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What’s Wrong with the World is dedicated to the defense of what remains of Christendom, the civilization made by the men of the Cross of Christ. Athwart two hostile Powers we stand: the Jihad and Liberalism...read more

About Those "Death Panels"......

This, just up, from Sarah Palin on her Facebook page (with footnotes too!):

Yesterday President Obama responded to my statement that Democratic health care proposals would lead to rationed care; that the sick, the elderly, and the disabled would suffer the most under such rationing; and that under such a system these “unproductive” members of society could face the prospect of government bureaucrats determining whether they deserve health care.

The President made light of these concerns. He said:

“Let me just be specific about some things that I’ve been hearing lately that we just need to dispose of here. The rumor that’s been circulating a lot lately is this idea that somehow the House of Representatives voted for death panels that will basically pull the plug on grandma because we’ve decided that we don’t, it’s too expensive to let her live anymore....It turns out that I guess this arose out of a provision in one of the House bills that allowed Medicare to reimburse people for consultations about end-of-life care, setting up living wills, the availability of hospice, etc. So the intention of the members of Congress was to give people more information so that they could handle issues of end-of-life care when they’re ready on their own terms. It wasn’t forcing anybody to do anything.” [1]

The provision that President Obama refers to is Section 1233 of HR 3200, entitled “Advance Care Planning Consultation.” [2] With all due respect, it’s misleading for the President to describe this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients. The issue is the context in which that information is provided and the coercive effect these consultations will have in that context.

Section 1233 authorizes advanced care planning consultations for senior citizens on Medicare every five years, and more often “if there is a significant change in the health condition of the individual ... or upon admission to a skilled nursing facility, a long-term care facility... or a hospice program." [3] During those consultations, practitioners must explain “the continuum of end-of-life services and supports available, including palliative care and hospice,” and the government benefits available to pay for such services. [4]

Now put this in context. These consultations are authorized whenever a Medicare recipient’s health changes significantly or when they enter a nursing home, and they are part of a bill whose stated purpose is “to reduce the growth in health care spending.” [5] Is it any wonder that senior citizens might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal end-of-life care? As Charles Lane notes in the Washington Post, Section 1233 “addresses compassionate goals in disconcerting proximity to fiscal ones.... If it’s all about obviating suffering, emotional or physical, what’s it doing in a measure to “bend the curve” on health-care costs?” [6]

As Lane also points out:

Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive -- money -- to do so. Indeed, that’s an incentive to insist.

Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit “formulation” of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would “place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,” I don’t think he’s being realistic. [7]

Even columnist Eugene Robinson, a self-described “true believer” who “will almost certainly support” “whatever reform package finally emerges”, agrees that “If the government says it has to control health-care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending.” [8]

So are these usually friendly pundits wrong? Is this all just a “rumor” to be “disposed of”, as President Obama says? Not according to Democratic New York State Senator Ruben Diaz, Chairman of the New York State Senate Aging Committee, who writes:

Section 1233 of House Resolution 3200 puts our senior citizens on a slippery slope and may diminish respect for the inherent dignity of each of their lives.... It is egregious to consider that any senior citizen ... should be placed in a situation where he or she would feel pressured to save the government money by dying a little sooner than he or she otherwise would, be required to be counseled about the supposed benefits of killing oneself, or be encouraged to sign any end of life directives that they would not otherwise sign. [9]

Of course, it’s not just this one provision that presents a problem. My original comments concerned statements made by Dr. Ezekiel Emanuel, a health policy advisor to President Obama and the brother of the President’s chief of staff. Dr. Emanuel has written that some medical services should not be guaranteed to those “who are irreversibly prevented from being or becoming participating citizens....An obvious example is not guaranteeing health services to patients with dementia.” [10] Dr. Emanuel has also advocated basing medical decisions on a system which “produces 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.” [11]

President Obama can try to gloss over the effects of government authorized end-of-life consultations, but the views of one of his top health care advisors are clear enough. It’s all just more evidence that the Democratic legislative proposals will lead to health care rationing, and more evidence that the top-down plans of government bureaucrats will never result in real health care reform.

[1]See http://blogs.abcnews.com/politicalpunch/2009/08/president-obama-addresses-sarah-palin-death-panels-wild-representations.html.
[2]See http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf
[3]See HR 3200 sec. 1233 (hhh)(1); Sec. 1233 (hhh)(3)(B)(1), above.
[4]See HR 3200 sec. 1233 (hhh)(1)(E), above.
[5]See http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf
[6]See http://www.washingtonpost.com/wp-dyn/content/article/2009/08/07/AR2009080703043.html].
[7]Id.
[8]See http://www.washingtonpost.com/wp-dyn/content/article/2009/08/10/AR2009081002455.html].
[9]See http://www.nysenate.gov/press-release/letter-congressman-henry-waxman-re-section-1233-hr-3200.
[10] See http://www.ncpa.org/pdfs/Where_Civic_Republicanism_and_Deliberative_Democracy_Meet.pdf
[11]See http://www.scribd.com/doc/18280675/Principles-for-Allocation-of-Scarce-Medical-Interventions.

Comments (75)

This is an interesting article on why ObamaCare is a terrible choice as a replacement for Medicare. It echoes some of the statements made on this blog about end of life care rationing, but goes into why Medicare, as bad as it is, is safer for the elderly and tax payers than the sort of solutions being proposed now

And see here on exclusions for readmission.

http://www.classicalideals.com/HR3200.htm

If anybody knows for a fact that this is presently part of Medicare, by all means, say so. But in that case it wouldn't need to be put in the Obamacare bill. Looks like a particularly blatant form of rationing. Think of elderly people who get sent home too soon from pneumonia and need to be readmitted.

"To me, “purely voluntary” means “not unless the patient requests one.”"

This is about the stupidest comment I have ever read. Carried to its logical conclusions, it would make medical practice impossible.

Lydia, sending folks home from hospital too soon is a well recognized problem; one that the bill seeks to remedy.

Oh, and Sarah Palin. lol? I thought you would have repented of that error in judgment by now.

Al, why should anybody waste time with you? You don't even try to take in facts and evidence when they are handed to you. Obviously, my point is that _if_ someone is sent home too soon it ought to be possible to admit the mistake and readmit him without first proving that one has released X number of other patients with that same condition. If this is the bill writers' idea of "remedying" the problem of sending people home too soon, they should keep their remedies to themselves. For those who claim there is no additional rationing in this bill, this is outright refutation: Hospitals must readmit by the numbers only, and if your local hospital has "too many" patients with X designated condition taking up beds, and you get worse and have to be readmitted "too soon," you're outta luck. Medicare users, beware.

A couple of questions:

(1) How does any of this justify - even a little bit - the claim that the current bill authorizes "death panels" to determine who does or does not deserve care?

(2) One reason to reform health care is to try to bring down health care spending. Does that imply that every aspect of a health care reform bill is designed to bring down spending? Surely it's plausible that well-meaning people who are attempting to draft a bill that - in part - brings down health care spending might also want to draft a bill that ensures that people have the care they need and the opportunity to decide how they want to be cared for. Is there some obvious reason to think that this portion of the bill is motivated by a desire to save money as opposed to a desire to provide the opportunity for quality care?

(3) Suppose that section 1233 does both. Suppose that it (a) brings down health care costs, and (b) helps to provide a higher quality of care. Suppose, as well, that a legislator is aware that section 1233 does (a) and (b). Finally, suppose that she thinks we ought to do (a) and (b) (if possible). Shouldn't she, then, support that section? The mere fact that that portion of the bill helps to bring down spending - if, in fact, it does - doesn't imply that it "diminishes respect for the inherent dignity of ..[human] lives." Right?

(4) Isn't it obvious that, all things being equal, it's a good thing for people to have access to consultations regarding end of life care, living wills, hospice, etc.?

(5) I hope that the answer to (4) is 'yes'. If it is, then we don't want to get rid of something like section 1233. Palin (and others (Beckwith?)) are concerned that merely allowing people an opportunity to consult with experts regarding these issues constitutes pressure to forego care. That strikes me as implausible. But, if you do have that worry, shouldn't you advocate for a modification to section 1233 which would help to ensure that appropriate safeguards against that sort of pressure are in place? Doing that would be far more productive - and honest - than simply trying to scare the bejeezus out of people with talk of "death panels". Right?

"One reason to reform health care is to try to bring down health care spending."

It's cost you want to bring down; not spending. If you one afford expensive care, who cares how much one spends?

One thing that confuses me about this bill is the implication that people are not having end-of-life consultations with their doctors. Does anyone believe that?

Are doctors assigning treatments without discussing them with their patients? Are people who are dying not assessing with the help of their families the benefits of continuing treatment?

This provision can only be in the bill for the purpose of driving the consultations in a particular direction.

Mr. H
http://www.allhands-ondeck.blogspot.com/

Francis,

Fair enough. Please read (2) with the appropriate revision.

Francis,

Though, it's worth noting that the bill specifically claims to be an attempt to reduce spending.

Lydia, I assume you are referring to Sec. 1151. Early discharge issues would seem to something best dealt with statistically considering the number of hospitals and patients. There will always be unavoidable errors in any human system. Systemic problems can only be dealt with by crunching numbers.

If you go to 1151(a)(7) you find,

"`(7) MONITORING INAPPROPRIATE CHANGES IN ADMISSIONS PRACTICES- The Secretary shall monitor the activities of applicable hospitals to determine if such hospitals have taken steps to avoid patients at risk in order to reduce the likelihood of increasing readmissions for applicable conditions. If the Secretary determines that such a hospital has taken such a step, after notice to the hospital and opportunity for the hospital to undertake action to alleviate such steps, the Secretary may impose an appropriate sanction.",

which would seem to anticipate a potential problem.

Al--you don't get it. It's _obviously new rationing_ to exclude payment for readmission if there are "too many" people still in the hospital for that condition. I certainly think it's inappropriate, and whether one thinks this rationing is just ducky, one should at least have the honesty to admit: "Yeah, this is rationing readmissions. It's micro-managing doctor and hospital decisions as to whether or not to readmit somebody. People could get refused readmission because they needed to wait in line. But that's okay with me for reasons of cost control."

Is there some obvious reason to think that this portion of the bill is motivated by a desire to save money as opposed to a desire to provide the opportunity for quality care?

Uh yeeeeahhhh, there iiiis. You would have to be living in a cave not to know that. Like, a cave where you don't hear everybody (including, unfortunately, some conservatives) howling and moaning about the supposed fact that government healthcare (medicare) in America is already too expensive because people are doing "too much" in the "last three months of life." Hello? Anybody ever seen this statistical claim about the percentage of Medicare payments during the last three months of life? Oh, horrors, horrors, people are spending "too much" in the last three months of life. Also, rhetoric about how Medicare is so expensive because people refuse to "accept the fact of death" and insist on "prolonging a wretched existence." I've been hearing this junk since Hilarycare was proposed nearly twenty years ago, for goodness' sake. In other words, end-of-life planning is *of course* supposed to be a cost-saving measure, the idea being that if we can get people to refuse these oh-so-expensive measures, we'll save the money on that _plus_ on their oh-so-expensive care when they end those wretched existences sooner than they otherwise would.

AI:

This is about the stupidest comment I have ever read.

So the idea that "purely voluntary" means purely voluntary is the "stupidest thing you've ever heard" and would somehow make medical practice impossible? Is English not your first language or something?

Systemic problems can only be dealt with by crunching numbers.

