easy question, but it's one that is being asked and debated at this very moment.

Let's go back a minute.

For decades, medicine has dealt with some very complex ethical issues. During our training in medical school, we are taught to consider the important decision of "benefit versus risk". Simply stated, does what we are considering doing for a patient have a greater chance of helping them, or of hurting them? At first blush, this would seem to be a no-brainer. Surely we wouldn't intentionally do anything that could possibly endanger someone! And the answer should obviously be no. Not intentionally. But medicine is not an exact science, and there is frequently some risk involved. Remember Hippocrates' primary admonition, "First do no harm". He knew many centuries ago that treating someone, intervening in their lives, doing something, would frequently entail some risk and the threat of harm.

Fortunately, many years later, a lot of what we do is straightforward. A broken arm needs a cast put on it, a lacerated finger needs to be cleaned and sutured, a strep throat needs antibiotics. These kinds of things make the equation easy to solve: there's a lot of potential benefit, with very little risk. No difficulty here.

However, there are other times when the decisions are not that simple.

When does someone with gallstones need to have their gallbladder removed? You have to weigh the benefits of reduced abdominal pain against the dangers of surgery. Or who should have their heart disease managed with medications versus open-heart surgery? Again, you have to weight the benefits versus the risks. Every patient is different, and no two circumstances are the same. But you learn to deal with that, to draw on your experience, to ask for the help of your fellow physicians, and to include the patient and his/her family in the discussion, all in an attempt to make the best decision you can.

Now we are dealing with another aspect of that equation, that of cost-effectiveness. The financial part of medical care has always been a factor, but today it is at the forefront. How much should it cost to fix a broken leg? How much should it cost to have a baby? What are we willing to pay? How much can we pay? The questions and issues go on and on.

And now we are being faced with perhaps the greatest dilemma yet - How many dollars should be spent to keep one person alive? Or restated in a more troubling way - What is the value of a human life? This is a question being considered and debated at this very moment by our elected officials.

The issue is couched in terms of "acceptable dollars spent per life saved", and there are discussions of "acceptable ranges" of dollars spent. For instance, most people would agree that $20,000 for a life saved would be "acceptable". But what if that amount was $100,000? Or $200,000? I guess it depends on whose life is in the balance, doesn't it? It we're talking about a stranger in Montana, or Florida, or Vermont, then it becomes a little less bothersome. But what if it's someone in your neighborhood or in your family? What if it's you?

There are no easy answers here, but we need to be aware that the questions are being asked. We just need to know who's going to be making those decisions and what they will really mean and how we are going to be affected. And we need to know before it's too late.

Once more: How much is your life worth?

I told you this was going to be spooky.