Now Why Would Anyone Be Worried About Death Panels?

Republicans in general, and Sarah Palin in particular are so silly. I mean, read this heartwarming article in the Wall Street Journal and then ask yourself this one question: With guys like Dr. Ezekiel Emanuel running Obamacare, what's there to worry about?

For those of you who don't know, Dr. Emanuel is special: The President has handed him two important appointments - health-policy adviser at the Office of Management and Budget and membership on the Federal Council on Comparative Effectiveness Research. He's Barack Obama's preferred health care policy wonk.

Here's a selection of Dr. Emanuel's thoughts on health care (not insurance) reform:

True reform, he [Emanuel] 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."

In other words, when you bring Grannie to her doctor for treatment, her doctor shouldn't be focused on getting Grannie well. He should be focused on working out a cost/benefit analyis on whether it is in "society's interest" to incur the cost of Grannie's treatment.

Pretty innocent, eh?

Then there's this:

In numerous writings, Dr. Emanuel chastises physicians for thinking only about their own patient's needs. He describes it as an intractable problem: "Patients were to receive whatever services they needed, regardless of its cost. Reasoning based on cost has been strenuously resisted; it violated the Hippocratic Oath, was associated with rationing, and derided as putting a price on life. . . . Indeed, many physicians were willing to lie to get patients what they needed from insurance companies that were trying to hold down costs." (JAMA, May 16, 2007).

But aren't the insurance companies the greedy ones? And the doctors? Is the Obama Administration now to the point where it's going to start blaming greedy patients? Sounds like that's exactly what Dr. Emanuel is saying, don't you think?

Anyway, there's more:

Of course, patients hope their doctors will have that single-minded devotion. But Dr. Emanuel believes doctors should serve two masters, the patient and society, and that medical students should be trained "to provide socially sustainable, cost-effective care." One sign of progress he sees: "the progression in end-of-life care mentality from 'do everything' to more palliative care shows that change in physician norms and practices is possible." (JAMA, June 18, 2008).

Boy, Sarah Palin really is a whack job. Isn't she?

And what about all that silliness about "rationing" health care? Dr. Emanuel puts that to rest:

"In the next decade every country will face very hard choices about how to allocate scarce medical resources. There is no consensus about what substantive principles should be used to establish priorities for allocations," he wrote in the New England Journal of Medicine, Sept. 19, 2002. Yet Dr. Emanuel writes at length about who should set the rules, who should get care, and who should be at the back of the line.

Can't infer rationing from that kind of talk, can you?

It gets better:

"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."

That's right. Society (i.e., individual consumers of health care) made the choice to pay the whole bill because they - and not some federal government drone - decided that having those dialysis machines was more important than using the money for something really important... like Cash for Clunkers.

Speaking of Cash for Clunkers:

Dr. Emanuel argues that to make such decisions, the focus cannot be only on the worth of the individual. He proposes adding the communitarian perspective to ensure that medical resources will be allocated in a way that keeps society going: "Substantively, it suggests services that promote the continuation of the polity—those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations—are to be socially guaranteed as basic. Covering services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic, and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia." (Hastings Center Report, November-December, 1996)

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.

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."

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." (thelancet.com, Jan. 31, 2009).

So what we have here is, in effect, Dr. Emanuel urging doctors to become their very own one person Death Panel. What's wrong with that? I mean, Dr. Ezekiel Emanuel may be a cold-blooded asshole with a God Complex, but...

 

After all, he is working for the good of The Collective.

Comments

[David]

Paging Dr. Mengele . . .

[Thingumbob]

Well, let's see, DR EZ-Kill's lifeboat ethics isn't "women and children first," instead it is "kill (or in PC parlance "withhold medical care from") the elderly and children first". This man is unarguably a monster. What does this say about Obama's intelligence and culpability in choosing this miscreant? What about the phase known or should have known applied to our erstwhile savior AKA "the One"?

[Billy]

Can't wait to see how Mark and Elliott try to spin this...

[Semantic "The Onanist" Leo]

Thingumabob,
I'm Stealing that, with an edit.Eazykill.

[richard mcenroe]

dennis, to be fair to Dr.Ezekiel "Der Weisse Engel" Emanuel, we should point out that he says his thinking on health care has now "evolved."

Apparently now we should also harvest the fillings and surgical prosthetics from the dead to help reduce the national deficit as well.

Of course, his "evolution" may be a tad "attenuated"...