I'm certain a bill such as this that touts the magnificent benefits of early departure opportunities for suffering patients, the aged and the terminally ill, will ultimately render remarkable accounting given the cost savings such truncated lifespans courtesy of yours truly will surely generate.

Therefore, you might consider posting a sign fashioned after the McDonald's one that features how many patients' lives were served to show the general public the millions of American citizens who met such a wonderful fate!

Of course, surely only person such as yourself are amongst those especially capable of appreciating the many positive benefits (cost efficiency and the immediate extinction of society's deadweights being only a few of these) that only the Culture of Death can provide!

Don't let silly matters such as morality, the noble calling of still higher ideals and ultimately Christian values bother you; these are merely outdated concepts that annoying worry-worts like Kevin and fascist professors like Dr. McGrew obssess over ever so unwaveringly -- it's almost pathetic.

It's not like, in the very end, it'll even matter much.

It seems to me that either a person runs out of money and can't pay for further services, or they run out of services due to rationing. Either way, the services referred to as end-of-life care are going to be limited somehow. Objections to any sort of limit on consumption of resources leads to crazy misallocation.

In other words, if it is costing everyone 10,000 dollars a day to keep you alive, then pull the plug. Your life isn't worth that, and frankly neither is mine. If your family wants to continue to pay, then that's fine (which is why I think medical care should remain a function of prices and markets), but when everyone is bearing the cost then you can't just consume forever, costs be damned.

At some point, someone is going to put a price on your life. It could be the insurance company, it could be your family, it could be the government. I don't see any way around this.

Look, if I don't want to live longer if it means stealing from someone who could have afforded the treatment if the government wasn't in charge.

Who wants to live in a world like that?


Dr. Beckwith:

Who wants to live in a world like that?

Perhaps you and Dr. McGrew should simply cease your rather ostentatious continued display of such remarkable narrow-mindedness; just because you and she have yet to step out of the dark ages does not mean you can blissfully play ignorant and, even further, deny folks like Al who deserve to live in the kind of world that only their ObaMessiah can fashion in which they would most certainly happily live!

Why shouldn't the One be denied the right to decide who should live and who should die?

It's merely an extra plus when such new powers afforded him by seemingly abhorrent policies as these provide the additional incentive of maximizing cost-savings, promoting system efficieny and even general population control.

Who needs grandma anyway?

At some point, someone is going to put a price on your life. It could be the insurance company, it could be your family, it could be the government. I don't see any way around this.

As the article I linked to pointed out, since Obama is folding everything together into one large program, that'll come pretty quickly. It'll happen the moment that the elderly bay for continued expensive treatment and children and teenagers have to compete. All life may be precious in the eyes of God, but a very old person isn't going to get the time of day in a triage situation when the other contender for treatment is a child. This is that situation that Obama is going to hasten.

Who needs grandma anyway?

The question, though, is at what point does extending the life of the elderly go from preserving life and human dignity to just vanity? Unfortunately, that'll be for The One(tm) to decide for everyone, rather than leave it up to families to figure out.

Systemic problems can only be dealt with by crunching numbers.

Until recently, I would not have considered the decision whether to allow Mom back in the hospital after too-early expulsion to be a "systemic" problem. Unless you have artificially created the systemic problem by mandating that the hospital live by a statistical average # of days of stay for X condition. But creating an artificial systemic problem does not warrant a solution by-the-numbers, it warrants unraveling the stupid system to begin with.

When you find a statistical difference, it shows that there is something to investigate , not something that needs changing. The fact that one hospital keeps some people longer than another could mean that they have better care, or that they have a slightly different population with conditions slightly more serious. Or it could be a statistical blip. Or other things. Crunching numbers does not resolve which of these it is - only looking at particular cases will establish the reason for the difference.

Mike T:

The question, though, is at what point does extending the life of the elderly go from preserving life and human dignity to just vanity? Unfortunately, that'll be for The One(tm) to decide for everyone, rather than leave it up to families to figure out.

Are you contending that it is actually vanity to keep the elderly alive beyond some subjectively-determined lifespan?

That families should act virtuously in this regard and simply let grandma conveniently expire; after all, what should be a blatantly murderous act as that can merely be rationalized as being a genuinely christian act meant to curb that awful vanity.

Amazing.

I would've expected something somewhat better from somebody of your supposed moral stature.

Al:

"`(7) MONITORING INAPPROPRIATE CHANGES IN ADMISSIONS PRACTICES- The Secretary shall monitor the activities of applicable hospitals to determine if such hospitals have taken steps to avoid patients at risk in order to reduce the likelihood of increasing readmissions for applicable conditions. If the Secretary determines that such a hospital has taken such a step, after notice to the hospital and opportunity for the hospital to undertake action to alleviate such steps, the Secretary may impose an appropriate sanction.",
which would seem to anticipate a potential problem.

How well is the Inspector General accounting for the Federal Reserve? Execution, my friend: the Achilles heel of all central planning. The federal government is horrid at it, our idealistic dreams notwithstanding, because they are as accountable as this public official or Ben Bernanke, who claimed Milton Friedman was right years ago, and we're paying for it now. What, are we going to vote Bernanke or that inspector out of office? Doesn't work that way, does it? Why? Because Big Business and Big Government are constantly colluding to stay in power, and giving Big Healthcare government security and Big Government control over our healthcare isn't going to make things better for the people. There is absolutely no evidence of that, from Massachusetts to California. It's certainly not going to be better for a nation with 300 million people, which far more than any socialized European nation.

Big Government works well in Singapore. Works so-so in Sweden, U.K., France. Works badly in Russia, China, USSR. It will work badly in the U.S.A. There is no historical evidence to suggest otherwise. But, if you still feel it might work, why not set up universal healthcare in one-half of the country, which is bigger than any European nation, and see what happens? If it's better in one-half of the country, then it will be easy to copy the system for the other half.

What say you?

Good name, by the way.

