Saturday, August 29, 2009

Fear the Reaper

I used to think Palin had gone off the deep end. Death Panels? Whatever one might say of the political position of a majority party having to respond to the Facebook post of a quitter ex-governor of a sparsely populated state, the death panel comment was over the top. Right? I mean, there wasn't anything in the healthcare reform bills that actually established such a thing. The mandatory (?) end of life counseling for seniors doesn't quite fit the bill.

At least that's the line I bought the whole time now. Then I found a link to this article on the Locker Room:

Obama's Health Rationer-in-Chief

A number of excerpts are worth pointing out:

Dr. Ezekiel Emanuel, health adviser to President Barack Obama, is under scrutiny. As a bioethicist, he has written extensively about who should get medical care, who should decide, and whose life is worth saving. Dr. Emanuel is part of a school of thought that redefines a physician’s duty, insisting that it includes working for the greater good of society instead of focusing only on a patient’s needs. Many physicians find that view dangerous, and most Americans are likely to agree.


True reform, he argues, must include redefining doctors' ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the "overuse" of medical care: "Medical school education and post graduate education emphasize thoroughness," he writes. "This culture is further reinforced by a unique understanding of professional obligations, specifically the Hippocratic Oath's admonition to 'use my power to help the sick to the best of my ability and judgment' as an imperative to do everything for the patient regardless of cost or effect on others."


"You can't avoid these questions," Dr. Emanuel said in an Aug. 16 Washington Post interview. "We had a big controversy in the United States when there was a limited number of dialysis machines. In Seattle, they appointed what they called a 'God committee' to choose who should get it, and that committee was eventually abandoned. Society ended up paying the whole bill for dialysis instead of having people make those decisions."

Emphasis mine.

Then there's what the column author grimly calls the "Reaper Curve"

In the Lancet, Jan. 31, 2009, Dr. Emanuel and co-authors presented a "complete lives system" for the allocation of very scarce resources, such as kidneys, vaccines, dialysis machines, intensive care beds, and others. "One maximizing strategy involves saving the most individual lives, and it has motivated policies on allocation of influenza vaccines and responses to bioterrorism. . . . Other things being equal, we should always save five lives rather than one.

"However, other things are rarely equal—whether to save one 20-year-old, who might live another 60 years, if saved, or three 70-year-olds, who could only live for another 10 years each—is unclear." In fact, Dr. Emanuel makes a clear choice: "When implemented, the complete lives system produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get changes that are attenuated (see Dr. Emanuel's chart nearby).

Dr. Emanuel concedes that his plan appears to discriminate against older people, but he explains: "Unlike allocation by sex or race, allocation by age is not invidious discrimination. . . . Treating 65 year olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not."

Don't worry, Geezers aren't the only ones who aren't as worthy.

The youngest are also put at the back of the line: "Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. . . . As the legal philosopher Ronald Dworkin argues, 'It is terrible when an infant dies, but worse, most people think, when a three-year-old dies and worse still when an adolescent does,' this argument is supported by empirical surveys." (, Jan. 31, 2009).

Babies? Meh.

Folks, this is the ideological impetus for the type of health care reform being sought. Whether you feel this kind of philosophy has merit, it definitely smacks of the sort of bureaucratic panel that Palin mentioned.

Also, I think Palin did accomplish something in bringing the issue up: she put it in everyone's minds. She forced the Democrats to denounce the concept, not just as being absent from their plans, but something they viewed with equivalent disgust. So when the next round of healthcare reforms are being proposed*, anything remotely approaching a death panel will be jumped all over.

* What, do you think they'll stop with one new law? Did you think Iraq was going to be a quick expedition to remove Saddam, install a pro-west democracy, and get out?

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