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.

 

WesternFront America

So, with the announcement/unveiling of PelosiCare, the Heath Care debate has heated up once again. Here’s my take on several of the debated issues.

Death Panels:  First, let me say that have a strong dislike for this term.  I believe it to be the hyperbolic, and not accurate to the true form and function of the heath care rationing that is to come.   That being said, there are some are some patterns in the actions of the government that suggest that there will be rationing decisions made that will end lives.  When Sara Palin suggested that people are going to be before “death panels” that would decide who live and dies, she was stretching the truth a bit.  Life and death decisions will be made, just not in that particular context.

End of life counseling, i.e., the “Death Panels,” are back.  The Democrats took it out of one of the earlier bills, after initially denying it existed.  They made a big deal out of removing it; yet apparently expect us to forget the whole thing.  In all honesty, I really don’t have an issue with end of life counseling.  Patients and doctors might see the need to discuss that issue.  However, it is completely inappropriate for the government to mandate it.  A medical professional knows when the “writing is on the wall,” and is fully capable, and trained, to bring up medical topics at the appropriate time.  Mandating it seems to be a “one size fits all” government approach.  Until, that is, you consider some of the other actions of the government.  When you look at the components of the change, and what the advisors and other are saying and doing, the real picture emerges.

Next, let’s take a look at this from CNS News.

Slashing Medicare payments to hospitals that readmit ailing senior citizens–a component of the health care reform bill under consideration in Congress–could have serious consequences for the hospitals, including raising costs on hospitals an estimated $19 billion over 10 years, according to the American Hospital Association.

A plan to reduce preventable hospital readmissions is included in all of the health care bills before Congress and would impose a fee on hospitals that readmit patients for certain conditions, such as pneumonia and heart failure.

The details on how the readmissions policy would work, however, are largely left up to the Health and Human Services Department (HHS), a fact that concerns the nation’s hospitals. The penalties would only apply to hospitals where the readmission rates were well above the national average.

OK then, since when is admitting someone for pneumonia or heart failure preventable?  I mean, if someone is having a heart attack, is there a more efficient alternative than admitting them…other than letting them expire in the ER waiting area?

Then, we must consider that the legislation in this case, does not set any criteria or qualifications for this, they simply charges Heath and Human Services with creating them.  Who is going to write them?  Will that process be open to debate?  Will we even be made aware of the rules, or will a “czar,” or will a special interest group write them?  Will the rules change with each new administration?  Will the rules ever make sense?  These are questions that need to be asked, however, we have to remember that this will be a “one size fits all” approach, so there will be little logic involved.

Here’s some more…

The Senate Finance Committee left the definition of a “selected condition” up to the HHS, specifying only that the government use eight conditions with a high rate or cost of readmission. The government can expand the list of selected conditions after three years, in 2016.

As the summary states, “Three years after implementation of the readmissions policy, the [HHS] Secretary would have the authority to expand the policy to other conditions. Additional conditions would be selected based on: (1) high spending on readmissions or high rates of readmissions; and (2) other criteria as determined by the Secretary.”

The American Hospital Association (AHA), in comments submitted to Baucus May 15, said that the Finance Committee’s plan could lead to “serious consequences” if the government does not get the details right.

“Hospital leaders and clinicians who care for patients recognize that some readmissions can be prevented,” the AHA said.

“But there are a number of factors beyond the hospital’s control that affect whether a patient is readmitted, including the natural course of the disease, the limited availability of post-acute and ambulatory health care services, high levels of poverty among some hospitals’ patients, and a lack of community-based social services,” it added.

“If these factors are not accounted for, they will lead to payment penalties, inequities and other serious consequences–intended and unintended–for hospitals, particularly safety-net hospitals,” said the AHA.

Now, they appear to be intent on punishing the hospitals for things that might be out of their control.  For example, what If the patient doesn’t go to follow-up appointments?  That’s a common occurrence.  What if the aftercare practitioner isn’t taking more patients dues to being ripped off by the government plan, or has retired as they can no longer make enough money to justify their effort?  What if the patient simply gets sick again?  That’s the problem with a “one size fits all” plan, it cannot see or take into consideration the individual needs of each patient, or facility.  There are facilities that are in areas with large senior populations.  That population, statistically, will be sicker, as well as have more repeat episodes.  Will hospitals in these areas simply have to cut back services as a whole?  Or will they discourage certain patients from returning?

