Isn’t that a fair headline?
Update: Over at Le-gal Ins-ur-rec-tion, Cornell Law prof William A. Jacobson dug out an article by Rahm Emanuel’s brother Ezekial, a respected bioethicist at the National Institutes of Health, and suggests strongly that Palin is just contributing to the the debate. In the paper (at Lancet, subscription required, but access to this paper is free because it’s so important), Dr. Emanuel and others discuss how to allocate health care resources to provide the greatest healing among many competing, worthy patients, when resources cannot be allocated to all of the worthy patients. Jacobson said:
Put together the concepts of prognosis and age, and Dr. Emanuel’s proposal reasonably could be construed as advocating the withholding of some level of medical treatment (probably not basic care, but likely expensive advanced care) to a baby born with Down Syndrome. You may not like this implication, but it is Dr. Emanuel’s implication not Palin’s.
Jacobson misses the greater point here, the part the sticks in the craw of those of us who have lived with these issues for 20 years, or 30 or 40: Dr. Emanuel’s paper discusses how to improve the current system of allocation of resources.
We aren’t debating whether to have “death panels.” The discussion is on how to make them work more equitably, and how to expand health care resources to make the need for such decisions less frequent. Palin’s point is to defend unfair death panels used often. She doesn’t know that, and Jacobson should realize that and not defend it.
Here’s the summary at Lancet:
Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.
He’s working to make the death panels more fair, more accurate, more beneficial. Palin suggests we should leave the current system in place where Palin’s death panels, though working hard, often are unfair and inaccurate, and waste resources.
In the present system, resources generally are allocated first on the basis of who has money. De facto, the system writes off to death anyone with a serious disease who is poor. “Poor” in this case doesn’t mean destitute. An annual income of $60,000 would put one into the category of “poor” I’m talking about here.
These critics, however, didn’t take the time to find out to what Palin was referring when she used the term “level of productivity in society” as being the basis for determining access to medical care. If the critics, who hold themselves in the highest of intellectual esteem, had bothered to do something other than react, they would have realized that the approach to health care to which Palin was referring was none other than that espoused by key Obama health care adviser Dr. Ezekial Emanuel (brother of Chief of Staff Rahm Emanuel).
I took the time to find out. I knew in advance. I’ve sat through hours of legislative hearings on this issue. In my opinion, Sarah Palin is still a carbuncle on the face of this debate. Her calling these panels “death panels” is designed to obfuscate the issues and deny the debate Jacobson says we need to have. She’s providing heat for cheap political gain, not light. She’s defending death, not life.
Shame on her. Jacobson should know better, too. I can all but guarantee that Palin didn’t read Dr. Emanuel’s paper, and didn’t consider the issues at all. I’ll wager she does not know that hospitals in her state make these decisions regularly.
Under Palin’s way, death panels already exist. Death panels make decisions on life or death every day, and the poor and uninsured are at the bottom of the scale of who gets to live, top of the list of who gets to die. Uninsured people often get shut out of the process, allocated pain and death from the start, because they lack insurance.
H.R. 3200 doesn’t do much to change this equation, the authors and legislators hoping to avoid cyanide politics like Palin plays; instead the bill encourages programs to help patients be on the “live if I want to live” side of the equation. These encouraged programs should be bread and butter to legal clinics at most law schools, by the way — great help to the poor in anticipating what to do in life-threatening emergencies. (I mention that because Jacobson is a clinical law professor — I don’t know which end of the legal clinics he works in, but he should know better anyway.)
We’ve already got the debate, and we already know that Palin’s trying to poison the well and fog up the lecturn, so that health care resources are misallocated. In reality, this leads to more unnecessary and preventable deaths.
Yes, let’s have the debate: Palin’s wrong to stand with unfair death decisions. She’s had her say, and she should be held accountable.
Agree or disagree, invite others to join the discussion: