Euthanizing Children in the US – Yes, it’s Here

The latest edition of a prestigious medical journal, The Archives of Pediatrics and Adolescent Medicine, has published a very disturbing piece of research. While the study is very small, the fact that it was done at all suggests that there might be a larger problem across the country: Euthanizing children right here in the US.

The study, of course, doesn’t talk about euthanasia. Here’s the title: “Considerations About Hastening Death Among Parents of Children Who Die of Cancer.”

I see. It’s not euthanasia, it’s hastening death. Sounds so much more, well, clinical, don’t you think?

Essentially, the researchers wanted to know, in terms of actual cases and presented possible scenarios, what parents’ attitudes were toward euthanasia when a child was terminally ill with cancer. No surprise, the more the actual case or scenario involved high levels of pain and suffering, the more likely parents were to consider euthanasia

Sorry, I meant “hastening death.”

Now, if the study only used contrived scenarios, the findings would be important, because they show, among other things, that parents are ignorant of palliative measures that can make terminally ill children comfortable in their final days.

However, among parents interviewed who literally had terminally ill children with cancer, there were several who actually discussed euthanasia for their child with their doctor, and, in three instances, where parents reported that the euthanasia was carried out.

Frightening, and even more so when you consider how small the study was.

And, it’s absolutely probable that if it‘s happening in the two hospitals covered by the study, it’s going on all over the country behind closed doors after whispered conversations.

Killing children because the are sick.

Here in these United States.

This is how things started in the Netherlands.

Let’s so all we can to make sure it doesn’t happen here.

Futile Care – Who's for the Blood and Gore?

Today the New York Times has a piece about the dilemmas of futile care.

What is futile care?

Glad you asked.

Futile care is essentially the idea that for many patients, there comes a point where medical treatment is useless, because it will not improve their condition. On its face, this seems reasonable, except for at least two points. One, we had better be careful about what we define as futile care. Why? Because, increasingly, feeding and hydration are being classified as medical treatments, ergo, they can be judged as medically futile and therefore withdrawn. Two, futile care arguments slip very easily into the realm of doing what’s cost effective. How so? Well, if there is an expensive medical intervention (and almost all medical interventions for these patients are expensive) wouldn’t the treatment be better utilized on someone who has a much better chance of getting better?

The NYT piece shows how biased the media has become when reporting on end-of-life issues, because it goes out of its way to tell us how awful and horrific end-of-life interventions can be.

The piece makes a stab at balance, noting that not all doctors think futile care is the way to go, and also acknowledges that sometimes it is more loved ones’ denial of the obvious, if painful reality. That’s fair enough – as far as it goes.

But read the opening sentence:

Aggressive treatment at the end of life — frantic CPR for a brain-dead accident victim, inserting a feeding tube in a dying Alzheimer’s patient — has become a staple of the health care debate. Critics argue that vast resources are squandered on care that is obviously futile.

No exactly nuanced, and it sets an unfortunate tone, especially entertaining the notion that it’s OK to starve Alzheimer’s people to death.

It goes downhill from there. Soon we are in the grimly grotesque world of a twenty-first century Frankenstein:

The subject of the first essay was a 2-year-old boy, severely brain-damaged from a birth defect. He was dead — his heart had stopped. His doctors and nurses knew that no matter how hard they might try to resuscitate him, they would never succeed. But they tried anyway; aggressively jamming large bore needles into his chest, pounding on him, applying paddles to shock his heart. One nurse was so upset she almost vomited.

Medically, this is accurate, I suppose. But you could couch open-heart surgery, drilling into a patient’s brain to relieve bleeding or even stitching up a gaping wound in exactly the same way – many medical interventions are gory, but that doesn't mean we don't do them. If we didn't, we'd never perform transplant surgery, amputations that save lives, or reattaching a severed limb, all interventions that are very often successful and for which patients are very grateful.

Later, in discussing CPR, the Times again prefers the gory option:

It’s a violent procedure, Dr. Helft said, “very invasive and disturbing.” Medical personnel press on a person’s chest with such force that they break ribs. They stab large bore needles into the chest to administer fluids and drugs. They shock the heart with bursts of electricity.

