Monday, August 17, 2009

"Guided by doctors, scientists and ethicists"

John Podhoretz explains why end of life issues will remain important in the debates about the expense and delivery of health care, and why accusing those who raise the concern of "lying" and "scaring the elderly" won't suffice to make the issue go away:
.... Anyone who has been paying attention to the medical-ethics discussions of the past quarter century is very familiar with the reason for the focus on end-of-life matters: the expenses that the medical profession has been required, ethically, to incur in the preservation of life among those who are inevitably going to die has seemed to many to be money wasted on health care that could be better spent elsewhere. As the one-time governor of Colorado, Richard Lamm, notoriously said in 1984, “We have a duty to die”—by which he meant, to die more quickly so that it wouldn’t cost his state too much in Medicare. What Lamm said was shocking, but only because he said it so crudely. The view that the American way of dying has become needlessly prolonged is at the heart of the professional medical-ethics ideology, an instrumentalist ideology whose implicit purpose is to raise moral questions and congratulate itself for raising moral questions before dismissing them in favor of the notion that moral decision-making has no place in medical matters.

Given this record, and given the implicit notion that costs will be controlled by fiat under the new ObamaCare dispensation, it is well within reason to assume that rationed care for the elderly will be the place to look for savings; that determinations of which care and of what sort will be covered would eventually become the purview of a committee; and that the decisions that committee makes will play a role in the deaths of those who are refused coverage. To deny that the subject the president himself called a “very difficult democratic conversation” is the choice between life and death, and that under ObamaCare those decisions will not eventually be the sole purview of the patient and his family, is disingenuous. As the president said in an April interview with David Leonhardt of the New York Times:
I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

LEONHARDT: So how do you — how do we deal with it?

THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think it has to be able to give you some guidance.
Given the president’s own admission back in April that the conversation is just so difficult in a democracy that it needs to be guided by experts is to travel part of the way down the road according to which experts not only guide a conversation but make the rules for the conversation as well. And that is why the matter is certainly worthy of a wide-ranging discussion, even when the discussion might turn into a very different kind of “very difficult democratic conversation”—one in which the conversation takes a course Obama and the supporters of ObamaCare do not wish it to take. 
 Update 7/18: Jonah Goldberg at NRO:
The more life expectancy improves, the more we will spend on health care. Despite his professed outrage over charges of “death panels” and whatnot, Obama admits this. In an interview with the New York Times last spring, he acknowledged that oldsters are a “huge driver of cost.” The “chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health-care bill out here,” Obama explained. Which is why he advocated an advisory panel of experts to offer “guidance” on end-of-life care and costs. But don’t you dare call it a “death panel.”

...[E]very nationalized health-care system to one degree or another rations care based on the quality of life and number of “life years” a procedure will yield. That’s perfectly reasonable. If you put me in charge of everyone’s health care, I would do that, too. That’s a really good argument for not giving me — or anyone else — that power.

When it comes to civil liberties, liberals are often distrustful of government power. But, for reasons that baffle me, they are quite comfortable with Uncle Sam getting into the business of deciding, or providing “guidance” on, which lives are more valuable than others. A government charged with extending life expectancy must meddle not just with our health care, but with what we eat, how we drive, how we live. A government determined to cut costs must meddle not just with how we live, but how we die. .... [more]

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