[Dennis the Peasant]

Billy-

You mean 1 of 2 and 2 of 2?

[richard mcenroe]

By the way, Dennis, you're making excellent progress. We'll have you back on the dark side in no time....

[Jim Ryan]

They're not fucking death panels, you inbred racist wingnut Hallithuglican Palinazi bible thumping Faux News crationist morons. The correct term is "social justice health distribution boards." Dilweeds.

[Dennis the Peasant]

I'm making progress. Yesterday I was a fucktard.

[David]

"Yesterday I was a fucktard."

Take refuge in the certainty that you can become one, instantly, by voting Dem.

[Jane2 McMahon]

In my legislative experience, end of life directives and decisions are determined more by case law than politicians or government bureaucrats who carry out the legislative directives of political bodies. The idea of death panels in G10 countries are hyperbole, whether said by Sarah Palin or deliberate misreadings such as the above. Please see what actually happens in actual countries with actual public health care.

As for rationing, of course public health care is rationed to some extent (no, I do not want my public dollars paying for your pec implants or brow lifts). Only in America is the sense of entitlement so great that unrationed health care is expected (and provided) at the expense of the public purse (Medicare today, anyone?).

[Jim Ryan]

Like I said.

[PeterUK]

"In my legislative experience, end of life directives and decisions are determined more by case law than politicians or government bureaucrats who carry out the legislative directives of political bodies."

Autism for beginners.

[Mark A]

Jane2, the nurse Ratched of the legislature.

[Jane2 McMahon]

Always a pleasure engaging in policy debates with ex-denizens of Yahoo chatrooms. To follow: "I know you are but what am I."

[Dennis the Peasant]

Jane2-

Sorry, it's been a contentious couple of days here.

Anyway, I am not as sanguine as you are about this. Legislative mandates can circumvent case law, as you will know. That is my fear... The mandates that would be developed by the unelected (such as Dr. Emanuel) and implemented without a vote.

[Tim]

Let's see, this is what Sarah Plain wrote:

“The America I know and love is not one in which my parents or my baby with Down syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil”

I wonder if her baby born with Down Syndrome fits in here somewhere:

Covering services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic, and should not be guaranteed.

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

[PeterUK]

Jane2. You have a touching belief in case law. Legality is not morality,understanding that is the ethical failure of today's society.
As a matter of interest,do you believe in legally sanctioned executions?

[PeterUK]

"Covering services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic, and should not be guaranteed."

There are some who it is difficult to asses,they look like everybody else. They are known as psychopaths.

[richard mcenroe]

And Congressmen.

[markg8]

I'm reposting this cuz it's just as good to debunk this post:

http://blogs.abcnews.com/politicalpunch/2009/08/zeke-emanuel-on-sarah-palins-accusation-of-death-panels-its-an-absolute-outrage.html

An opponent of euthanasia, Emanuel says he “abhor”s people “cavalierly distorting those writings and the work that I’ve done over 25 years to help improve medical care in America for vulnerable people who often have no voice.”

In fact, as an academic he looked into the notion of euthanasia when the “Right to Die” movement started gaining attention and he says he’s been “very solidly consistently against it.” The misperception was prevalent, he says, that those seeking assisted suicide did so because they were “writhing in pain,” when in fact the main motivation for those seeking voluntary euthanasia was depression.

One of the passages written by Emanuel and used as evidence by Palin and others that he would favor withholding medical care from those who aren’t productive members of society include a 1996 contribution to the Hastings Center Report, in which he said that under the “civic republican or deliberative democratic” construct, “services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia. A less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason."

Is he saying, as Palin and others have suggested, that those who aren’t “participating citizens” should have no guarantee to health care?

“No,” Emanuel says, “and I think I made it pretty clear I wasn’t endorsing that view, I was analyzing that perspective and what it might mean in practical terms. The rest of the text around that quote made it made it pretty clear I was trying to analyze it and understand it, not endorse it.”

Emanuel acknowledges that philosophical treatises can be difficult to consume and might lend themselves to this kind of misinterpretation. People in the world of academia “tend to know your whole body of work, and when they make a response it tends to be to one line of argument in context.” But that said, “a lot of philosophy can sometimes seem extremely abstract to people and hard to follow -- even well-educated people.” He says sometimes he has trouble following a philosophical article. “They’re not necessarily the easiest thing to read.”

(See also our blog “When Academic Words Become Political Ammunition,” July 28.)