Well, not exactly. CPR does not necessarily mean ribs get broken. It's possible, and sometimes it happens, but suggesting that it's always the case is bunk. Emphasizing the gore betrays where the writer’s sentiments lie.

Here’s a further quote about that same little boy:

Dr. Helft explained why. “In a sense what it does is, it says that we are doing this procedure, using this procedure on the boy to benefit the family,” he said. “We are using this boy as a means to an end, an end unrelated to his own well-being. You will hear clinicians say this all the time: ‘Even though the patient is already gone, we are treating the family now.’ There are lots of other ways the family can be treated.”

OK, I see - the boy’s wellbeing was to be dead. That’s not a cynical observation. If you read much of the medical literature you can’t get away from the perception among many that death is a form of wellbeing over living and suffering.

Just like for your pet dog.

Let me be clear: There is clearly a time when reality means all medical efforts should cease. However, the trick is to know when to desist - and therein lies the judgment of the medicos, who are very far from perfect in what they can prognose.

The way they see it, however, Doctor Power should prevail.

Let’s look at the second reported case, DeeDee, an elderly woman with advanced Alzheimer’s disease who was subjected to “aggressive” resuscitation efforts and survived:

DeeDee was saved. She’s still demented, of course, and cared for round the clock by dedicated attendants.

See? What a waste of time, effort, and money. We still have to care for this demented woman around the clock, such a waste of energy and money.

Money spent on a demented old lady could have been better spent on people who are in their right mind.

Frightening.

Frances Inglis Does Not Deserve to be on Trial for Murder. . . No, wait . . .

The UK press has been all atwitter about a sensational murder trial now under way in London. I’m not sure why, given the general cheerleading done by the UK media for assisted suicide and euthanasia.

On trial at the Old Bailey is Frances Inglis:

In 2007, Inglis’ son, Thomas, had been involved in some kind of altercation and was being taken to hospital by ambulance. His injuries were apparently minor. However, Thomas jumped from the ambulance, hit his head on the road, and sustained severe brain damage. He’s been in a deep coma ever since, although medical consensus was that since the accident he had been making some improvements and could well have recovered some function.

Too bad his mother was Frances Inglis. She immediately became obsessed with ending his life, repeatedly making the case to anyone who would listen that she did not think any treatment was in her son's best interest. She visited her son almost constantly and was described by Thomas’ brother, Alexander, as “obsessive and negative.”

She took matters into her own hands – twice.

Only 10 days after the accident, Inglis decided that she had to “put her son out of his misery.” So she injected him with a lethal dose of morphine. While Thomas was successfully resuscitated, he had been without oxygen long enough that his brain damage was much worse.

Frances Inglis was not a happy camper.

Not because she was arrested for attempted murder, but because her son was still alive.

What’s a mother to do?

Why, try again, of course.

And she did.

Out on bail, a condition of which was that she go nowhere near Thomas, she disguised herself as Thomas' aunt, fooled the nurses, and injected Thomas with a fatal dose of heroin.

Horrific, I think we can all agree. However, I must say that I don’t know what all the fuss is about.

Let’s be clear, shall we?

Frances Inglis and the pro-euthanasia and assisted suicide crowd are pretty much on the same page of the playbook:

They both see killing people as a way to put them out of their misery.

They would both agree that Thomas’ life was not worth living.

They would both think killing OK because there’s little or no quality of life for people in this condition.

They would both acknowledge that people in persistent nonresponsive states are as good as dead, so killing them is not a problem.

I think Frances Inglis is getting a bad rap.

If she had pulled a Debbie Purdy and fought passionately in the press to take Thomas to Dignitas in Switzerland for assisted suicide, just as the parents of Daniel James did, she’d be a free woman.

She’d also be a hero instead of a murderer.

Gotta Love the Dutch, Those Merciful Killers!

Let’s open the New Year as we left the old year, shall we?

You know - that part about how we are now becoming quite accustomed to killing people because somebody has decided they are not worth keeping alive.

All in the decedents’ best interests, of course.

Media in the Netherlands reports that there was an increase in the number of people euthanized in 2009 – including people in the early stages of dementia. No surprise there, but I think it’s instructive to look at what is reported, and the subtle subtexts that are nevertheless coercive in slanting a favorable impression of medicalized killing.

Sidebar: I’m not suggesting that the reporter deliberately thought this through, but I think it’s obvious that things in the Netherlands are so pro-euthanasia that the article’s bias is assumed to be “balanced coverage,” which it’s not.

From a piece DutchNews entitled More Cases of Euthanasia in 2009.

First, the obvious is reported, that there were more 200 more cases of euthanasia in the Netherlands last year than 2008, where the killing total was 2,500.

Then:

It is not known how many cases of mercy killing there actually are in the Netherlands, but in 2007 experts said around 80% of instances are registered with the monitoring body.

Well, mercy for whom, exactly? What exactly is the nature of this “mercy?” How can we be assured that the “mercy’ is not for those left behind who found the patient too much of a burden? What about the survivors benefitting from such “mercy” as they inherit goodies from the person they coaxed to assume a duty to die? No way to tell, of course.

“Merciful” because people are in unbearable pain and suffering? Not exactly, because many people who are euthanized are not in pain, and because, in the Netherlands, you can request euthanasia for just about any reason at all, pain or no pain.

Also, after all the fanfare in the Netherlands about making euthanasia legal so that it could be officially controlled, what do we find? Well, it’s not controllable.

Remember, too, that the registering “monitoring body” (sounds so nice, certain, and transparent) is a review panel that examines the circumstances of the killing AFTER it has occurred.

Now, here's the next snippet that contradicts the whole pain-and-suffering angle:

There were also six registered cases of euthanasia on elderly patients with senile dementia, all of whom were in the early stages and able to make their wishes known.

Ah, I see. Where to begin? Dementia, though tragic and unfortunate, is not physically painful (originally, at the top of the slippery slope, euthanasia was ONLY for untreatable physical pain among the terminally ill). Psychologically painful? Clearly, for persons who are aware that their faculties are diminishing, but how do other people make this determination? (Those with dementia don’t euthanize themselves, after all). Where is the bright clear line between someone with early dementia who requests euthanasia (in their right mind, so to speak) and someone who’s condition is more far advanced and is judged not competent to request euthanasia?

Don’t worry, the Dutch doctors have a solution for this latter group – they kill them too. The explanation? Had these people been in their right mind, they would have requested euthanasia anyway.

On we go:

The law states a number of criteria, which must be met before euthanasia can be administered. For example, the patient must be suffering unbearable pain and the doctor must be convinced the patient is making an informed choice. The opinion of a second doctor is also required.

More shooting fish in barrels here: Where’s the “unbearable pain” in dementia? How can a doctor ever possibly be sure that, knowing a diagnosis of dementia has already been made, calibrate that the dementia is not affecting the request for euthanasia?

Short answer, I’m afraid: All the contortions of logic and single-mindedness betray, with increasing smugness, that in many places we have decided who should live and who should die.

First those who are terminally ill and in untreatable pain. Then people who are not terminally ill but who might have physical or psychological pain. Then people who are judged to never be able to have a better quality of life. First adults. Then children.

Who’s next?

Useless Eaters . . No, Wait, “Complete Lives”

As jackbooted healthcare legislators attempt to force on us a bill that most people don’t want and that we can’t possibly pay for, we had better understand what this will likely mean.

First: The government will become your doctor.

Here’s how it will work:

You go to your doctor with symptoms a, b, and c.

After tests, your doctor or a specialist makes a diagnosis which determines what medical treatments are necessary.

The government is paying for your treatment, so the government decides which treatment you should get - if any at all.

The treatment the government decides you should get may well be based on a proposed treatment allocation idea called the Complete Lives System and devised, among others, by Dr. Ezekiel Emmanuel, President Obama’s Special Advisor for Health Policy.

The policy is laid out on a recent article in the Lancet. This from pages 428-429:

When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated . . . the complete lives system justifies preference to younger people . . . Additionally, the complete lives system assumes that, although life-years are equally valuable to all, justice requires the fair distribution of them.

Here’s what this means in plain language:

1. The Complete Lives System will divide Americans into those who are more worthy of treatment and those who are less worthy of treatment. Top priority will go to those between 15 and 40 (because they have the best potential for longer, healthier, and more productive lives, that is, “complete lives”).

