Choosing to Die?

The top three causes of death in wealthy countries are preventable. You can steel yourself against coronary heart disease and strokes through diets low in fat and salt, exercise and the decision not to smoke. To prevent tobacco-related cancers, you can avoid cigarettes and smokeless tobacco.

Life in Wealthy Countries

The top cause of death in wealthy countries is coronary heart disease (CHD), according to 2008 data from the World Health Organization. That fact is a product of the long life span and lifestyle characteristic of high-income nations. In our hypothetical world, there would be a cure for CHD. You could eat steak subs every day, but with the help of a pill, your arteries wouldn't clog.

Another pill would protect smokers, people with high blood pressure and diabetics from strokes, the second-largest killer in rich countries [source: WHO]. If you assume people are inherently pleasure seekers, you'd expect them to eat whatever they wanted, exercise less and smoke more in a world full of magical medical bullets.

More people also might light up because lung cancer and related cancers, the third leading cause of death in rich countries, would be curable [source: WHO]. Not that smokers necessarily would live excellent lives. Many would be diagnosed with lung cancer, take a pill and then get lung cancer again. They'd have to cyclically solicit treatments for their smoking-related problems.

So far, this hypothetical world looks pretty bad -- that is, until we consider modern incurable diseases. Children with cerebral palsy or muscular dystrophy could choose a different life, if they wanted. AIDS patients could swap a succession of hospital visits and expensive drugs for an immediate, sweeping fix.

Not only would our experiment imagine away the big burdens, but also the little annoyances, like colds, ear infections and the flu. Since all of these ailments are viral, today's best efforts typically center on treating the symptoms and waiting for your body to clear the infection [source: Fauci]. In our what-if world, you'd spend fewer days suffering and miss less work or school.

What if mental illnesses became curable? Sure, many mental illnesses are controllable, sometimes to the point that the people who have them don't notice them, but for the top three mental illnesses in the United States -- anxiety disorders, depression and attention deficit hyperactivity disorder -- there can be a period of chaos before control is achieved, and control can involve lifelong medication or worries about relapse [source: Kessler]. Cures could lead to a better quality of life. We also suspect that by alleviating mental illness two institutions would lose residents: hospitals and jails [source: Harcourt].

Rich countries have a tidy system of doctors, hospitals, pharmacies and emergency crews. How would it change if every disease had a cure? If the medical system were interested in keeping the most people healthy, it might expand screening. Medical establishments tend to invest in screening when catching a disease early really helps the patient, as with breast cancer. In our world of cures, doctors would be trying detect all diseases early, except no country could afford to do that. So, the public and every other interested party you could imagine would fight over how much to spend and which illnesses to include.

We'll take all these hypothetical cures to a low-income nation next.