Tuesday, September 8, 2009

Health Care, Death Panels and GPFM

Recently, Sarah Palin and other prominent Republicans have repeated claims that the proposed health care legislation would result in the creation of so called "death panels."This claim was quickly determined to be an egregious falsehood. However, the damage was already done and all elements of the proposed legislation that dealt with end-of-life issues were removed. My father has a piece up at the Oxford University Press Blog arguing that in fact death panels aren't such a bad idea. Essentially, the point is that one of the major reasons our health care costs are so high in the United States is because we go through tremendous effort to extend life during the last few months of life for many elderly. It is an issue very much worth discussing.

However, there are two related matters I'd like to mention. First, we should not lose track of how incredibly mendacious Palin and her compatriots have been about this matter. The fact that Bush's earlier proposed health care legislation had nearly identical end-of-life provisions is just one of the many ways in which Palin has simply become divorced from anything resembling reality. At this point, one must wonder if reality has taken out a restraining order on Palin.

Second, as someone who grew up with a very Jewish ethic about end-of-life issues it is emotionally very hard to agree to actively deciding that we will no longer provide health care to certain people. In classical Jewish thought, every effort must be made to continue to sustain life, regardless of cost. However, this view was constructed when medical technology was very different. Two-thousand years ago we didn't have the option to add a few painful months of life to someone at the cost of millions of dollars. We do now. This different situation may require serious reexamining of this sort of belief. This probably isn't an issue for most people in the US or at least the form it will take will be very different. Catholicism for example has for a long time tried to make a distinction between ordinary and extraordinary standards of medical care. In event, as medical technology becomes even more advanced, more and more value systems are going to need to serious think about these issues. Go read his piece here.


Anonymous said...

Hm, this is all certainly true, but it seems a bit unnecessary, when one of the main benefits of having this end-of-life counseling is to already cut costs in a similar manner, no? Doctors provide extraordinary medical care because they don't want to get in trouble, but if people went in for end-of-life counseling, they'd actually leave living wills way more often, which would increase by a lot the number of cases where doctors could say for certain that they didn't have to do this. It seems a bit of a silly proposal when we can probably get much of the effect without implementing things that many people will have (better-informed) moral objections to. (Admittely, I have no idea what the actual numbers are; I suppose that could change it.)

Jay said...

My grandmother passed away a few years ago at the age of 99. She had been lucid and largely self sufficient until about the age of 95 or so. She was a devout Catholic, as are my mother and her siblings.

By the time my grandmother went into the hospital for what would be the last time, she had deteriorated to the point that she spent most of her time medicated into unconsciousness. During her brief periods of wakefulness she wasn't aware of where she was or who was with her. She held on in this state for several weeks while my mother and her siblings struggled to let go.

I don't know all of the details that they considered, but I do know that there was debate regarding the Catholic view of life and how it applied in a situation where the person in question was very old and beyond all but palliative care.

While it's difficult to second-guess decisions several years after the fact, I can't help but think that the situation would have been easier to manage had my grandmother and her children gone through end of life counseling while she was still lucid enough to make her own wishes clearly known.

It's fairly clear to me that the right thing to do in terms of efficient use of healtcare resources would have been to limit care to the minimum necessary to ensure that she wasn't in pain at the end, but it's not easy to square that analysis with the fact that it's a much-loved family member in the hospital bed.

It's a tough topic to address, and it won't get any easier if it's used as a political sledgehammer every time it's brought up.

Joshua said...

Jay, there's a nice symmetry there between your experience and where my father is coming from. As he discusses in the piece, as a recent grandfather, he is taking a long view of things and willing to have the possibility that the plug will be pulled on him if it means a better world for his grandchildren.

Joshua said...

Two other thoughts:

Harry, yes that might very well be the case. But we're not even having that discussion now about whether that would be sufficient.

Jay, while I agree that these are issues where it is hard to use them to score cheap political points, I for one can't resist bashing Palin. Indeed, the fact that she's still going on about death panels even after all the end of life material has been removed from the legislation shows that she is either completely removed from reality or just evil.

Jay said...

Joshua -

Don't take anything I wrote as implying that Palin isn't deserving of bashing.

If she rattles on long enough, eventually she's bound to inadvertently brush up against an interesting topic.

(Personally, I think she's dumber than a box of hair, which works nicely with either of the two possibilities you suggested.