That is the question that right-wingers and health-care opponents are forwarding; you have probably heard the claim that Obama’s health care package would lead to the euthanization of seniors.
So, where does this claim come from? One front stems from the fact that Ezekiel Emanuel, noted bioethicist and Chair of the Department of Bioethics at The Clinical Center of the National Institutes of Health (and, least importantly, Rahm Emanuel’s brother) has been tapped as an advisor for the health care reform project. While right-wingers call him “top advisor to Obama,” he is in fact “Special Advisor to Peter R. Orszag, Director of the Office of Budget and Management (OMB),” which means that he’s on a panel of people who are providing input which will shape health care policy.
Why is this even an issue? Well, Dr. Emanuel, as a bioethicist, has naturally written papers on bioethics. When social health resources are limited, triage must be performed–for example, when there are ten candidates for a liver transplant but only one liver is available, who gets it? This is always a controversial subject, and I doubt it is possible to write anything specific which cannot in some way be easily twisted to suggest that the writer is a cold-hearted villain for denying a life-saving procedure to nine people. The fact is, we must choose–the very real application of the question “if you see ten people drowning and must save only one, how do you choose?” You have probably been asked that question at some point in your life and have had to think about how we prioritize life, but for you it was almost certainly a purely academic question. Not so for bioethicists.
The right wing is getting its ammo from a couple of papers written by Emanuel, in which he advocates a triage system which favors younger patients. In a paper titled “Where Civic Republicanism and Deliberative Democracy Meet” (PDF, hosted on a right-wing site) written 13 years ago, Emanuel wrote [emphasis on words highlighted by critics]:
This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity-those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia. A less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason.
This has been taken to mean that Emanuel is suggesting that all health services should be taken away from the elderly and they be allowed to die. A bit of a stretch, of course; while Emanuel’s words “not guaranteeing health services” seem to suggest the removal of all health services, a read of the entire article suggests that he is talking about public-funded health care services which treat the specific irreversible illness–not euthanizing those with illnesses like dementia. Nor is it proffered as an absolute, but rather as a triage device when one must choose between providing government-subsidized care for one person or another in the context of preventing public health care from encompassing every single medical service available and thus breaking the bank (something that conservatives would demand).
A key point here is that the charge is one-sided, and completely ignores that there is a choice being made. The accusation that Emanuel is suggesting we do not provide public medical care for people at the end of their lives suffering from irreversible illnesses could be turned around, and the accusers could be characterized as wanting to deny treatment which could save the life of a child in favor of providing care to someone who is incurably ill and is going to die anyway. They’re baby-killers! Those bastards!!
This is why bioethics is sticky, and is easy fodder for politics: it deals with heart-wrenching decisions that we cannot avoid, and can easily taken out of context and used to wrongly accuse someone of being a cold-hearted killer.
Then consider that this is not being forwarded as the official policy of Obama’s health care plan, but rather is an opinion forwarded by one of many advisors to someone writing the plan in a paper written thirteen years ago. Emanuel is not fully in charge of the plan, is not dictating terms, and there is zero proof that what critics are blasting him for is being adopted in the plan currently before Congress.
A source of more hysterical right-wing frenzy on this is a provision in the health care bill which would add funding for extra optional counseling of people facing end-of-life circumstances:
… such consultation shall include the following: An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to; an explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses; an explanation by the practitioner of the role and responsibilities of a health care proxy.
In essence, the section provides funding for seniors, if they so choose, to meet with health care providers about how to plan for their twilight years, to prepare for death and its consequences. The idea is to give people near the end of their lives all the information necessary to face their situation–not to give up fighting, not to surrender health care. In fact, quite the opposite–this would be an expansion of services for people nearing the end of their lives.
Right-wingers have twisted this into a “mandatory” counseling with government bureaucrats who will tell seniors “how to end their life sooner.”
Not exactly the same thing.
So, as it turns out, the criticisms are completely bogus. Obama is not out to hack grandma to pieces to save a few bucks.
Surprise!