Saturday, August 22, 2009

Krauthammer v. Palin---The "Death Panel" Debate

Charles Krauthammer wrote a column over at Town Hall. It begins with:

“Let's see if we can have a reasoned discussion about end-of-life counseling.

We might start by asking Sarah Palin to leave the room. I've got nothing against her. She's a remarkable political talent. But there are no "death panels" in the Democratic health care bills, and to say that there are is to debase the debate.”

In response, East of Eden* wrote:

Dear Mr. Krauthammer:

If one thinks that a "death panel" is always and only a handful of implacable bureaucrats -- be they doctors, scientists, ethicists or some other suitably selected expert -- functioning like a parole board or the rank and tenure committee at a university, then, of course, you will not find "death panels." Whether by incompetence or morally culpable indifference, those charged with designing "Obamacare," have conjured far more insidious death panels.

Consider but one part of 1233:


(A) IN GENERAL- For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.

And now consider Pres. Obama's well-known remarks to Mr. Leonhardt of the NY Times:

"Well, 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. 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. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now." LINK

Now, there is clearly much that is objectionable about Pres. Obama's comments. But the point is: Of course some supplicant will not be hauled before some tribunal. Rather the "death panel" will be further removed, more amorphous, hence more noxious yet no less real. No, the death panel will be that task force, or panel of experts, or "consensus-based organization," or "independent group that can give you guidance." And they will appropriate physicians as the mechanism of implementation, under the guise of incentives, but it will really be the coercive bureaucracy that routinely judges whether physicians meet the standards of care determined by our "consensus-based organization."

Or consider the "independent group that can give you guidance" now being used by the Veteran's Administration to counsel those facing difficult choices, in the grimly ironically titled "Your Life, Your Choices":

"Who is the primary author of this workbook? Dr. Robert Pearlman, chief of ethics evaluation for the center, a man who in 1996 advocated for physician-assisted suicide in Vacco v. Quill before the U.S. Supreme Court and is known for his support of health-care rationing.

"Your Life, Your Choices" presents end-of-life choices in a way aimed at steering users toward predetermined conclusions, much like a political "push poll." For example, a worksheet on page 21 lists various scenarios and asks users to then decide whether their own life would be "not worth living." (from Jim Towey, "The Death Book for Veterans," WSJ, Aug 18, 2009)

Because he calls it a "death book", should we ask Mr. Towey to leave the room, too, as you have asked Ms. Palin to leave the room?

Our juries comprise 12 or perhaps a couple dozen citizens. But as you well know, some 500 hundred Athenians sat on Socrates' jury. Juries can be quite large or small. And "death panels" may be found behind an inconspicuous door, where sits a small handful of "health care jurists," waiting to give some anxious and fearful family our current President's idea of guidance.

Or death panels, Mr. Krauthammer, may be dozens or even scores of Dr. Robert Pearlmans, distributed throughout the country, perusing the health care data summaries prepared by technocratic lackeys, so that the Pearlmans may then anonymously conjure the protocols that will "guide" but "not be determinative of" some "incentivized" doctor as he or she "counsels"...who? those from the Greatest Generation? the Baby Boomers that promise to swell the ranks of Medicare recipients? my mother? you?...counseling that "You've had a good life; perhaps now is a good time to think about other options."

Our bureaucracy doubtless will not put a name plate on the door that says "Death Panel." But death panels there may be, nonetheless.

I do not know whether Sarah Palin is the only person in the room who saw through the ominous jigsaw that is HR 3200. But she is the one who named it. And while you have my sincerest respect, asking her to leave is simply ingracious..........END.

In this case, I'm inclined to agree with E of E, that while the term "death panel" may be considered extreme or even extraneous, I would submit that the intentional dialogue, (currently written in this healthcare bill), is indeed fraught with government intervention into our still private health care choices. Whether this remains the case, is, (hopefully), still up for debate.

* (note: "East of Eden" is a longtime friend who provides me with some reasonable insights from time to time, and prefers to remain anonymous)

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