Entrusting ones life to Congressional fiat

In the aftermath of the Stupak flimflam on abortion funding, it would be a good idea to revisit the problem of inviting the Pelosi-Reid-Obama team into the hospital room. Lately, Congress seems to be full of people who zealously adhere to principles dictating life-and-death control over the vulnerable. Yet they appear to have no understanding of the principle that matters most in health care: upholding the dignity of the human person.

Anyone who saw the YouTube video of Rep. Bart Stupak (whose amendment enabled Pelosicare to pass), http://www.youtube.com/watch?v=URr68joWr1E http://www.all.org/newsroom_judieblog.php?id=2844 in which he admits that—win or lose on abortion funding—he would support an Obamacare bill, knows exactly what I mean. The “majority” means more to these politicians than whether or not taxpayers pay for murder—at least according to Stupak.

So what about the defenseless among us who are already born? What might be in store for the severely disabled, the terminally ill and the “better off dead”? Will decisions be made by an ethical medical professional or a bioethics panel? What should we expect if the Obama administration gets its way?

The stark difference between ethical decision making and applied bioethics could provide a hint.

Professor Dianne Irving explained in Crisis magazine, http://www.hospicepatients.org/prof-dianne-irving-bioethics-mess.html “Traditional medical ethics focuses on the physician’s duty to the individual patient, whose life and welfare are always sacrosanct. The focus of bioethics is fundamentally utilitarian, centered, like other utilitarian disciplines, around maximizing total human happiness.”

Bioethicist Arthur Caplan defines the role of the bioethicist as a “moral diagnostician.” http://www.bioethics.upenn.edu/documents/Caplan-Letter_to_future_bioethicists.pdf However, Caplan defends Ezekiel Emanuel’s http://www.washingtontimes.com/news/2009/aug/14/white-house-adviser-backs-off-rationing/?page=2 approach to caring for the dying, telling reporters that Emanuel is an “outspoken critic of euthanasia” at the same time he attacks Governor Sarah Palin’s comments on the reality of “death panel” proposals in various health care reform bills.

It is troubling when a self-described moral diagnostician sides with an avowed supporter of allocating “scarce medical interventions.” http://www.ncpa.org/pdfs/PIIS0140673609601379.pdf Emanuel is on record opining, “For indivisible goods, benefiting people equally entails providing equal chances at the scarce intervention—equality of opportunity, rather than equal amounts of it” (page 6).

The Caplan/Emmanuel utilitarian approach confirms Irving’s definition. So let’s move on, because clearly it is the bioethicists, not the traditional medical ethicists, who are influencing Congress these days.

This is one of the primary reasons why direct government involvement in the extremely delicate question of defining who is dying versus who is not could be treacherous. The U.S. Conference of Catholic Bishops walks a fine line in this area and has articulated the reasons why.

In a paper entitled “Killing the Pain, Not the Patient: Palliative Care vs. Assisted Suicide,” http://www.usccb.org/prolife/programs/rlp/98rlpdoe.shtml Richard M. Doerflinger and Carlos F. Gomez, M.D., Ph.D., discuss the use of morphine as a pain reliever and the question of “terminal sedation”:

Very rarely it may be necessary to induce sleep to relieve pain and other distress in the final stage of dying. Euthanasia advocates call this “terminal sedation,” but it is the same kind of sedation that is sometimes needed to calm distressed or restless patients with non-terminal conditions. While some terminally ill patients may die under such sedation, this is generally because they were imminently dying already.

In competent medical hands, sedation for imminently dying patients is a humane, appropriate and medically established approach to what is often called “intractable suffering.” It does not kill the patient, but it can make his or her suffering bearable. It may also allow a physician the time to re-assess a patient’s pain needs: The terminally ill sedated patient may later be withdrawn from the sedatives and brought back to consciousness, with his or her pain under control.

This may sound tricky, so what if a bioethics panel, approved under Obama-style “health care reform,” is making these decisions and recommending terminal sedation as a cost-saving measure? Who would you trust if the patient in that bed was a member of your immediate family?

As Wesley J. Smith articulated in his analysis of the health care situation in the United Kingdom, http://article.nationalreview.com/?q=MzVjMTU3ZGE2MDVkM2ZjMTg1YTY3NDIwYjdmOWZmYTE=

[T]he U.K.’s notorious rationing board, the National Institute for Health and Clinical Excellence (NICE), urged hospitals, nursing homes, and hospices to follow an end-of-life protocol known as the Liverpool Care Pathway. The Pathway’s guidelines instruct doctors to put patients thought to be near death into a drug-induced coma, after which all food and fluids, as well as medical treatments such as antibiotics, are withdrawn until death. …

Chillingly, current Obamacare plans call for the creation of many cost/benefit/best-practices boards, the full power of which won’t be fully known until the bureaucrats promulgate tens of thousands of pages of regulations between now and 2013, when the law would go into effect. Making matters more alarming, these boards would not only govern treatment provided in any public-option health plan, but would also be empowered to set the standards of care paid for by private insurance. Unless the final version of Obamacare is amended explicitly to prohibit such centralized health planning, don’t be surprised if an American version of the Liverpool Care Pathway comes soon to a hospital or nursing home near you.