In another article used as grist for his critics, in Lancet in January 2009, Emanuel and two co-authors discussed rationing care. But Emanuel cautions the goal of the article was not to apply his views of rationing onto providing health care in general.

“We were examining a very particular situation,” he said.

The situation: “we don’t have enough organs for everybody who needs a transplant. You have one liver, you have three people who need the liver - who gets it? The solution isn’t ‘We get more livers.’ You can’t. It’s a tragic choice.” It’s a decision made in the story in the context of “absolute scarcity.”

“it doesn’t apply generally to health care services more broadly,” Emanuel underlines. “Only by ignoring what we say there could anyone come to a different conclusion. Only by taking two sentences out of their complete context.”

In that article Emanuel analyzed eight different views that have been advocated and, with his co-author, argued none are adequate. They combined five views to create the “Complete Life” theory. One of the arguments it that the younger patient should get the liver before the older patient -- though Complete Life theory makes exceptions to that rule.

Emanuel points out that there is some support for the positions he takes in that article from public polling, and that none of these discussions are removed from the world -- as with the prioritization by the Centers for Disease Control and Prevention for those who are health care workers, or pregnant women, to get the H1N1 vaccine.

“Throughout my career I’ve taken on those kinds of questions,” he says, “ones that people don’t like confronting.” They’re difficult issues, he says, but society already makes decisions, one way or another, about who gets the liver, and how to care for dying patients. “I understand it can make people queasy but there’s no way of escaping it. I hope at the end of the day I can make things better for people, especially vulnerable people.”

The oncologist suggests that his words are being twisted because opponents “don’t have a solution” to the health care reform debate. “Maybe the only tactic is to sow fear and use whatever means you have to attack whether that’s grounded in reality or not... If you don’t have good arguments you use whatever you got, I guess, to say things that are distortive and untrue.”

He says “there have been previous attempts to come after me and after some of my colleagues, but this is certainly on a completely different scale and magnitude. I’ve never been mentioned on Sunday shows in this light and certainly never on the floor of Congress. The distortions are much larger than I’ve ever seen or would have believed could happen.”

Much of the last quarter century he’s spent as an oncologist, he says, has been devoted to improving end of life care in America. He was told when he began exploring some of these issues in the 1980s not to do it.

About 15 years ago he did think rationing was necessary because of cost issues but he has come to change his mind. “The more I’ve looked into it the less I think it’s true,” he says. “We spend a lot of money and resources -- hundreds of billions of dollars -- for unnecessary care, care that doesn’t help patients,” and in some case might make them sicker by exposing them to hospital-acquired infections.

[PeterUK]

More flip flops than a sandal factory

[PeterUK]

“We spend a lot of money and resources -- hundreds of billions of dollars -- for unnecessary care, care that doesn’t help patients,”

Yes there was some cove,77 years old,just jossed it,who absorbed a vast amount of money to keep him voting.

[Jane2 McMahon]

Peter, if "legally sanctioned execution" is capital punishment, no I do not. Of course, it's not legally sanctioned in my country, so it's a moot point with me.

Some of the arguments against (and for) single-payer public health care are reminding me of the arguments against Saskatchewan public health care 50 years ago, only then it was "forced abortions" instead of "death panels". The fact is that the USA has a rather extensive single-payer public health care system already in place, and for seniors no less. There are no calls to dismember it, or no claims of death panels now, and I can't imagine anyone actually implementing them (and nor do I buy the claims that insurance companies are de facto running death panels already...the argument from the other side).

Heck, if a watered down public health care (or insurance "reform" or cooperative or whatever the heck it is) system gets such a reaction, surely the state killing of little Trig or Grandma wouldn't get very far.

Advanced care directives are now pretty much a standard thing...and it was judges, not politicians that emphasized individual choice and the age at which people could determine those directives (a lot younger than politicians wanted). Also consider the eleventy jillion abortion laws passed and struck down since Roe v. Wade...pandering to a certain "
morality" doesn't stand up in the face of law.

[PeterUK]

Jane,

But you see,don't you,"Attenuation" is a form of capital punishment.
In actuality,the decision is made by doctors on the spot,forget the judges chambers, go to the hospital,one's life is only as god as the paperwork.

As for a state health system,it will bankrupt you.

As for law. There have been far too many "autistic" decisions from the bench to risk ones life on. The Law that gave Ted Kennedy a rap over the knuckles for leaving a girl to die?