One more thing…  What happens when the patient’s government insurance stops paying for an episode of care and wants the patient discharged?  Then, the patient gets sick again, and the facility is penalized for doing what the government told them to do?  Sounds like the banks being ordered to make bad loans, and then being blamed when the bad loans clobber the banking system, doesn’t it?  Might this cause facilities to find ways not to admit or treat certain patients?  Is this part of a way to penalize facilities for treating senior citizens?

Next up, this from the Wall Street Journal…

• Expanding Medicaid, gutting private Medicare. All this is particularly reckless given the unfunded liabilities of Medicare—now north of $37 trillion over 75 years. Mrs. Pelosi wants to steal $426 billion from future Medicare spending to “pay for” universal coverage. While Medicare’s price controls on doctors and hospitals are certain to be tightened, the only cut that is a sure thing in practice is gutting Medicare Advantage to the tune of $170 billion. Democrats loathe this program because it gives one of out five seniors private insurance options.

So, their denial that they are going to gut Medicare was yet another lie?  Of course, they seem to hate anything that is privately controlled.

In discussing the “death panels,” we have to take yet another look at Ezekiel Emanuel.  Besides being the brother of Obama’s chief of staff, Rahm, Dr. Emanuel is a prominent if medical ethicist that has, shall we say, some rather interesting ideas about medical treatment.  Here are some quotes from Dr. Emanuel:

This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. 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. Conversely, 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.

So, the government will have the authority to deny treatment for those individuals that they deem unfit for living.  What criteria would be use?  Do you get to appeal?  Do you have any choice?  Under a government controlled plan, I would venture to guess no.

Source:  First Things

“Strict youngest-first allocation directs scarce resources predominantly to infants. This approach seems incorrect. The death of a 20-year-old woman is intuitively worse than that of a 2-month-old girl, even though the baby has had less life. The 20-year-old has a much more developed personality than the infant, and has drawn upon the investment of others to begin as-yet-unfulfilled projects…. Adolescents have received substantial substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments…. It is terrible when an infant dies, but worse, most people think, when a three-year-old child dies, and worse still when an adolescent does.”

Note that the decision has been made based on the amount on money the government has spent “developing” a human.  He is essentially reducing the value of human life to the amount of resources that society has expended upon the said human.  Now, the left can decry the 2% profit margin of the insurance companies; yet engage in far more sinister statistical calculations for who gets care and who gets to die?

“Ultimately, the complete lives system does not create ‘classes of Untermenschen whose lives and well being are deemed not worth spending money on,’ but rather empowers us to decide fairly whom to save when genuine scarcity makes saving everyone impossible.”

This is phenomenal wordsmithing.  He denies in the first part of the sentence, and endorses in the second.  Sir, just saying that the grass isn’t green does not make it orange!

“When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated”

So, I am to be “attenuated?”  Can we say that this is discrimination based on age?  Are all AARP members reading this?  How many times have the Democrats claimed that the Republicans are going to freeze, starve, or kill of the old people? -  Just about every election cycle.  However, look at who is openly proposing to do it!!!

“Every favor to a constituency should be linked to support for the health-care reform agenda. If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration’s health-reform effort.”

As I have said many, many, times, government assistance comes with strings attached.

Source: NCPA

“Doctors take the Hippocratic Oath too seriously, as an imperative to do everything for the patient regardless of the cost or effects on others”

So, is this simply redistribution of wealth, or is it something more?  I believe that this is really about creating a system of scarcity, and using it as means to manipulate population.  It also de-emphasizes ethical considerations, and switches that emphasis to an economic one, especially ironic from a man who is a medical ethicist!

Source: Journal of the American Medical Association, June 18, 2008

“There is a widespread perception that the United States spends an excessive amount on high-technology health care for dying patients. Many commentators note that 27 to 30 percent of the Medicare budget is spent on the 5 percent of Medicare patients who die each year. They also note that the expenditures increase exponentially as death approaches, so that the last month of life accounts for 30 to 40 percent of the medical care expenditures in the last year of life. To many, savings from reduced use of expensive technological interventions at the end of life are both necessary and desirable.”