Under Obamacare, cost-benefit ratios could become a bioethicist’s mantra. Actually, this is part of what bioethicists do: attempt to balance cost against compassion. Think about it.

Peter J. Smith (no relation to Wesley J. Smith) analyzed the reasons why “death panels” continue to be a major concern: http://www.lifesitenews.com/ldn/2009/oct/09103018.html

[I]ncentivizing doctors to offer “end-of-life planning consultations” could lead to senior citizens, the terminally ill, or disabled, being pressured into accepting lower quality care from a doctor who figures he can receive higher reimbursement rates for talking with a patient about when or how he can refuse treatment.

Indeed, as American Life League documented recently, http://www.all.org/article.php?id=12330&search=Victory%20or%20Defeat section 240 of the Pelosicare bill http://docs.house.gov/rules/health/111_ahcaa.pdf (page 130) contains the sort of language that could easily be interpreted as a free pass to making life-and-death decisions.

It is noteworthy that when the editor of the American Journal of Bioethics, Summer Johnson Ph.D., discussed Obamacare spending proposals, she devoted over half of her commentary to pointing fingers and tossing barbs. http://www.mercatornet.com/articles/view/give_me_obamacare_and_my_grandmom_is_doomed She described the current U.S. health care system as “under-performing, over-priced, and inequitable,” whereas she had high praises for the notorious and inefficient health care rationing programs of the United Kingdom and Canada.

Johnson also took a shot at Governor Palin, who seems to be fair game for everyone, telling her readers, “I would happily put Harvard’s Atul Gawande MD and the National Institutes of Health’s Ezekiel Emanuel MD, PhD in a room with former Governor and vice-presidential candidate Sarah Palin and let them duke it out over health reform any day and let the chips fall where they may. They have two MDs and one PhD on their side; she has rhetoric and a moose gun.”

Fortunately, there is a counterpoint to Johnson’s silliness. It was written by long-time traditional medical ethics expert Nancy Valko, a registered nurse. http://www.mercatornet.com/articles/view/have_death_panels_already_arrived

Unlike Johnson, Valko focused on actual statements from organizations for and against health care rationing, analyzing them fairly and expressing hope that common sense will soon emerge in the health care reform discussions. She makes it clear that some of the travesties that concern us in the various Obamacare proposals are already occurring and efficiently ending lives:

Today we have ethics committees developing futility guidelines to overrule patients and/or their families even when they want treatment continued. We have three states with legal assisted suicide. We have even non-brain dead organ donation policies (called non-heart beating organ donation or donation after cardiac death). Some ethicists even argue that we should drop the dead donor rule. http://content.nejm.org/cgi/content/full/359/7/674

We see living wills and other advance directives with check-offs for even basic medical care and for incapacitated conditions like being unable to regularly recognize relatives. We are willing to sacrifice living human beings at the earliest stages of development to fund research for cures for conditions like Parkinson’s rather than promote research on ethical and effective adult stem cell therapies.

So we should pay attention when Valko warns,

Death panels are not the overwrought fantasy of right-wing nut cases. Real “death panels” are already at work. They have been created by apathy, misplaced sympathy, a skewed view of tolerance and an inordinate fear of a less than perfect life. Death panels? In the famous words of the comic strip character Pogo, “We have met the enemy and he is us.”

Let us not be complacent or fearful when it comes to expressing our concerns about Obamacare. We must not be intimidated into silence by those who label us as politically incorrect, ill-informed or crazy for daring to oppose it. Pelosi, Reid, Obama and their ilk want to drown out our voices as they aggressively promote the agenda that helps them make their way into that hospital room.

What these ideologues are literally telling America by their actions is “Trust us; we know what’s good for you. But please, don’t ask us for any facts to support our position and the policies we want to foist upon you with your own money.”

As I have told people with ever increasing frequency, the only reason our opposition wants to shout us down is that they have taken the indefensible position that they have the authority to choose who lives and who dies. These are the people who have trashed traditional medical ethics in favor of bioethics.

You decide: Will you entrust your life to congressional fiat or common sense? They are not synonymous.

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