1. Welcome to CowboysZone!  Join us!  Come on!  You know you want to!

Ezekiel Emanuel Confirms "Death Panels"

Discussion in 'Political Zone' started by zrinkill, Aug 28, 2009.

  1. zrinkill

    zrinkill Diamond surrounded by trash

    32,996 Messages
    719 Likes Received
    Dr. Ezekiel Emanuel, health adviser to President Barack Obama, is under scrutiny. As a bioethicist, he has written extensively about who should get medical care, who should decide, and whose life is worth saving. Dr. Emanuel is part of a school of thought that redefines a physician’s duty, insisting that it includes working for the greater good of society instead of focusing only on a patient’s needs. Many physicians find that view dangerous, and most Americans are likely to agree.

    The health bills being pushed through Congress put important decisions in the hands of presidential appointees like Dr. Emanuel. They will decide what insurance plans cover, how much leeway your doctor will have, and what seniors get under Medicare. Dr. Emanuel, brother of White House Chief of Staff Rahm Emanuel, has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of the Federal Council on Comparative Effectiveness Research. He clearly will play a role guiding the White House's health initiative.

    Dr. Emanuel says that health reform will not be pain free, and that the usual recommendations for cutting medical spending (often urged by the president) are mere window dressing. As he wrote in the Feb. 27, 2008, issue of the Journal of the American Medical Association (JAMA): "Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely 'lipstick' cost control, more for show and public relations than for true change."

    True reform, he argues, must include redefining doctors' ethical obligations.

    In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the "overuse" of medical care: "Medical school education and post graduate education emphasize thoroughness," he writes. "This culture is further reinforced by a unique understanding of professional obligations, specifically the Hippocratic Oath's admonition to 'use my power to help the sick to the best of my ability and judgment' as an imperative to do everything for the patient regardless of cost or effect on others."

    In numerous writings, Dr. Emanuel chastises physicians for thinking only about their own patient's needs. He describes it as an intractable problem: "Patients were to receive whatever services they needed, regardless of its cost. Reasoning based on cost has been strenuously resisted; it violated the Hippocratic Oath, was associated with rationing, and derided as putting a price on life. . . . Indeed, many physicians were willing to lie to get patients what they needed from insurance companies that were trying to hold down costs." (JAMA, May 16, 2007).

    Of course, patients hope their doctors will have that single-minded devotion. But Dr. Emanuel believes doctors should serve two masters, the patient and society, and that medical students should be trained "to provide socially sustainable, cost-effective care." One sign of progress he sees: "the progression in end-of-life care mentality from 'do everything' to more palliative care shows that change in physician norms and practices is possible." (JAMA, June 18, 2008).

    "In the next decade every country will face very hard choices about how to allocate scarce medical resources. There is no consensus about what substantive principles should be used to establish priorities for allocations," he wrote in the New England Journal of Medicine, Sept. 19, 2002. Yet Dr. Emanuel writes at length about who should set the rules, who should get care, and who should be at the back of the line.

    "You can't avoid these questions," Dr. Emanuel said in an Aug. 16 Washington Post interview. "We had a big controversy in the United States when there was a limited number of dialysis machines. In Seattle, they appointed what they called a 'God committee' to choose who should get it, and that committee was eventually abandoned. Society ended up paying the whole bill for dialysis instead of having people make those decisions."

    Dr. Emanuel argues that to make such decisions, the focus cannot be only on the worth of the individual. He proposes adding the communitarian perspective to ensure that medical resources will be allocated in a way that keeps society going: "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. Covering 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." (Hastings Center Report, November-December, 1996)

    In the Lancet, Jan. 31, 2009, Dr. Emanuel and co-authors presented a "complete lives system" for the allocation of very scarce resources, such as kidneys, vaccines, dialysis machines, intensive care beds, and others. "One maximizing strategy involves saving the most individual lives, and it has motivated policies on allocation of influenza vaccines and responses to bioterrorism. . . . Other things being equal, we should always save five lives rather than one.

