http://blogs.tnr.com/tnr/blogs/the_treatment/archive/2009/08/08/have-you-no-decency.aspxHave You No Decency?
Harold Pollack is a professor at the University of Chicago School of Social Service Administration and Special Correspondent for The Treatment.
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To be clear, it is downright evil to establish a “death panel” that decides who is allowed to live based on their “level of productivity in society.” Less clear is what the heck Palin or Bachmann are talking about. I can’t find the words “death panel” in any administration position paper, the stimulus package, or the House and Senate draft health reform bills. Don’t take my word for it. Read the bills.
Palin and Bachmann take pot shots at Ezekiel Emanuel, one of President Obama’s health policy advisors. Dr. Emanuel, a prominent medical ethicist and oncologist, makes a juicy target because he is Rahm’s brother, and because his paper trail provides incautiously blunt commentary regarding the pathologies of American health policy. It’s easy to lift one or two sentences from him, throw them onto the internet, and set the right-wing blogosphere aflame.Palin and Bachmann remind no one of Hillary Clinton in their success in grasping complex policy issues, or in their desire to do so.
It may be too much to expect them to trace the origin and veracity of these talking points. These originate in a New York Post op-ed by Betsy McCaughey, which Bachmann essentially recites on the House floor. In the original op-ed, McCaughey mushes together and distorts three articles Emanuel wrote between 1996 and 2008. I wish the Post would exercise greater quality control over what appears in its pages.
Human rights and human dignity indeed belong at the center of medical care. Americans hold vastly different ideas about how to best honor these values when human life nears its end or when basic physical and cognitive functioning can no longer be preserved.
I do know four things.
First, these issues are quite separate from the main issues being debated in health reform. Under a single-payer system, a strong public plan, or under a libertarian’s privatized dream-system, we will still face fundamental dilemmas in caring for our loved ones, and ourselves. This is not merely or primarily a money issue. Like other forms of care, end-of-life care is sometimes wasteful or ineffective, but nobody is looking to skimp on or ration such care to finance health reform. Nor should they.
Second, health reform would address an equally fundamental dilemma of human dignity and human rights: millions of people’s lack of access to basic care. Many of these people are disabled or live with chronic illnesses. Over at Obsidian Wings, Publius yesterday noted the predicament of children with Down Syndrome denied health insurance because they have a preexisting condition.
Governor Palin writes: “And who will suffer the most when they ration care? The sick, the elderly, and the disabled.” It’s telling that she omitted one category: Poor people, whose care is now cruelly rationed in ways the Obama administration and congressional Democrats are trying to address in health care reform. Palin brings genuine moral passion to the issue of cognitive disability. I wish she would bring that same passion to the plight of uninsured patients forced to seek substandard, delayed care, or the millions of Americans facing the dual challenge of serious illness and large medical bills. If you live in any big city, go down to your local public hospital emergency room. You will probably find people in visible discomfort or illness languishing for hours. A society that cares about human rights and dignity would not tolerate this.
Third, people genuinely worry that comparative effectiveness research (CER) is a stalking horse for rationing or for curtailing care for the sick, elderly, or disabled. This is a misplaced concern. I recently noted an Institute of Medicine CER report. None of the identified high-priority items involved anything approximating the rationing of life-saving or life-extending care. End of life care ranked 28th in their chart of priority areas for CER research. This may be a mistake. Better approaches to palliative care often look very good when evaluated against the standard benchmarks of medical cost-effectiveness.
Fourth and finally, publicity-seeking politicians subtract a lot from these conversations. Palin, Bachmann, and others score cheap points by scaring people and by spreading falsehoods. Their disrespect goes beyond their own political base to those whose views they so recklessly misconstrue.
Dr. Emanuel’s oncology career provides more than passing familiarity with the consequences of devastating, sometimes life-ending illness. He has written widely about the dilemmas of relying on medical care proxies in caring for desperately ill patients, chemotherapy at the end of life, and other intimate clinical concerns. There is nothing Orwellian about him. He has prominently opposed legalization of euthanasia and physician-assisted suicide, for example.
Emanuel’s work offers a model of sustained achievement that both Governor Palin and Representative Bachmann would be wise to emulate. He deserves better than to be trashed in this way. So do the rest of us
--Harold Pollack
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http://euthanasia.procon.org/viewsource.asp?ID=533Ezekiel Emanuel, MD, PhD, his views on euthanasia
"The proper policy, in my view, should be to affirm the status of physician-assisted suicide and euthanasia as illegal. In so doing we would affirm that as a society we condemn ending a patient's life and do not consider that to have one's life ended by a doctor is a right. This does not mean we deny that in exceptional cases interventions are appropriate, as acts of desperation when all other elements of treatment- all medications, surgical procedures, psychotherapy, spiritual care, and so on- have been tried. Physician-assisted suicide and euthanasia should not be performed simply because a patient is depressed, tired of life, worried about being a burden, or worried about being dependent. All these may be signs that not every effort has yet been made.
By establishing a social policy that keeps physician-assisted suicide and euthanasia illegal but recognizes exceptions, we would adopt the correct moral view: the onus of proving that everything had been tried and that the motivation and rationale were convincing would rest on those who wanted to end a life."
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