At some point, someone is going to put a price on your life. It could be the insurance company, it could be your family, it could be the government. I don't see any way around this.

Actually, my life does not have a "price," since it is not a thing that I own. It is what I am. And I am, like you, a person of immeasurable worth. That, by the way, should be the starting of point of all human institutions including medicine. Once that's gone, all bets are off.

"Health care," indeed, has a price; but so does food, liquor, travel, and a nice drive up Pacific Coast Highway. But the prices of these things should not be inflated or deflated--or access to them lessened or increased--because of the budget constraints of a government "policy expert" who employs a pattern of "perfect justice" by which he assesses who is allocated what. For such a "pattern"--informed by egalitarianism, utilitarianism, and a "thin-theory of the good"--will put people in harm's way who would have not otherwise been in harm's way in a more market-driven world of health care. Yes, in that world, there are some uninsured. And in the president's plan there are no uninsured. But why is equal mediocrity better than unequal excellence? After all, the only reason why we have so much excellence in health care right now is precisely because it is not egalitarian. If equality means killing the goose that laid the golden egg, then such equality is unjust.

Actually, my life does not have a "price," since it is not a thing that I own. It is what I am. And I am, like you, a person of immeasurable worth. That, by the way, should be the starting of point of all human institutions including medicine. Once that's gone, all bets are off.

If this were actually true, then I wonder how much would be collected on your life insurance if God forbid you should expire unexpectedly before your time.

The fact of the matter being that your very life, even if you happen to disagree morally or whatever, does have a price.

The question is whether or not the market, the government or what not should be the deciding factor on what it's actually worth.

Until recently, I would not have considered the decision whether to allow Mom back in the hospital after too-early expulsion to be a "systemic" problem. Unless you have artificially created the systemic problem by mandating that the hospital live by a statistical average # of days of stay for X condition. But creating an artificial systemic problem does not warrant a solution by-the-numbers, it warrants unraveling the stupid system to begin with.

Hurray, Tony!!!! Exactly. I couldn't have said it better. What's really freaky is that leftists talk as if we _already_ have entirely socialized medicine--"our health care system" "our health care dollars"--and they, the Anointed, are just trying to help us to manage it more rationally. Of course, more rationally--which is what all would-be central planners think.

Lydia would you please give the section, etc. on which your assertions are made. I just don't see it.

Al, yes, I am talking about section 1151. We could start right at the beginning, with the purpose of reducing "excess" readmissions by punishing hospitals that have them. Here's this language:

IN GENERAL- With respect to payment for discharges from an applicable hospital (as defined in paragraph (5)(C)) occurring during a fiscal year beginning on or after October 1, 2011, in order to account for excess readmissions in the hospital, the Secretary shall reduce the payments that would otherwise be made to such hospital under subsection (d) (or section 1814(b)(3), as the case may be) for such a discharge by an amount...

There follow abstruse references to ratioa of "expected" to "excess" readmissions. In other words, hospitals will be deliberately underpaid for the treatment of patients over the course of a year if they readmit "too many" of them for the same condition within a time period determined by the bureaucrats. (And yes, it does say, a bit further down, that the time period will be determined by the bureaucrats.)

Now, obviously, what this means is that if you really need, medically, to be readmitted later, because the hospital sent you home too soon, or you were an atypical case and needed to be readmitted even though they couldn't have predicted this, they will have a motive for finding some way not to readmit you. Because if they have "too many" readmissions by this calculus the government engages in as to how many readmissions they _should_ have for that condition, then they will be punished by way of reduced payments. This provides a motive for the patient not to be treated as an individual and on the basis of his actual medical needs at some particular time but rather as part of an aggregate, with his care determined by whether "too many" other people have already received that care already (namely, readmission within the applicable time period for his same condition). There is only one word for this, and that is "mandatory rationing." The government is deliberately pushing hospitals not to readmit.

Of course, the claim will be made that they are pushing them not to discharge too soon, which is supposedly causing "excess" readmissions. But that is the most blatant bureaucratic, money-driven micromanaging interference in what should be a medical decision, as well (for that matter) as being informed by the patient's own priorities about wanting to be home. This just _is_ what people mean by rationing, and it is being _added_ to the present system.

THE DEATH PANELS ARE D.O.A!

WASHINGTON – Key senators are excluding a provision on end-of-life care from health overhaul legislation after language in a House bill caused a furor.

Senator Chuck Grassley of Iowa, top Republican on the Senate Finance Committee, said in a statement Thursday that the provision had been dropped from consideration because it could be misinterpreted or implemented incorrectly.
http://news.yahoo.com/s/ap/20090813/ap_on_go_co/us_health_care_end_of_life_2

And why am I so harsh and cynical?

"WHEREAS, Healthcare Decisions Day is designed to raise public awareness of the need to plan ahead for healthcare decisions, related to end of life care and medical decision-making whenever patients are unable to speak for themselves and to encourage the specific use of advance directives to communicate these important healthcare decisions. WHEREAS, in Alaska, Alaska Statute 13.52 provides the specifics of the advance directives law and offers a model form for patient use.

WHEREAS, it is estimated that only about 20 percent of people in Alaska have executed an advance directive. Moreover, it is estimated that less than 50 percent of severely or terminally ill patients have an advance directive.

WHEREAS, it is likely that a significant reason for these low percentages is that there is both a lack of knowledge and considerable confusion in the public about Advance Directives.

WHEREAS, one of the principal goals of Healthcare Decisions Day is to encourage hospitals, nursing homes, assisted living facilities, continuing care retirement communities, and hospices to participate in a statewide effort to provide clear and consistent information to the public about advance directives, as well as to encourage medical professionals and lawyers to volunteer their time and efforts to improve public knowledge and increase the number of Alaska’s citizens with advance directives.

WHEREAS, the Foundation for End of Life Care in Juneau, Alaska, and other organizations throughout the United States have endorsed this event and are committed to educating the public about the importance of discussing healthcare choices and executing advance directives.