“Many have linked the effort to reduce the high cost of death with the legalization of physician-assisted suicide. One commentator observed: “Managed care and managed death [through physician-assisted suicide] are less expensive than fee-for-service care and extended survival. Less expensive is better.” Some of the amicus curiae briefs submitted to the Supreme Court expressed the same logic: “Decreasing availability and increasing expense in health care and the uncertain impact of managed care may intensify pressure to choose physician-assisted suicide” and “the cost effectiveness of hastened death is as undeniable as gravity. The earlier a patient dies, the less costly is his or her care.”

America, are you reading this?  These people are making economics out of death!  Beyond that, they are projecting savings that can be achieved if you die early.  Combine that with their other actions, and it appears that they are trying to save a buck!  Isn’t that what the left hates about the “evil” insurance companies?  There is a difference though…the state wants to industrialize and manage it at the federal level!

“Although the cost savings to the United States and most managed-care plans are likely to be small, it is important to recognize that the savings to specific terminally ill patients and their families could be substantial. For many patients and their families, especially but not exclusively those without health insurance, the costs of terminal care may result in large out-of-pocket expenses. Nevertheless, as compared with the average American, the terminally ill are less likely to be uninsured, since more than two thirds of decedents are Medicare beneficiaries over 65 years of age. The poorest dying patients are likely to be Medicaid beneficiaries. Extrapolating from the Medicare data, one can calculate that a typical uninsured patient, by dying one month earlier by means of physician-assisted suicide, might save his or her family $10,000 in health care costs, having already spent as much as $20,000 in that year.”

Excuse me for being a bit cynical here, but after reading all of this, can we say that they are trying to sell families on killing off their own family members?  Are they going to sell this to the families as a cost savings for giving granny the “pain pill?”

Source: What Are the Potential Cost Savings from Legalizing Physician-Assisted Suicide? New England Journal of Medicine, July 1998

I think that anyone who reads this should be frightened.  This has happened before, particularly in Nazi Germany, with their T4 program.  While the T4 program focused on the mentally ill and mentally retarded, it did strike on similar themes, particularly cost savings.

One might ask, why question what a medical ethicist that works for the NIH thinks in regard to the heath care debate?  That is a good question.  In that capacity, those questions should be asked.  I view ethicists as philosophers; they are supposed to ask the difficult or uncomfortable questions. That’s what they are supposed to do.  However, Dr. Emanuel isn’t with the NIH right now.  Why do I say this?  Well, here is the NIH site for Dr. Emanuel:

Ezekiel J. Emanuel is Head of the Department of Bioethics at The Clinical Center of the National Institutes of Health and a breast oncologist. He is on extended detail as a special advisor for health policy to the director of the White House Office of Management and Budget.

So, he is a White House adviser…for health policy???  This leads to the question; why have this guy as a special adviser if the administration was not at least evaluating his ideas? And, what does that say about the administration’s stance towards rationing?

It is useful to note that, just like the “czars,” Dr, Emanuel is claiming that his statements are being taken out of context.  That seems to be the claim du jour from the left.  Van Jones, Cass Sunstein, The POTUS, Barney Frank, and the others have all made this claim.  However, I’ll leave the judgment to you.  After all, the doctor has written multiple articles on the topic, and they all end up in the same place.

So, when the Democrats state that there is nothing called a “death panel” in the legislation, they are being truthful, at least superficially.  The real “devil,” as Ross Perot used to say, “is in the details.”  There are cuts in care for the elderly, the mandated “end of life” counseling, and a White House advisor that has repeatedly published his ideas about cutting off care for the elderly and for those “not worthy of life.”  Add this all together (and a few more details- I didn’t want to write a book here), and the pattern emerges.  They do speak to limiting care, and to whom it is to be limited.  They are translating that into their legislation, but not stating it openly.  They do it by creating circumstances in which it will be done, while at the same time denying any complcity.  I beleive that they hope that once the legislation is passed, and takes effect, there will be nothing to do to stop it.  In the end, we arrive at the same place that Sara Palin fears-just in a different form.  Nancy Pelosi, Harry Reid, Barak Obama, and Ezekiel Emanuel are taking us there.

H/T: Jeff Head; Notes from Dr. RW

 

WesternFront America