Death Panels Revisited
When since Sarah Palin made her famous post on Facebook about "Death Panels", the debate on "End Of Life Care and Counseling" in relation to President Obama's Health Care Reform heated up. Many on the right took up use of the term and many on the left attacked it. PolitiFact even made it their "Lie of the Year" for 2009. Many on both sides of the issue circled around their political opinion of ObamaCare and never bothered to to check into end-of-life counseling and see what the whole thing was about. Now, with the return of end-of-life counseling via a Medicare decision and the release of a memo by Earl Blumenaeur (D Oregon) the debate seems to have heated back up. I wanted to do a little research to see what we were talking about when it came to end-of-life counseling and who is right and who is wrong on the issue.
1. Was "Death Panels" really a lie?
I could take the easy way out on this one. To any discerning reader, PolitiFact basically admitted in their own article that the statement that they chose to be the lie of the year isn't really a lie. I quote here.
The phrase "death panels" appears to be original to Palin. A search of news databases showed no use prior to her Facebook posting.History professor Ian Dowbiggin, who has written several books on medical history, euthanasia and eugenics, said he had never heard the term before Palin used it. He said the phrase invokes images of Nazi Germany, which denied life-saving care to people who were not deemed useful enough to broader society. Adolf Hitler ordered Nazi officials to secretly register, select, and murder handicapped people such as schizophrenics, epileptics, disabled babies and other long-stay hospital patients, according to Dowbiggin.
Hence, politifact is basically making the claim that the saying, which had no meaning prior to its first use, is a lie because people get images of things that aren't true when they hear it. In fairness, however, they did also get into what Sarah meant by the claim.
Her assertion — that the government would set up boards to determine whether seniors and the disabled were worthy of care — spread through newscasts, talk shows, blogs and town hall meetings. Opponents of health care legislation said it revealed the real goals of the Democratic proposals. Advocates for health reform said it showed the depths to which their opponents would sink. Still others scratched their heads and said, "Death panels? Really ?"
So, is it fair to say that our Government would deny treatment to the elderly that they see fit to let die? Is there any example of that happening in our Country?
The 64-year-old Oregon woman, whose lung cancer had been in remission, learned the disease had returned and would likely kill her. Her last hope was a $4,000-a-month drug that her doctor prescribed for her, but the insurance company refused to pay.
What the Health Plan did agree to cover, however, were drugs for a physician-assisted death. Those drugs would cost about $50.
"It was horrible," Wagner told ABCNews.com. "I got a letter in the mail that basically said if you want to take the pills, we will help you get that from the doctor and we will stand there and watch you die. But we won't give you the medication to live."
How was this decision reached? Apparently, somebody at this insurance company, perhaps even a board of people, reviewed the case of one Barbara Wagner and determined that the cost of extending her life was greater than the value of that life to society. So which evil insurance company did this to her? It was the Oregon Health Plan. Yes, that would be oregon.gov. Now, does it really seem that far fetched to speak of government "boards to determine wether seniors and the disabled were worthy of care"? The phrase may indeed "invoke images of Nazi Germany" to some, but to others it simply invokes images of Liberal America.
The determination to offer drugs for physician assisted death was made in compliance with the Oregon Death with Dignity Act, which allows terminally-ill Oregonians to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose. But, here is where it gets a little spooky. The attending physician must do the following in accordance with the law.
127.815 s.3.01.Attending physician responsibilities.
(1) The attending physician shall:
(a) Make the initial determination of whether a patient has a terminal disease, is capable, and has made the request voluntarily;
(b) Request that the patient demonstrate Oregon residency pursuant to ORS 127.860;
(c) To ensure that the patient is making an informed decision, inform the patient of:
(A) His or her medical diagnosis;
(B) His or her prognosis;
(C) The potential risks associated with taking the medication to be prescribed;
(D) The probable result of taking the medication to be prescribed; and
(E) The feasible alternatives, including, but not limited to, comfort care, hospice care and pain control;
(d) Refer the patient to a consulting physician for medical confirmation of the diagnosis, and for a determination that the patient is capable and acting voluntarily;
(e) Refer the patient for counseling if appropriate pursuant to ORS 127.825;
(f) Recommend that the patient notify next of kin;
(g) Counsel the patient about the importance of having another person present when the patient takes the medication prescribed pursuant to ORS 127.800 to 127.897 and of not taking the medication in a public place;
(h) Inform the patient that he or she has an opportunity to rescind the request at any time and in any manner, and offer the patient an opportunity to rescind at the end of the 15 day waiting period pursuant to ORS 127.840;
(i) Verify, immediately prior to writing the prescription for medication under ORS 127.800 to 127.897, that the patient is making an informed decision;
(j) Fulfill the medical record documentation requirements of ORS 127.855;
(k) Ensure that all appropriate steps are carried out in accordance with ORS 127.800 to 127.897 prior to writing a prescription for medication to enable a qualified patient to end his or her life in a humane and dignified manner; and
So, before a physician can receive suicide drugs, they must be evaluated by a doctor, be suffering from a terminal illness, be informed of possible treatments, and in a sound state of mind, determine to forego those treatments with life ending drugs.Since Oregon is the only state with physician assisted suicide laws on the books, it is indeed the only state where the outcome of the process described above would be assisted suicide, yet it is a State in America with a death panel as described by Sarah Palin. But how would it work in other states? For that we turn to "Caring Advocates", a physicians group that states as their objective "to plan and honor end-of-life decisions". The first paragraph of their mission statement says the following.