2. The youngest and oldest will have less chance of a shot at medical treatment because, statistically, the chances of them attaining "complete lives" are much lower than among 15-40 year- olds.

3. Oh, yes, and even those lucky 15-40 year-olds who make the privileged cut might not get what they need, because “complete lives” will have to be distributed “justly” across the population.

There it is:

Living, or have great potential for a “complete” life? Between 15 and 40? The Government will likely OK necessary medical treatment (unless, of course, what should have been coming to you needs to be “justly" given to someone else).

Living, but don’t have such a great potential to get to a “complete” life? Younger than 15? Older than 40?

You are judged incomplete. You are damaged. You have little potential for attaining completeness.

Complete, you live.

Incomplete, you die.

If You’re Not Conscious, You’re Dead

Over the last few days the media have been marveling at the story of Belgian Rom Houben. In 1983, at age 20, Rom was severely injured in a car accident. He was diagnosed as being in a persistent non-responsive state (derogatorily often referred to as a persistent vegetative state).

Doctors using the standard diagnostic protocols reconfirmed Rom’s diagnosis several times over the years. Medical opinion was that he was severely brain damaged and permanently unconscious.

Doctors urged that his nutrition and hydration be removed so that he could die.

Thankfully, Rom’s mom refused.

For 23 years.

Then, enter Dr. Steven Laureys, who used state-of-the art diagnostic technology (unavailable until very recently) to examine Rom’s brain function.

Surprise, surprise.

Rom’s brain function was almost normal.

Bigger surprise: Rom was conscious.

He had been conscious for every one of those for those 23 long years, but was physically completely unable to move to tell anyone (he can’t even cry).

Using a fairly low-tech communication board and the tiniest movement of one finger, he’s now connected to his loved ones and the world.

Much of the media, and many bioethicists, are falling over themselves to spin this as the rarest of events.

Nope – there are hundreds of similar cases reported and validated worldwide.

Here’s the chilling part (after you get over trying to imagine what it’s like to be able to hear everything going on around you for 23 years but can’t let anyone know):

Bioethics is well on the way to redefining what death is. If some get their way, Rom would have most decidedly been pronounced ”dead” after his initial diagnosis years ago because others would have decided that (a) Rom had no quality of life and (b) because keeping people like Rom alive is futile, his organs could have been harvested for transplantation.

Making lemonade out of lemons, so to speak.

Imagine the unspeakable horror of being conscious and being starved and dehydrated to death, or euthanized for your organs.

No doubt in my mind that it’s already happened – repeatedly.

I’m also left with an even more heartrending question:

What might have been if Terri's husband had allowed Dr. Laureys to examine Terri Schiavo?

First They Came for the Mammograms….

There’s been a great deal of consternation over the last few days about the US Preventive Services Task Force recommending new guidelines for breast cancer screening and evaluation. Essentially, the task force recommends that routine screening begin at age 50 and is probably statistically useless after 75 or so. They further suggested that breast self-examination is so unreliable that women shouldn’t bother.

The history of when to begin screening women for breast cancer has a long history, as noted by ABC News. The guidelines have shifted over the years depending on what the latest studies showed.

It’s also important to understand that conflicting findings are very common in all forms of research and often leave the public confused or increasingly unwilling to believe in the accuracy of any research findings at all.

The task force’s report, however, concerns me for two other reasons.

First, the recommendations are based on statistical significance. All that means is that across all women, the most likely age for getting breast cancer is around 50 or older. Also, across all women, screening after 75 is not recommended because, statistically, they are near the end of their lives anyway.

See the shift? Breast cancer intervention based on probability, not individual medical needs.

Second, the recommendations will inevitably lead insurance companies to adopt the guidelines, which are obviously in their favor, because they can justify not paying for mammograms for women younger than 50 or older than 75. And if insurance companies know anything at all, it’s about probability and statistics.

Which brings us to rationing. The US Senate will debate its healthcare monstrosity tomorrow. Aside from all the other spending-into-oblivion by the current administration, the money to be spent in this bill will inevitably result in needed medical care far, far outstripping the resources to pay for it.

