American Elephants

Today’s  headline reads:  “Sentenced to death on the NHS: Patients with terminal illnesses are being made to die prematurely under an NHS scheme to help end their lives, leading doctors warn today.”

In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.

Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.

But this approach can also mask the signs that their condition is improving, the experts warn.

This is Britain’s National Health Service.  Somebody said something about “Death Panels,” and I hasten to add that the words “Death Panel” do not appear in the U.S. House Bill 3200.

They don’t need to appear in the bill.  Bureaucratic control of what treatment you may have already appears in H.R. 1, The Recovery and Reinvestment Act, better known as the Stimulus Bill which contains $1.1 billion to fund the Federal Coordinating Council for Comparative Effectiveness Research.  This was the brain child of former Health and Human Services Nominee Tom Daschle.

Well, of course Tom Daschle had tax problems and lobbyist problems and did not become Secretary of HHS; but he did venture that health-care reform “will not be pain free.”  Seniors should be more accepting of the conditions that come with age instead of treating them.

President Obama’s chief medical adviser is now Ezekiel Emanuel M.D., the brother of the President’s chief of staff Rahm Emanuel.  Both Tom Daschle and Dr. Emanuel are very interested in the fact that costs at the end of life are especially high (perhaps because people are often near the end of life because they are ill).  Young, healthy people don’t make such demands on a health care system.  Which is the kind of observation that people who are more interested in statistics than in human beings are apt to make.

In the British National Health Service (NHS), a government agency approves only those expensive treatments that add at least one Quality Adjusted Life Year (QALY) per £30,000 (about $49,685) of additional health-care spending.  If a treatment costs more per QALY, the health service will not pay for it.

Dr. Emanuel is a bioethicist.  He has written extensively about who should get medical care, who should decide, and whose life is worth saving.  Dr. Emanuel is also a communitarian. He belongs to a school of thought that redefines a physicians’ duty, believing that it means working for the greater good of society rather than focusing on an individual patient’s needs.  Many physicians find this view dangerous.

According the Betsy McCaughey, writing in the Wall Street Journal, says Dr. Emanuel said:

Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely “lipstick” cost control, more for show and public relations than for true change.

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. … In numerous writings, Dr. Emanuel chastises physicians for thinking only about their own patient’s needs.

This may be why Dr. Emanuel doesn’t do doctoring, he does thinking about doctoring.

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…  —  Lancet, Vol 373, Jan. 31, 2009.  p. 425

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…. 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.   — Lancet, Vol 373, Jan. 31, 2009, p.428

Comparative Effectiveness Research is designed to have a panel of bureaucrats in Washington decide what treatments are most “effective” by looking at statistics from across the country and send that information to physicians, which doctors will be required to follow.  This ignores the fact that people are not building blocks, all alike, to be moved this way or that.

These may not be “death panels” as such, but they are deciding who gets what treatment, and it is not you and your doctor who would make that decision.  At the very least, it is cold.  Very, very cold, and I want no part of it.