[Jim Ryan]

The fact is that the USA has a rather extensive single-payer public health care system

It's broke. And they want to expand it. And force out private insurance companies. The result will be rationing, just as in Canada and UK. The result of rationing will be sickness and death.

Of course US Medicare and Medicaid don't ration. They just steal from our grandchildren. Once that game's up, the rationing will begin. And there won't be any private insurance companies to opt for.

The left will eventually try to make it illegal to use one's own money to get immediate treatment, as it is in Canada. But Americans will never stand for that kind of subsumption of the individual into the General Will.

[Jim Ryan]

US Medicare and Medicaid are broke. How have they avoided rationing? By stealing from our grandchildren. As in Canada and UK, it will be rationed. The rationing is about to begin. (via Insty)

And the left wants to expand this black hole to the rest of the economy and make it impossible to form from contracts with private insurance agencies. After that, they will make it illegal to get quick medical care using one's own money, as they did in Canada. This is an unconscionable violation of individual liberty. It also inefficient and imprudent.

Government health care is a death panel. It is in Canada. It is in the UK. It will soon be so here. It's totalitarianism. Americans won't stand for it.

[Jim Ryan]

Oops retyped that. Didn't see it.

[Jane2]

Jim, the reason it's broke is because it isn't rationed...no public entity can provide unrationed anything, including health care. And it's simply not fiscally responsible, much less fiscally feasable.

Why anyone would expect an unrationed system is beyond me...despite rationed health care, G10 countries are NOT broke, and their health and mortality indicators surpass those of the USA, and they spend less percentage of GDP on health, to boot.

As for forcing private companies out, I have Blue Cross, I use a private physical therapist, and receive private chiropractic care. If I want an MRI and don't want to wait for my public system to provide me with one (incidentally, the lists are determined by doctors, not bureaucrats), then I can go to Calgary and pay my bucks for a private one. On the other hand, when a friends daughter spent six months in the hospital with Hodgkins, I never once asked, "do you have adequate insurance?" That's a pretty good trade-off.

[Jane2 McMahon]

And as for getting private medical care with one's own money, there is nothing illegal about that....I can go to the US and get any old operation I want if I want to pay for it. The problems start when I return to Canada and whine that my government won't cover it...even though I could easily have sought permission for it in the first place, but didn't because I'm a greedy old whiner.

[PeterUK]

"I can go to the US and get any old operation I want if I want to pay for it. The problems start when I return to Canada and whine that my government won't cover it...even though I could easily have sought permission for it in the first place, but didn't because I'm a greedy old whiner."

"Please Mr/Ms Gubmint,kin I have permission to look after my health"?

Do you have an option on which taxes you pay?

[Jane2 McMahon]

Peter, I see a fair bit of public benefit for my tax dollars. I'm not thrilled about paying for agricultural subsidies up the wazoo, for example, but at the end of the day, I see enough tangible benefits to keep me from loading my staple gun (it *is* Canada, after all).

[PeterUK]

Jane,
Yes you pay what is demanded and accept what is given.

[Jane2 McMahon]

Peter, we all do...it's part of not having to move to Montana and live in a compound with no high-def while plotting against the government. We get to vote every so often and vote for some black cats instead of white ones (look up "Mouseland" by Tommy Douglas)...when I look around the world, it's working pretty good for us, recession notwithstanding. Personally, I plan on voting "none of the above" in the next federal election, but I still get to vote, even if my cat Phil gets only one write-in vote.

[PeterUK]

Looks like Canada's future is in American hands.

[dick]

Jane,

If the US gets the single payer, then where are you going to get your optional medical care in the US? That option will no longer exist. Also what will happen to the drugs you might need. The money to develop them will no longer be available for R&D. Since the US will no longer pay the premium prices for drugs we do now, then the other countries will probably have to pay market prices for the drugs and that will raise you costs.

With the pay for doctors being cut, look for fewer people to go into medicine in the future. There go the surplus doctors we have now so there will be even fewer opportunities for the Canadians to cross the border and get the medical care that they either cannot get or cannot afford to wait for.

I would imagine that the US going for a single payer plan will have a big affect on the other countries just because we have for so long been producing the majority of the new drugs, the new machines, etc. That too will probably be affected negatively.

At that point attenuation will be just about the only answer and Dr Mengele Emanuel will be in it for all his glory. His ethical philosophy of medicine will be the norm.

Personally I do not trust this whole crew as far as I can throw them and I have emphysema so I cannot throw them far.