WHEREAS, as a result of April 16, 2008, being recognized as Healthcare Decisions Day in Alaska, more citizens will have conversations about their healthcare decisions; more citizens will execute advance directives to make their wishes known; and fewer families and healthcare providers will have to struggle with making difficult healthcare decisions in the absence of guidance from the patient.

NOW, THEREFORE, I, Sarah Palin, Governor of the state of Alaska, do hereby proclaim April 16, 2008, as:

Healthcare Decisions Day in Alaska, and I call this observance to the attention of all our citizens.

Dated: April 16, 2008 "

Aristocles,

Are you contending that it is actually vanity to keep the elderly alive beyond some subjectively-determined lifespan?

That families should act virtuously in this regard and simply let grandma conveniently expire; after all, what should be a blatantly murderous act as that can merely be rationalized as being a genuinely christian act meant to curb that awful vanity.

Amazing.

I would've expected something somewhat better from somebody of your supposed moral stature.

You know I was contending no such thing. There is a point of absurdity in medical intervention for the elderly. When the elderly simply cannot survive without it, and the bills are reaching the point of bankrupting the family, you're starting to get there. At some point, the efforts to stay alive in the face of nature taking its course reach the point that it is as vain as a middle age woman getting lipo, a boob job and a facelift to avoid aging gracefully.

Then again, I've never understood the cultural protocol that, with regard to lifeboats and sinking ships, preferred young fathers to go down with the ship so that the elderly could have their place. I always wondered how the old coots could feel any sense of personal honor in letting children grow up fatherless so that they could live just a few more years.

And why am I so harsh and cynical?

We don't know. Why?

"The fact that the 2 authors of Section 1233 are major proponents of euthanasia and assisted suicide.

The first is Oregon Congressman Earl Blumenauer. Recall Oregon was the 1st state to legalize physician assisted suicide almost 12 years ago. Blumenauer wrote on Huffington Post July 28:

Rep. Buck McKeon admonished people to read the bill and then specifically cited Section 1233. Actually, I know a little bit about this section because it's a bill that I wrote which was incorporated into the overall legislation.

Blumenauer wrote an amicus brief in support of assisted suicide in a case before the U.S. Supreme Court in 2005, Gonzalez vs. Oregon....

Bluemenauer also links on his website to a 1960 Harper's magazine article (see right) promoting both voluntary and involuntary euthanasia.

The group Compassion & Choices, formerly known as the Hemlock Society. is also says it had a hand in crafting Section 1233, writing July 27":

Compassion & Choices has worked tirelessly with supportive members of congress to include in proposed reform legislation a provision requiring Medicare to cover patient consultation with their doctors about end-of-life choice (section 1233 of House Bill 3200).

http://www.jillstanek.com/archives/2009/08/section_1233_au.html

(6) How is it that section 1233 is supposed to put pressure on people to minimize end of life care? Palin implies (and, Francis agrees?) that that section of the bill gives health care workers an incentive to do so. But, that's not right, is it? That section of the bill gives health care workers an incentive to discuss end of life care and to provide information regarding, for instance, living wills. But, it doesn't provide incentive to advocate for some particular option regarding end of life care. In fact, that section of the bill explicitly mentions that information regarding end of life care should concern all options, including full treatment for end of life care. So, how is this section of the bill supposed to generate the supposed pressure? You don't think, do you, that simply providing information regarding the available options constitutes pressure?

"You don't think, do you, that simply providing information regarding the available options constitutes pressure?"

That's a good question to ask those who oppose providing the facts of fetal development to women who visit abortion providers.

Francis,

Alright. If I run into any, I'll ask them.

Now, though, I'm wondering what you think about this issue.

Al:

The Alaska resolution you reprint is perfectly fine, and not inconsistent with opposing the sort of protocol in section 1233. The animating principle behind the former is: the patient should do what is good for you and your family. The patient is neither a ward of the state nor its employee. The latter is a government rule embodied in a law that applies all the participants, all of whom depend exclusively on the state for the benefits they receive.

In the former, the context is a wide range of physicians with different understandings of the good life and the nature of medicine. So, if a patient thinks her physician is more Jack Kevorkian than Marcus Welby, then she can find another with which to consult, one that is free to offer her advice consistent with shared values. In the latter, the only considerations that are deemed relevant by the state are utilitarian, with no consideration given to what the patient or physician may think is the true "end" of life. It detaches medicine from philosophical anthropology by state fiat. It treats medicine as if it were a commodity rather than a healing practice.

Remember, the people giving us HR 3200 are the same ones that maintain that the state ought to be neutral on the question of man's nature and its proper end. So, they support education, with no reference to the proper end of learning. They support "health," with no reference to what constitutes a person's well-ordered good. They support "environment sustainability," and apparently know enough about nature to know precisely how many redwoods belong in the Pacific Northwest, though they don't know the proper end of man.

Kevin--on the "death panels being D.O.A." Sort of. It's good that they are cutting the whole end-of-life counseling thing out. We'll hope it doesn't sneak back in later.

But let's not forget: The Commissioner (always capitalized) and the Committee still set benefits. That is the cornerstone of the entire plan. That couldn't be cut out without ditching the entire Obamacare plan. Obviously, they can and will ration care by controlling benefits.

Mike T:

Then again, I've never understood the cultural protocol that, with regard to lifeboats and sinking ships, preferred young fathers to go down with the ship so that the elderly could have their place. I always wondered how the old coots could feel any sense of personal honor in letting children grow up fatherless so that they could live just a few more years.
It has something to do with this apparently outmoded idea of the strong protecting the weak, despite the fact that the weak are, well, really, truly weak. Perhaps it also has to do with an also apparently outmoded idea of the elderly being storehouses of wisdom earned over a lifetime with much to contribute to society, rather than useless, physically weak inconveniences with nothing valuable to contribute to a materialistic society.