    "However, other things are rarely equal—whether to save one 20-year-old, who might live another 60 years, if saved, or three 70-year-olds, who could only live for another 10 years each—is unclear." In fact, Dr. Emanuel makes a clear choice: "When implemented, the complete lives system produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get changes that are attenuated (see Dr. Emanuel's chart nearby).

    Dr. Emanuel concedes that his plan appears to discriminate against older people, but he explains: "Unlike allocation by sex or race, allocation by age is not invidious discrimination. . . . Treating 65 year olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not."

    The youngest are also put at the back of the line: "Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. . . . As the legal philosopher Ronald Dworkin argues, 'It is terrible when an infant dies, but worse, most people think, when a three-year-old dies and worse still when an adolescent does,' this argument is supported by empirical surveys." (thelancet.com, Jan. 31, 2009).

    To reduce health-insurance costs, Dr. Emanuel argues that insurance companies should pay for new treatments only when the evidence demonstrates that the drug will work for most patients. He says the "major contributor" to rapid increases in health spending is "the constant introduction of new medical technologies, including new drugs, devices, and procedures. . . . With very few exceptions, both public and private insurers in the United States cover and pay for any beneficial new technology without considering its cost. . . ." He writes that one drug "used to treat metastatic colon cancer, extends medial survival for an additional two to five months, at a cost of approximately $50,000 for an average course of therapy." (JAMA, June 13, 2007).

    Medians, of course, obscure the individual cases where the drug significantly extended or saved a life. Dr. Emanuel says the United States should erect a decision-making body similar to the United Kingdom's rationing body—the National Institute for Health and Clinical Excellence (NICE)—to slow the adoption of new medications and set limits on how much will be paid to lengthen a life.

    Dr. Emanuel's assessment of American medical care is summed up in a Nov. 23, 2008, Washington Post op-ed he co-authored: "The United States is No. 1 in only one sense: the amount we shell out for health care. We have the most expensive system in the world per capita, but we lag behind many developed nations on virtually every health statistic you can name."

    This is untrue, though sadly it's parroted at town-hall meetings across the country. Moreover, it's an odd factual error coming from an oncologist.

    According to an August 2009 report from the National Bureau of Economic Research, patients diagnosed with cancer in the U.S. have a better chance of surviving the disease than anywhere else. The World Health Organization also rates the U.S. No. 1 out of 191 countries for responsiveness to the needs and choices of the individual patient. That attention to the individual is imperiled by Dr. Emanuel's views.

    Dr. Emanuel has fought for a government takeover of health care for over a decade. In 1993, he urged that President Bill Clinton impose a wage and price freeze on health care to force parties to the table. "The desire to be rid of the freeze will do much to concentrate the mind," he wrote with another author in a Feb. 8, 1993, Washington Post op-ed. Now he recommends arm-twisting Chicago style. "Every favor to a constituency should be linked to support for the health-care reform agenda," he wrote last Nov. 16 in the Health Care Watch Blog. "If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration's health-reform effort."

    Is this what Americans want?

    http://sbk.online.wsj.com/article/SB10001424052970203706604574374463280098676.html?mod=rss_Today%27s_Most_Popular


    .
    .
    .
    .
  2. JBond

    JBond Well-Known Member

    6,726 Messages
    36 Likes Received
    I posted his ratio of spending vs age and people said it didn't mean anything. They claimed it was academic. Well now that he is running things, it's not so academic.
  3. zrinkill

    zrinkill Diamond surrounded by trash

    32,996 Messages
    719 Likes Received

    How can anyone say that Palin was wrong now?
  4. ShiningStar

    ShiningStar Well-Known Member

    6,290 Messages
    556 Likes Received

    They didnt, democrats attack the person not the facts. They dont say shes wrong, they dont show if she was wrong, they just attack her. The problem is now shes not grounded as she was before and now THEY really fear her.
  5. zrinkill

    zrinkill Diamond surrounded by trash

    32,996 Messages
    719 Likes Received
    There was quite a few people saying she was wrong in that thread.

    I am waiting on them to explain "Dr" Emanual's comments.
  6. ShiningStar

    ShiningStar Well-Known Member

    6,290 Messages
    556 Likes Received

    Well since we'll be waiting a long time, you have a deck of cards or something? :D
  7. Angus

    Angus Active Member

    5,064 Messages
    1 Likes Received
    For the people who are comfortable with the Emanuel concept regarding physicians, most of whom will be young, healthy, and not anticipating severe medical problems in the future, certainly not end of life decisions about them personally made by somebody else, I wonder if they would be comfortable with the legal profession adopting a similar concept?

    Suppose lawyers adopt something akin to the Emanuel concept. You hire him to represent you in a business deal to rent a building that some other people also want to rent. He gets your OK to make a bid and does, but finds that someone else who bid, though their bid was not as good as yours, intends to use the building for a 'greener' use than you intend.

    Would you feel betrayed if your lawyer withdrew your bid without your consent and let the other person have the rental because it would be better for the social environment? Or, if he represented you in a criminal matter and, because he decided it would be better for society if you were locked up, puts up only a half hearted defense or pleads you guilty against your wishes?

    Obama has put this country on a slippery slope in more ways than one.

    ;)
  8. Temo

    Temo Active Member

    3,723 Messages
    15 Likes Received
    It seems to me that he's saying this:

    - If you can pay for your healthcare, go ahead and do it.

    - If you can't pay for something and the public is shouldering the cost (say the cost of cancer treatment for the poor), then you receive care according to the greatest soceital good. Therefore, the person who is in their 20s, has a great shot at beating the cancer and can benefit from a long, productive life if they beat cancer gets priority over the person who is 80 and not likely to beat the cancer.

    The public can't pay for everything, so we have to decide who can get the most good out of the resources we have.

    K, now let me hear the opposite side, with as little name calling as possible (though I know some of you can't help yourselves).
  9. JBond

    JBond Well-Known Member

    6,726 Messages
    36 Likes Received
    See, that is were you and I go separate ways. You could have stopped with the first sentence. You pay for the stuff you want and I pay for the stuff I want. Stop asking me to pay for your stuff.
  10. ABQCOWBOY

    ABQCOWBOY Moderator Staff Member

    34,805 Messages
    1,699 Likes Received
    I think that before I can answser that Temo, I would have to understand a bit better what the precentages are of cancer survival. Do statistics prove that young people who have cancer survive longer once succesfully treated? I don't know.

    The problem here is that older people, who have retired and worked their whole lives have paid into the system. You can't just take that away from them.

    I liken this to somebody who has served in the military. If I'm making a decision between a guy who is short and a guy who has no time in, I'm going to pick the guy who is short, all things equal. The guy who has put in his time gets the benefit because he's paid his dues already. That's kinda how I see it with the elderly.
  11. joseephuss

    joseephuss Well-Known Member

    21,241 Messages
    1,176 Likes Received
    His comments are a separate issue from what was actually proposed. The propose bill did not force anyone to sign DNRs or anything that would end their lives. It gave them the option to talk to their doctors about end of life matters. It was still the patient that determined if they wanted to even discuss it. Even if they did discuss it they had the right to choose treatment options. Some may sign a DNR and some may say do what you can to keep me alive.

    His comments don't confirm a death panel at all. He may be for a death panel, but that was not what was written in the proposed bill. I don't even see his comments as being pro-death panel. That is a rather extreme interpretation of his comments.

    I think people do need to be more aware of end of life matters especially as we get older. That doesn't mean such things as DNRs or any medical services less than wanted should be forced upon people. We should just be aware of our options and our options should remain options. Our doctors should also make us aware of all of our options and then let us make the decisions. As far as I can tell the proposed bill still leaves the decisions up to the patients and not the doctors.
  12. TheCount

    TheCount Pixel Pusher

    20,980 Messages
    988 Likes Received
    This, to me, is the main problem here. In the end the issue is money, if I've lived my whole life paying into the system (which I may, or may not have taken advantage of), what right does the government have to say that I, as an 85 year old, do not deserve care as good as a 20 year old?

