Monday, August 10, 2009

The Newest Member Of The Truth’s “Death Panel”

William A. Jacobson, a conservative professor of law at Cornell University, has taken the task of defending Sarah Palin on the use of the term “death panel” and the claim that Barack Obama would kill her son with down syndrome. Palin wrote on her Facebook page:
“The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.”
Jacobson defends Palin on the use of two terms “death panel” and “level of productivity.”

In his defense Jacobson states that Palin is explaining a concept developed by Ezekial Emanuel, a bioethicist, written in a paper titled “Principles for Allocation of Scarce Medical Interventions,” published in The Lancet in January 2009. Jacobson writes:
“While Emanuel does not use the term ‘death panel,’ Palin put that term in quotation marks to signify the concept of medical decisions based on the perceived societal worth of an individual, not literally a ‘death panel.’ And in so doing, Palin was true to Dr. Emanuel's concept…”
Neither Palin nor Jacobson took the time to describe the scope and aim of Emanuel’s paper. The scope of the paper and the preceding research is to examine existing concepts of distributing scarce medical commodities, such as organs, vaccines or even hospital beds efficiently. Efficiency in terms of this proposal is a measure of survivability or the expected life of the recipient of the scarce resource. I don’t want to get very deep in discussing the Emanuel paper. You can read it from the link provided at the bottom of this post. Emanuel evaluates three systems for distributing the medical resources and discusses their advantages and disadvantages. He also proposes a new systems he calls Complete Lives. Complete Lives as Emanuel describes, “prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.”

The discussion that Emanuel has engaged here is not a simple one. It has inherent life and death questions. As well as issues of fairness. Unfortunately Palin criticism is simple and ignores the question of scarcity. She does not ask the question “Who gets the heart for transplant?” Instead she tells us that a proposal, not legislation, by an academic bioethicist, is going to kill her parents and her child. She ignores that fact that if her father gets the heart someone doesn’t. Scarcity means not everyone gets some. The “death panel” as she calls it would take into account age and prognosis. That is practical. As cold as it sounds I want bioethicists to make statements such as:
“Ultimately, the complete lives system does not create ‘classes of Untermenschen whose lives and well being are deemed not worth spending money on’, but rather empowers us to decide fairly whom to save when genuine scarcity makes saving everyone impossible.”
Jacobson writes:
“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.”
Organ donation is as close as we get to a zero-sum situation. We already withhold medical treatment from people. Let me correct that, we can’t withhold a heart that has already been given to someone. I did not read anywhere in the Emanuel article the call for withholding treatment from people with Down Syndrome. What I did read was prioritizing people by age. The term “instrumental value” may give people pause, include Palin, because it can be a measure of future usefulness. But it is a concept that many support inherently in the statements that support our troops, first responders and our leaders.

After defending Palin on Jacobson writes:
“Certainly, no Democrat is proposing a ‘death panel’, or withholding care to the young or infirm. To say such a thing would be political suicide.”
Should he not turn his criticism at this point to Palin. She is putting out this idea that the President is forming “death panels” to kill old people and disabled babies. He does not, instead he writes:
“But one interesting concept which is central to the concepts being discussed is the creation of a panel of "experts" to make the politically unpopular decisions on allocating health care resources.”
At this point Jacobson takes the role of Sarah Palin as fear-mongerer. He is referring the MedPAC program developed in 1997 to advise Congress on how to cut costs of Medicare. The President has spoken about this program many times. Barack Obama has said in a letter to the Senate:
“I am also open to your ideas about giving special consideration to the recommendations of the Medicare Payment Advisory Commission (MedPAC), a commission created by a Republican Congress. Under this approach, MedPAC's recommendations on cost reductions would be adopted unless opposed by a joint resolution of the Congress. This is similar to a process that has been used effectively by a commission charged with closing military bases, and could be a valuable tool to help achieve health care reform in a fiscally responsible way.”
Will MedPAC allow the government to kill the old and disabled babies? Jacobson writes:
“Will such a commission decide to curtail allocation of resources to those who are not deemed capable of ‘complete lives’ based on prognosis and age, as proposed by Dr. Emanuel? There is no way to tell at this point since we do not have a final Democratic proposal, or know who would be appointed to such a commission.”
No legislation. No Proposal. He is correct. There are five bills in congress but no proposal. The Complete Lives idea is not a proposal, Emanuel writes:
“Accepting the complete lives system for health care as a whole would be premature. We must first reduce waste and increase spending. The complete lives system explicitly rejects waste and corruption, such as multiple listing for transplantation.”
Jacobson is wrong about not knowing who is on the commission. Here is a link to MedPac and here is an announcement of who is on the commission.

It is disturbing that a law professor at Cornell University would defend the misleading statements by Sarah Palin. And in that defense imply that Barack Obama is considering the Emanuel proposal as a cost cutting measure.

William Jacobson the newest member of the truth’s “death panel.” Sphere: Related Content

11 comments:

Neonightcrawler1 said...

this is a Harvard law professor?

The Observer said...

He teaches at Cornell Law

Anonymous said...

Thanks for pointing me to this.

Anonymous said...

If you don't have insurance coverage, this is all moot, right?

Interesting that a person's worth to society is based on their wealth. Especially in a "Christian nation."

Anonymous said...

I say, "Kill old disabled babies!"

Dave said...

Organ donation doesn't have to be a zero-sum game. If donated organs are allocated first to registered organ donors, an incentive is created for non-donors to become donors. So the supply of organs increased.

LifeSharers has implemented this idea. Check it out at www.lifesharers.org. Membership is free. You can donate your organs to other organ donors, and you could save your own life in the process.

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