Granted, the culture of the baby-boomer generation has, in more ways than one, strained the plausibility of "the strong should protect the weak" and "old people being wise and useful" to the breaking point, but that's simply because the baby-boomer generation, generally speaking, is maleducated, stupid, historically ignorant, selfish, narcissistic, and perfectly willing to sacrifice both their children and their parents so they can have more convenient lives, the future be damned.

that's simply because the baby-boomer generation, generally speaking, is maleducated, stupid, historically ignorant, selfish, narcissistic, and perfectly willing to sacrifice both their children and their parents so they can have more convenient lives, the future be damned.

If anything should serve as a striking example of this, it is the variety of purportedly conservative individuals here who advance arguments that are little more than catcalls and vituperations.

I submit into evidence the general posts that usually inundate the main page which hardly contain any substantive points against an equally deplorable array of makeweight opponents.

Oh how I miss the conservatives of yesterday who knew then, among other things, what a true argument essentially comprised and what genuine conservatism was.

It has something to do with this apparently outmoded idea of the strong protecting the weak, despite the fact that the weak are, well, really, truly weak. Perhaps it also has to do with an also apparently outmoded idea of the elderly being storehouses of wisdom earned over a lifetime with much to contribute to society, rather than useless, physically weak inconveniences with nothing valuable to contribute to a materialistic society.

Or perhaps it is just one of those illogical social foibles. Considering the typical situation of widows and orphans in times gone by, the plight of the widow and fatherless was stronger than the plight of the elderly.

But let's not forget: The Commissioner (always capitalized) and the Committee still set benefits. That is the cornerstone of the entire plan.

Lydia, Rationing is here, but our side is asking all the right questions and forcing a national converation many would prefer to avoid. Whatever happens now, it will be with eyes wide open with no opportunity for the old; "how were we to know?" routine.
I do think in addition to questions, we should offer some answers, or at least an outline. A genuine Patient Bill of Rights may be the the place to start, and I doubt Al and others will find the enumerating of protections a needless duplication after we are done.

...our side is asking all the right questions and forcing a national converation many would prefer to avoid...

Our side?

Since when did members of the evil GOP suddenly become distinguished members of Kevin's "side"?

Aren't these folks who promoted such high ideals in these matters members of that very same deplorably immoral and even ignoble Republican party which Kevin dedicated seemingly endless screeds to in past discussions along with his playmate, Lydia?

Our side?

Ari, I am talking about the prolife community. Republican politicians are responding to pressure emanating from within their oft-neglected base. The true test for the GOP establishment will come when, and if they have to choose between the grassroots and the business lobbies of Big Pharma and the insurance industry who have signed on to this legislation. I never called an entire party "immoral", though certain policies, mental tendencies (the idolatrous worship of the Nation-state and its militarized liturgies) and personalities (how's Erik Prince doing lately?) are clearly heretical, delusional and frequently immoral.

Kevin:

Thank you for elucidating on this as well as on certain points previously expressed.

Still, I can't seem to shake off the notion of how much better off we might have been if only we didn't have the abhorrently Pro-abort administration in power in the first place; what with all the rather evidently heretical, delusional, and frequently immoral (and even notably wicked) acts that screams quite loudly that, like these, its exponents are all but staunch servants of the "Culture of Death".

Frank, what happened to your correction article on Ezekiel Emanuel? It's disappeared, and your link to it on this thread goes to a page full of HTML code.

The Deuce:

I don't know for how long you've been a reader of this blog; however, Dr. Beckwith has the rather regrettable habit for often causing such tremendous temporal distortions so as to indulge his fancy for re-writing history in order to deliver a more preferred version of the sort -- in particular, with respect to a certain of his posts which somehow tends to suffer a Bermuda Triangle-like fate, unfortunately.

Though, to be fair, I'm not entirely certain if whether it is actually on account of his own personal will in the matter or more so due to perhaps some influence imposed upon him by the prodigious likes of Dr. McGrew (though, the Obama Vegas whore was one I actually would have endorsed; only insofar as it would've certainly have given the wrong impression of the kind of blog this actually is or even claimed to be).

The only posts I have ever suggested that anyone take down were actually offensive because of language or something of that sort. And come to think of it, I can think of only one or two of those. I certainly did not suggest that the other post be taken down, and I wouldn't have. I put a comment in the comments thread suggesting that the "correction" was jumping the gun a bit, but that was not intended as a suggestion that it be taken down. Please, Aristocles, keep your conjectures to yourself.

Does anyone else wish Aristocles would just stop commenting? He doesn't seem to be able to either read or think very clearly, and he certainly can't write clearly. Just pipe down and stop muddying the waters!

"The Alaska resolution you reprint is perfectly fine, and not inconsistent with opposing the sort of protocol in section 1233. The animating principle behind the former is: the patient should do what is good for you and your family. The patient is neither a ward of the state nor its employee. The latter is a government rule embodied in a law that applies all the participants, all of whom depend exclusively on the state for the benefits they receive."

As with the hospital admissions issue above you insist on conflating rules regarding reimbursement with some action imposed on the patient. All the section in question does is outline the circumstances under which physicians will be paid for counseling.

There is a simple chain here. If this a good thing (and Ms Palin thinks it is) then perhaps it would be good to cover it under Medicare. But, if we decide to cover it, we need to set some guidelines lest the greedy and mendacious take advantage of the patient and the taxpayers.

Again you ignore process, substituting a crude materialistic causal chain for a serious analysis of how we get from a rule regarding payment for a service to a universal mandate as to the results of that service.

"Remember, the people giving us HR 3200 are the same ones that maintain that the state ought to be neutral on the question of man's nature and its proper end."

Since that is the nature of a pluralistic, secular democracy I'm not sure how that observation advances your case. Sounds somewhat subversive to me.