    I think the term death panel is political fluffery (and I even doubt that this article is directly related to the health care proposal), it sure sounds sinister but the truth is that once you get in a situation where the government controls the funds, at the end of the day they will make some decisions based on cash flow, for better or worse.
  13. joseephuss

    joseephuss Well-Known Member

    21,241 Messages
    1,176 Likes Received
    That is true of private business(insurance companies) as well.
  14. Angus

    Angus Active Member

    5,064 Messages
    1 Likes Received
    joseephuss, that is a reasonable argument, but it won't carry the day with most people affected, I believe because, whatever the present intent of the legislation might be, it will be subject to the interpretation of future bureaucrats and a capricious Supreme Court.

    The U.S. government is not trustworthy. That's where the 'living constitution' has left us. If the original intent of the Constitution is no barrier to finding new, court-discovered constitutional 'rights' in the 'penumbra' of the official document, there is no reason to think the original intent of of a law will be honored. If it can be wrongly used, one must expect that it will be wrongly used.

    :cool:
  15. joseephuss

    joseephuss Well-Known Member

    21,241 Messages
    1,176 Likes Received
    I can agree with that. I think the same applies to the current system of insurance and medical care. If it can be abused it will be abused. And not just by the providers, but patients as well.
  16. jimmy40

    jimmy40 Well-Known Member

    15,141 Messages
    290 Likes Received
    What if the 20 year old is a worthless idiot with kids and the 80 year old is the worthless idiot's grandfather who is having to raise the kids?
  17. ABQCOWBOY

    ABQCOWBOY Moderator Staff Member

    34,805 Messages
    1,699 Likes Received
    That is my fear as well. I mean, lets be reasonable. Nobody here believes that it's a bad idea to provide education on how best to deal with death when your time comes. Living wills, steps that can be taken to make it easier when for your surviving families to deal with it. Those are all very good, very positive things. Unfortunatly, we have a credability issue with the current Administration. It's not entirely their fault because this distrust of Government has been building for some time. If the opportunity is their for something to be taken advantage of, somebody within government will do it. I think it's very important that nothing is passed that could allow for misusage of power in the future. This healthcare bill could allow for that because of how its written. That's a valid concern IMO. It's not too much to ask that we get legislation that safe guards us from future idiots who may be elected.

    :)
  18. arglebargle

    arglebargle Well-Known Member

    5,034 Messages
    144 Likes Received
    Good discussion. Though I think the foofaraw over just the discussion of DNR or living wills is more of a political wedge or, alternately, hysterics.

    How many of you have been faced with this descision for a loved one? I have. And it is very tough. But it's a lot easier if you know exactly what the person in question would have wanted. Some have brought up that this shouldn't just be a checkmark on some paper. It really should be something worked out with those on whose shoulders it may fall. But you do the best you can. The more serious the consideration the better.

    So, put some failsafes in it. Do the best you can. It's not like the current situation is all that different. And I certainly don't think the insurance exec (or intern) that might be making these calls on paying for my treatment is that much greater a choice than a government bureacrat.
  19. Angus

    Angus Active Member

    5,064 Messages
    1 Likes Received
    Right. But patients can vote with their feet to find a different insurance carrier that will treat them better - they think. Can't do that locked in to a government program.

    :D
  20. arglebargle

    arglebargle Well-Known Member

    5,034 Messages
    144 Likes Received
    Not if you are getting it through your job, especially if you work for any sort of larger company. And you didn't even get to make the decision on the insurance available there. Some exec who will never be tied to that insurance made the decision, and most of the time it was based on the bottom line, and not the services to be rendered.

    This is why the modern insurance model fails the free market test. The person who buys it is not the person who really uses it, and the user can't move to something different.

Share This Page