I have warned about the problem of socialist statists in a place where they can decide who lives, who dies.
Commie governments killed 100 million of their own people in the 20th century, according to the Black Book of Communism (Cortois et.al. 1999) so it’s important to keep socialist fanatics in check.
The Nazis, who were socialist statists–used the term ‘useless eaters.’
They also considered uncooperative people, who didn’t obey the state diktats to be expendable, that’s why priests and other dissidents were swept up.
Stalin considered pogroms and purges a cleansing thing.
Zeke Emmanuel is a prominent former Harvard faculty physician, oncologist, ethicist, Physician, National Institutes of Health and Office of Management and Budget Policy maker in the current federal administration. In 2011 he left government for U of Penn Medical School and Wharton School appointments. He has some quality of life called the Complete Lives Systems rules he’d like to apply about who deserves to have resources expended on their health.
Of course being sick moves you onto a lower quality of life so you’d better get well QUICK in the Zeke world of medical resource allocation or you’ll go on the expendable list.
I will give Emmanuel credit for being on the right side of the Euthanasia issue–he rejects legalizing euthanasia unless he changes his mind. He recognizes properly that patients who want to be Euthanized often are depressed, and proper professional care cannot be provided in an environment where Euthanasia is a legal alternative.
I would say it is asking physicians to do something unethical and agree with Emmanuel.
Emmanuel also is against single payer healthcare for sound reasons–which is why we have this current mess of a government dominated but public/private system. Emmanuel promoted a government that shadowed a controlled private insurance sector. His attitude, is not consistent, however, with his almost triumphal declarations that private insurance will be dead when the reform project is over. There are some contradictions in the Emmanuel positions.
The junk science aspect of the Emmanuel proposals for healthcare reform and new leftist attitude is that medical care is supposed to be for the sick and to comfort and aid the elderly, but a new post modernist morality allows one to redefine individuals in terms of relative value of their lives and how much of a burden they might be on the statist collective. Their current contributions to society–yadayada. He calls it the Complete Lives Systems. The most obvious part of the strategy is it diminishes the value of the elderly. Emmanuel defends that aspect just so:
“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.”
No place in the secular, materialist, deterministic, situational ethics for those old-fashioned ethical principles once enshrined as sacred for physicians. People are not precious individuals in the moral doctrines of the Emmanuel crowd, they are cogs in a statist wheel, to be neglected, even discarded, if they are a burden, since the disabled and old and no longer significant contributors are now members of the now to be evaluated for their contributions or burdens on the more important COLLECTIVE. The old/young/disabled/sick/weak/non productive are the modern version of useless eaters.
This is a good discussion that got me going, again about the danger of the fatal conceit and how Zeke may suffer a bad case:
http://www.americanthinker.com/2014/04/ezekiel_emmanuels_reaper_curve.html
Leo Alexander MD consultant to the Nuremberg Tribunal that hanged many Nazi physicians for murderous unethical human experiments and patient abuse like sterilization without knowledge or consent wrote about how professionals can be compromised in their ethics by the state and society.
“Medical Science under Dictatorship”–New England Journal of Medicine July 1949, republished 1996. A wonderful essay, stunning insights.
http://www.physiciansforlife.org/content/view/1333/33/
I have warned about the corruption of Medical Ethics. Emmanuel says that the old ethics is counter productive–results in too much care and concern about patients.
My Essays on bad healthcare policy making and junky myths of policy makers are below and an essay on new versus old bioethics. Jerry Arnett MD, pulmonologist from West Virginny, coauthored the ethics essay.
Dunn–myths of healthcare policy making
www.jpands.org/jpands1504.htm
Arnett and Dunn-Bioethics and rationing
http://www.americanthinker.com/2011/12/the_danger_of_a_new_medical_care_bioethics.html
Some newer ideas are good – living wills for example.
They allow a person to give directives as to not prolonging his/her life under certain circumstances – it must be an individual’s choice.
We should not give governments the right to enact “living wills” for us.
We have already seen what governments will do when given this power. The current government and related entities seem way too eager to accomplish this.
There are many people as severely disabled, many. If you believe this disabled people should be sedated to death, you go with the Liverpool pathway of the UK. I have experience with many severely demented people–good supportive care and witholding certain kinds of care is humane. Food, water, comfort, hygiene are appropriate, antibiotics for pneumonia or resuscitation would not be good comfort humane care. Pneumonia is the old man’s friend. Some dementias are very rapid in progression, some very slow. It is not a monocolor problem, for example Alzhiemers versus mini stroke, vascular disease may be quite different in progression. I am opposed to euthanasia of any kind–what’s left of the human that inhabited the body should recieve respectful care but not care that is intended to kill–there may be some sedations and pain medications that clearly can hasten demise, but not given in order to hasten death.
The concepts in this post don’t stand up to actual experience. My ex-wife, a wonderful home health aide took care of a fellow losing his ciognition. At first he would sit in a straight back chair and gaze at TV. He would smile at people talking to him “Joe you owe me mony” would generate a smile from him. Over several months his brain deteriated to the point where he did not remember how to chew food. My ex would make up a milkshake like concoction that would be emptied directly into his stomach. After a couple hours, she would change his diaper. Was Joe alive? I tjought not, but the wife insisted on the grotesque care.
I enjoyed and agree with your article and now on to the references. Note of and discussion of IPAB, NICE, and QALY might also be appropriate.