Aristocles combines picknose triumphalism with equally facile forms of sneering contempt for anyone or any idea that presumes to so much as take note of those mundane facts. If a plank needs to be removed from an oppositional argument, he's (it has to be a he) only too happy to sneer at and dynamite the entire structure, in lieu of bringing thought, in lieu of bringing mind to bear.

But thou shalt appreciate his very presence, or thou shalt experience the almighty's disdain. Arrested development.

Al,
1)Glad to see you think process is important.Give us some protections you want built in and upfront that would secure the safety of patients from the conflicting interests of a financially distressed, rationing regime.

2) If a " pluralistic secular democracy" is neutral on matters of life and death then should we really entrust the well-being of terminally ill, emotionally despondent and expensively maintained patients to its value-free ministrations?

Kevin we are not neutral on matters of life and death. The protections you seek are already hardwired into the Constitution,; we don't have to endlessly repeat them. If the state can impose involuntary euthanasia, we are no longer under the Constitution and we have bigger problems.

"and apparently know enough about nature to know precisely how many redwoods belong in the Pacific Northwest, though they don't know the proper end of man."

The redwoods (I assume you mean sequoia sempervirens) aren't native to most of the Pacific Northwest (the present range is confined to an approximate two million acre strip near the Pacific ocean ranging from the Big Sur area in Central California to just over the Oregon line near Brookings) but the answer is easy - assuming a minimum of 48" dbh as desirable, about 30 million. Assuming that extinction is the proper (well earned?) end of man, those numbers may be attained.

Involuntary euthanasia will first appear as "voluntary", an exercise in personal autonomy facilitated by noble agents of mercy and liberty. Obamacare is just the latest attempt to conceal a primordial disdain for the weakest members of the herd, a heartless servitude to the cash nexus and the neo-pagan's disbelief in the redemptive nature of suffering in a haze of lofty sentiments and obfuscations.

Apropos of which, some might be interested in this story:

http://edition.cnn.com/2009/WORLD/asiapcf/08/14/australia.right.to.die/?imw=Y

Involuntary euthanasia will first appear as "voluntary", an exercise in personal autonomy facilitated by noble agents of mercy and liberty.

On the other hand, there are abuses on the other side like those who refuse to acknowledge living wills. That happened to my great grandfather. He didn't want to be euthanized, but was one of those men who wanted to die in bed naturally, rather than being kept alive by a cocktail of pills and life support machines. Apparently, that was too much to ask of his hospital staff, despite the fact that they had a copy of his will on file.

The cultural climate hardly seems like the kind where many will be unduly kept alive.We might as well worry about a sudden wide-scale embrace of chastity leading to a social epidemic in sexual frustration.

"Australian law gives patients the right to refuse life-saving treatment, but helping someone commit suicide is a crime that can carry a life prison sentence. The Brightwater nursing facility sought the ruling to make sure it would not be held liable if it complied with Rossiter's request to stop all nutrition and hydration, except to be given enough liquid to make it possible to take pain medication."

What's the objectiont here? This guy would be force fed in a world ruled by Kevin or Lydia? In the former Soviet Union, political prisoners on a hunger strike would be force fed. Using the power of the state to provide health care for all who want it is wrong but forcing nutrition on folks is ok?

Sorry, Al, I couldn't even begin to be more uninterested in discussing this issue with you. The man is said to have a right to be dehydrated to death. (The article is slightly inaccurate there; death by dehydration long precedes death by starvation in such cases.) I disagree. I was not inaugurating a discussion with you but rather informing people who would be interested in the information, as the link seemed relevant to one of Kevin's recent comments.

I'm for providing healthcare for all. I just don't consider denying people food and water and medicine, therapies, or emotional -spiritual support are humane forms of " care".
It is apt that you would allow prisoners to starve themselves to death, since your stance has more in common with that of a war criminal than someone devoted to the Sermon on the Mount.

It is apt that you would allow prisoners to starve themselves to death, since your stance has more in common with that of a war criminal than someone devoted to the Sermon on the Mount.

Why yes, Jesus famously commented in the Sermon on the Mount that "blessed are that they save their neighbor from himself..."

The list of things which you would force others to do and not force them to do, based on purely religious arguments, is arbitrary. You would force feed someone participating in a hunger strike, but not support the state ordering the execution of someone who creates a competition aimed mainly at teenagers to see who can most creatively blaspheme the Holy Spirit... (Not that I support either, as I fundamentally believe in free will and reject the idea of making people behave virtuously as opposed to not inflicting harm on each other)

It is the body of Christ, not humanity at large, that Christ charged with caring for the needy.

I wasn't interested in a discussion, merely some clarity. That you cop an attitude and Kevin goes off the wall to a simple question is interesting, to say the least.

Michael B & Frequent Reader:

Amazing demonstration of both your abilities to sink to an ever remarkable display of self-parody.

Too bad I hardly have the time nor inclination to entertain, let alone, indulge such obvious masters or errata.

Lydia:

The fact of the matter is more often than not, Dr. Beckwith's posts have historically tended to somehow suffer such strange disappearing acts (the Las Vegas Obama Whore was merely one example).

To deny this very fact (especially given you are co-contributor and, thus, are certainly well aware of this) is an act of sheer dishonesty; especially coming from somebody of your supposed Christian stature, I would not have expected you of being capable of such apparent disingenuousness.

Aristocles, I said nothing about what Frank chooses to do. I said something about what *I ask him or anyone else to do*. I am moved once again to wonder if English is your first language. Seriously. I was simply saying that I can think of only one or two posts that *I have suggested be taken down*. I was responding to your out-of-the-blue conjecture that I might have pressured Frank to take down the post you were discussing. I was saying, "Don't bring me into this or blame me for this." In fact, it would have been pretty stupid for me to take the time to comment on the post and then ask immediately that it be taken down, making my own comment disappear. Why would I have bothered to comment? Try a little harder to understand what I write, Ari.

