Obama's Death Panels: Whose Life Is It, Anyway?

The Real "Death Panel" Threat Is the Morality of Collectivism
by Robert Tracinski editor, www.TIADaily.com

"The big story of the past week is the controversy over "death panels"—Sarah
Palin's term for the idea that "my parents or my baby with Down Syndrome will
have to stand in front of Obama's 'death panel' so his bureaucrats can decide,
based on a subjective judgment of their 'level of productivity in society,'
whether they are worthy of health care."

The basis for this claim is two different provisions put forward in various
versions of the (still not completely written) health-care bill.

The first is a proposal to establish a panel of medical experts who would
determine which treatments are supposedly most cost-effective and thus will be
paid for under a government-run system—and which will not.

In a New York Times interview in April, which makes very instructive reading in
the current debate, President Obama explained that "part of what I think
government can do effectively" is to be a "broker" "between patient and
provider"—that is, between you and your doctor—"in assessing and evaluating
treatment options."

He continued: "And certainly that's true when it comes to Medicare and Medicaid,
where the taxpayers are footing the bill and we have an obligation to get those
costs under control."

The example he gives? Whether his ailing grandmother should have been allowed a
hip replacement in the final months of her life.

"End-of-life care" he said, is an area where "you just get into some very
difficult moral issues. But that's also a huge driver of cost, right? 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."

So who is going to make the decisions about grandma's cancer treatment and hip
replacement surgery?

"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."

Just don't call it a "death panel"!

Other countries already have such a system. In Britain, it's known by the
creepy, Orwellian acronym NICE, for National Institute for Health and Clinical
Excellence, and it is the panel charged with deciding, for example, that a
cancer drug that would extend your life by six months is too expensive because
you don't have enough "quality adjusted life years" remaining to justify your
cost to the National Health Service.

This is a rationing board for government-provided medical care, based on a
bureaucratic formula that tells you how much your life is worth to the state.

The second provision in the current health-care reform, covered in more detail
by Palin in a follow-up posting, is a proposal—actually included in a Senate
version of the bill until Palin pointed it out—that would give doctors a
financial incentive to approach their patients about "end-of-life planning."
This would likely have the effect of pushing doctors to discourage additional
treatment in the last years and months of one's life in order to cut costs for
the government.

Obama has dismissed these concerns—somewhat flippantly—as mere "rumors." But
they are totally in keeping with his own statements and with the logical
consequences and overall direction of the bill.

And worse: the fears about "death panels" and rationing of care for the elderly
are validated by the moral justifications offered for the health-care bill in
the first place.

In a recent editorial, the Wall Street Journal does an excellent job of
describing the economic factors that will necessitate rationing of health-care
and denial of care for the elderly. But it is important to grasp that this is
not an accidental or unintended consequence of government control of health
care. It is an intended consequence, following directly from the basic moral
premise behind the health-care bill: the premise that your medical care is the
business of "society."

Thus, when discussing the "difficult moral issues" that are raised by
end-of-life care, President Obama says, "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," leading to Obama's idea of an "independent group" being put in charge.

Is this how you would naturally think about decisions regarding the end of your
own life? Would you say, "let's have a democratic conversation about it"? Or
would you respond that this is your life and hence your decision, which cannot
morally be made by anyone else?
Jack Wakeland sent me an e-mail yesterday which captured how these "end-of-life"
decisions—let's put it bluntly: decisions about dying—are currently, and
properly, treated.

"When a patient is terminally ill, it is entirely proper and legitimate for
doctors to push for frank discussions between the patient and his family about
whether or not the medical profession can really do anything for him other than
alleviate pain. It is entirely proper and legitimate for the patient to consider
the financial burden he is imposing on his family if they are supporting him, or
the financial loss to his family if he intends to bequeath to them what remains
of his estate after his death.

This kind of end-of-life cost/benefit analysis is a deeply personal issue. It is
so intensely personal that one's own family members—including one's own wife or
husband—may not legitimately involve themselves in the decision unless they're
asked by the one who is to die."

Yet Obama is proposing to turn the subject over to a whole bunch of strangers,
to an "independent group" "guided by doctors, scientists, ethicists."

Under what morality is this acceptable?

Ask one of the "ethicists": Ezekiel Emanuel, a physician, the brother of White
House Chief of Staff Rahm Emanuel, and a "special advisor for health policy" in
the Obama administration. Dr. Emanuel has advocated the denial of care based on
a viciously thorough, consistent version of collectivism: the premise that an
individual's life is only valuable insofar as he is valuable to the collective.

In an article titled "Principles for Allocation of Scarce Medical
Interventions," published in the medical journal The Lancet in January of this
year, Dr. Emanuel and his co-authors advocate "a priority curve on which
individuals aged between roughly 15 and 40 years get the most chance, whereas
the youngest and oldest people get chances that are attenuated."

Get that? We're going to "allocate" "chances that are attenuated." Just don't
call it a "death panel"!

The administration's toadying defenders in the press have leapt to object that
Dr. Emanuel was "only addressing extreme cases like organ donation," but the
examples that lead his article include "beds in intensive care units,"
penicillin, and kidney dialysis (which were once quite scarce). Yet what is
important is not so much the treatments that are to be rationed, but the
principle on which they would be rationed.

In a 1996 article, Emanuel advocated government guarantees of health care for
those treatments that would make possible the "full and active participation by
citizens in public deliberations," while "services provided to individuals who
are irreversibly prevented from being or becoming participating citizens are not
basic and should not be guaranteed."

Thus, it is "public participation"—a person's usefulness to society—that is the
criterion by which health care is granted or "attenuated."
Of course, this raises the specter of the politicization of health care. After
all, are the tea party protesters good "participating citizens"? Not according
to Nancy Pelosi. So maybe those good "participating citizens" in the Service
Employees International Union should be first in line for the state's allocation
of scarce health-care resources.

Decades after the collapse of the Soviet Union, the left still adheres to the
philosophy of collectivism—the ghostly influence of the twisted moral code that
inspired the murder of millions in the 20th century.

The American people sense this, and that is why they are recoiling in horror
from Obama's plan for a greater government role in health care. Once the
government sets itself up as the allocator of "society's" resources, the
people—and especially the elderly—are afraid that they will be granted or denied
care based on some nebulous criteria that attempts to measure how useful they
have been or will be to society.

Greater government control puts the individual's life at the mercy of
collective—which means the state. And that is what makes people justifiable
terrified of Obama's health-care plan.

The individual is not a mere cog in the collective and cannot be regarded as
such—or discarded when he is no longer useful to the state. That view is a
fundamental rejection of the founding ideal of this nation: that all men are
created equal and endowed with inalienable rights to life, liberty, and the
pursuit of happiness. That means that each individual life is an end in itself,
an irreplaceable value whose fate can only be decided by one person: the
individual himself.

Any legislation that threatens to undermine this code of American individualism
must be thoroughly and immediately rejected. It's time to convene a death panel
to discuss end-of-life planning for Obama's health-care bill.

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