To educate professionals and the public about what seems revolutionary now but had been for eons, the conventional way that most people died. People who were extremely ill simply no longer ate or drank. Cancer patients often completely loose their interest in Food & Fluid, and their wishes are respected since they can still speak for themselves. But for those patients who cannot currently voice their wishes, however, others sometimes impose their view of what is on them. The only way to prevent this from happening is to strategically create effective documents while patients still have the capacity to make their own medical decisions.
It sounds a lot better when you just say "Caring Advocates", doesn't it? While Oregon's policy is much more aggressive, the end result is the same. You die.
But where we get it all twisted is in the term "voluntary". Remember, Oregon's Death with Dignity Act is completely voluntary. Furthermore, a physician must determine that the patient who voluntarily participates in it must understand the options. So what happened in the case of Barbara Wagner? Well, her "end-of-life counseling" was indeed voluntary. Fortunately for her, the evil prescription drug company "Genentech" saved her from the kind and loving "End-Of-Life Care" offered by her liberal State, and provided her with the medication she needed free of charge.
2. What Would Liberals Do?
No name was cited in the health care debate more than that of Ted Kennedy. He also suffered from cancer, but the story of his treatment was much different.
Doctors initially told Kennedy the tumor was inoperable, but he looked around for other opinions and decided on the most aggressive and exhausting course of treatment possible. On June 2, 2008, Kennedy underwent brain surgery at Duke University Medical Center in an attempt to remove as much of the tumor as possible. The 3½-hour operation, conducted by Dr. Allan Friedman while Kennedy was conscious to minimize any permanent neurological effects, was deemed successful in its goals. Kennedy left the hospital a week later to begin a course of chemotherapy and radiation treatment. Opinions varied regarding Kennedy's prognosis: the surgery typically only extended survival time by a matter of months, but sometimes people lived for years.
The operation and follow-up treatments left Kennedy thinner, prone to seizures, weak and short on energy, and hurt his balance. Kennedy made his first post-illness public appearance on July 9, when he surprised the Senate by showing up to supply the added vote to break a Republican filibuster against a bill to preserve Medicare fees for doctors. Though additionally ill from an attack of kidney stones and against the advice of some associates, Kennedy insisted on appearing during the first night of the 2008 Democratic National Convention on August 25, 2008, where a video tribute to him was played. Introduced by his niece, Caroline Kennedy, the senator said, "It is so wonderful to be here. Nothing – nothing – is going to keep me away from this special gathering tonight." He then delivered a speech to the delegates (which he had to memorize, as his impaired vision left him unable to read a teleprompter) in which, reminiscent of his speech at the 1980 Democratic National Convention, he said, "this November, the torch will be passed again to a new generation of Americans. So, with Barack Obama and for you and for me, our country will be committed to his cause. The work begins anew. The hope rises again. And the dream lives on." The dramatic appearance and speech electrified the convention audience, as Kennedy vowed that he would be present to see Obama inaugurated.
In the case of Barbara Wagner, physicians used the "five-year 5 percent rule". That means, they don't treat you if you have a 5 percent survival rate after five years. Kennedy received treatment that was far more expensive and would only extend his survival time by a matter of months. Why the difference?
The difference would occur under either ideological system. Republicans opposed the health care reform that passed, yet they would certainly not rob Kennedy of the quality health care that his financial status had put him in position to afford. Barbara, on the other hand, would get treatment, but nowhere near the level of Kennedy, because she could not afford it.
The striking difference comes on the other end of the spectrum. From the Liberals who claimed to be doing the work of Jesus with this reform, to deny to the commoner what is given to the elite is hypocrisy. Was it not these very liberals who said that it is time that the rich "pay their fair share" and that they wanted to "spread the wealth around"? It's funny how that always ends up being money taken from a plumber to give to a landscaper rather than money taken from a politician and given to a dying grandmother.
3. Final Conclusion
In and of itself, there is nothing wrong with end-of-life counseling. In fact, it is a good thing. It is always better to make an informed decision when possible. The act of giving the counseling is undertaken by a physician who has dedicated his life to treating illness and improving the quality of the lives of his patients. That is an act of compassion that is above denigration.
The Death with Dignity Act is in my view also very compassionate. To me, it is morally wrong to deny one who is suffering and will never recover the option to end that suffering. I wish that every state had a law like this.
The problem is when we combine the two practices and place the charge of them in the hands of the State. Barbara Wagner received end-of-life counseling, and it caused her no harm. The counseling was voluntary, but the result was not. Her choice when left in the hands of the Government was to die quickly from a pill or to die slowly from a disease. She had the ability to opt out of the counseling, but the Government denied her the ability to make a decision for treatment after the counseling. It was the private sector that offered her that option.