Al, I don't know what you mean by "cop an attitude." I was simply being polite enough to respond to your comment while at the same time declining to discuss the issue with you. Nothing I said was unclear, that's for sure. But let me be a little clearer still: I posted the link for my fellow conservatives' benefit. Sorry if you don't like that, but shrug. Not a big deal to me what you don't like.

Trying to wed "Live and Let Die" libertarianism to the Gospels is an absurd proposition.One can only adopt an attitude of passive resignation towards suicide by either misintepreting Scripture or getting lost in a maze of modern theories. This thread is not about the death penalty, so I won't get diverted by your comment in support of it,other than to say, your postions on suicide and capital punishmnet are remarkably consistent. So too my opposition to each.

"Self-parody"? "Ever remarkable"? I've never commented before! What are you talking about?! "such obvious masters or errata"? Totally incoherent, as usual.

Frequent Reader, Aristocles does have an unusually high percentage of comments which are unclear, opaque, or off target. I think it has something to do with a deep-seated habit of cynicism, but I could be wrong. Some of us tend to tolerate his obfuscatory comments while enjoying his 1-in-10 good shot. Such is life. Or you can do what Lydia recommended a few months back and simply ignore him.

Al, it is possible to disapprove of the act of suicide while not thinking that we need a a federal bureaucracy to intervene and put an end to it. There are lots of evils that we tolerate, and there are lots of evils that are dealt with by a response at a much lower level than federal agents. The fact that Lydia does not support a federal system of providing suicide pills to those who might want to take their lives (and, gradually, to those who don't clearly wish to retain their lives, and then those who ought not wish to remain alive...) does not automatically mean she supports a federal system that steps in to force-feed a dehydrating prisoner.

Let me ask something: please help me understand one straightforward deficiency in the current system that this bill will solve, and then show that (a) this problem is a federal problem in its essence, and (b) this solution is the least intrusive way such a problem can be handled.

This thread is not about the death penalty, so I won't get diverted by your comment in support of it,other than to say, your postions on suicide and capital punishmnet are remarkably consistent. So too my opposition to each.

And here, ladies and gentlemen, is another fine example of Kevin trying to dodge one issue by pretending that it's another issue. My comment had little to actually do with the death penalty itself, but rather why Kevin is so gung ho about ramming the full Catholic social program down on society, yet has never once supported anti-blasphemy laws since blasphemy of the Holy Spirit is, in Jesus' own words, an unforgivable sin.

Geesh MikeT by interjecting anti-blasphemy laws into this thread it is you who is changing the subject, not me. I must admit I haven't given the subject much thought since bequiling heresies with Christian accents are the greater danger.

Mike T:

but rather why Kevin is so gung ho about ramming the full Catholic social program down on society, yet has never once supported anti-blasphemy laws since blasphemy of the Holy Spirit is, in Jesus' own words, an unforgivable sin.

So is bearing false witness against thine neighbor, as you seem to have done so here; however, rather than comment in full (else the remarkable likes of "enlightened" types such as Tony, "Frequent Reader" et al.), let me just simply say that there isn't actually anything wrong with Kevin's objectives -- it is merely his approach to the matter that might be questionable.

To think that you would present the very acts even Our Lord Himself preached rather prevalently about in the Gospels (particularly, in Matthew 25), as if it were actually tyranny can only speak volumes of the modern Christian whose semblance bear little to none to Our Saviour Himself and genuine Christianity but more secular in origin.

Never mind "Amen I say to you, as long as you did it to one of these my least brethren, you did it to me."; today's Christian takes profound joy and even glories in The New Gospel: "Got Mammon?"

let me just simply say that there isn't actually anything wrong with Kevin's objectives -- it is merely his approach to the matter that might be questionable.

And that is precisely to what I object: his approach. It is soundly statist.

Society bears witness to the fact that we implicitly recognize two moral codes: total morality and morality that is within the sphere of the state's competence and interest. If we didn't, then telling a lie would be punished as a grave offense. So would greed, envy, gossip, behaving maliciously and a whole host of other things which the state is no good at handling.

We're just quibbling over where that line is. As my wife commented about Ron Paul and libertarianism in general, if we lived in such a society, we'd know pretty quickly who has God's blessing and who doesn't since all of the fake virtue would no longer be required.

"War is the health of the state." With that in mind, shouldn't an avid supporter of the military-industrial complex be a little more introspective before he calls anyone a "statist"?
The weak, the poor, the vulnerable deserve and need juridicial protection from powerful forces and tendencies. That means, for the purposes of this thread, a legal code informed by traditional Christian sanctions against suicide and exploitation.
As for the "why does this call for a federal solution" whine, maybe if people experienced the grace of "little platoons" and saw subsidiarity and solidairity in action, rather than merely heard rumors of their existence, they wouldn't view the State as a safe harbor. Besides, people fear the cold, imperious and impersonal voice on the phone regardless if it originates from either the 800 or 202 area codes.

You are not mistaken, that's right

In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.

Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.

But this approach can also mask the signs that their condition is improving, the experts warn.

As a result the scheme is causing a “national crisis” in patient care, the letter states. It has been signed palliative care experts including Professor Peter Millard, Emeritus Professor of Geriatrics, University of London, Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke’s cancer centre in Guildford, and four others.

“Forecasting death is an inexact science,”they say. Patients are being diagnosed as being close to death “without regard to the fact that the diagnosis could be wrong.

“As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to patients."


http://www.telegraph.co.uk/health/healthnews/6127514/Sentenced-to-death-on-the-NHS.html

Wow. Good link. Horrible story. I see Wesley J. Smith has it, or I was going to send it to him.

We can hope a trans-Atlantic backlash against an anti-human dystopia is starting to emerge, but I need to see the outrageous self-termination plan targeting our veterans receive greater scrutiny and put to an emphatic end.

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