Decisions will have to be made. Some will get breast cancer screening, others will not. Guess what this will mean for your 76 year-old mother?

But the Obama administration didn’t wait for the prestigious semi-independent US Preventive Service Task Force. They have already set up an official government mechanism for using research to justify rationing: The Federal Coordinating Council for Comparative Effectiveness Research Membership.

A whole new bureaucracy to tell us what care we may or may not get by telling us that the “research” has made it so.

The government giveth, the government taketh away.

Death by Following Orders

Law enforcement types are well aware of the phenomenon called “Death by Cop.” Death by Cop is a way for some disturbed people to commit suicide without having to do the deed themselves. Do something threatening and dangerous in front of officers with their weapons drawn, and off you go.

I think we need a new term: Death by Following Orders.

Read on.

Two years ago, 26 year-old Kerrie Wooltorton killed herself by drinking auto antifreeze mixed with soda. By most accounts Kerrie had severe psychological problems of depression and suicidal ideation. As best anyone can piece together, it was mostly related to a medical condition that meant she could not have children. She had tried to commit suicide before but had always been revived by hospitals and doctors who got to her in time.

But Kerrie was determined to die – if only she could stop herself from getting saved. So Kerrie figured out how to do Death by Following Orders.

Here’s how she did it:

Kerrie knew that for the last several years the UK has been immersed in the assisted suicide and euthanasia debate. She surely watched as the pro-death lobby chipped away at the age-old social taboo of assisted suicide and euthanasia.

Kerrie also knew that in 2005 the UK’s Mental Capacity Act had introduced living wills (advanced directives) whereby those with terminal illnesses, as long as they were of right mind, could legally decline any or all future medical treatment. She also knew that if the directive was valid, its conditions had to be respected by all medical personnel under penalty of civil prosecution or even criminal charges.

Kerrie, in her psychological and emotional turmoil, got desperately and horribly creative. She was determined to kill herself but she didn’t want to suffer and she didn’t want to die alone.

So, three days before her death, she wrote out her advance directive that should she be admitted to a hospital for any reason, she would (legally) refuse all treatment.

The die was cast.

On September 18^th, 2007, Kerrie drank the antifreeze and then called an ambulance. At the hospital she presented her advance directive to the staff. As the Telegraph noted:

The will said that if she called for an ambulance it was not because she wanted life-saving treatment but because she did not want to die in her flat alone or in pain.

She died the following day.

Last week an inquest ruled that the doctors and hospital had acted exactly as the law intended in not treating Kerrie because had they done so, they would have been committing an illegal act. Here’s Coroner William Armstrong’s cold observation:

She had capacity to consent to treatment which, it is more likely than not, would have prevented her death. She refused such treatment in full knowledge of the consequences and died as a result.

Kerrie followed the rules.

The hospital followed the rules.

The doctors followed the rules.

The law ordered that Kerrie should die.

Kerrie knew that.

The hospital knew that.

The doctors knew that.

Tragically, Kerrie got everything she wanted.

She died.

She didn’t die alone.

She didn’t die in pain.

Death by Following Orders, indeed.

Life Not Worth Living? The Obama Administration Thinks So – at Least for Veterans

We have a rule in our family: Whenever we see members of the US military, we stop, shake their hand, and thank them for their service. As a naturalized citizen, I add my own piece: The United States has offered me immense opportunity that even as a (then) privileged white South African, I could never have had, and that it is the service of our military that has kept me safe and free to pursue the American Dream.

However, it’s getting difficult to keep thinking that our government actually appreciates our veterans just like my family does, after reading the Veteran’s Administration’s (VA) end-of-life booklet, “Your life, Your Choices.”

The document, written by the Clinton Administration, was later withdrawn by the Bush Administration, but it’s been in play since being reintroduced by the Obama Administration this past February.

With some parts of the media beginning to sniff around the document, the Obama Administration, trying to head off another PR disaster, today hastily added a note to the booklet’s webpage (the page has since disappeared altogether):

The document is currently undergoing revision for release in VA. The revised version will be available soon.

Nonsense. The administration got caught on the wrong foot, when somebody noticed what it really thinks of the value of Vet’s lives - as policy, in black and white, for everyone to see.

It’s a disturbing document, because woven among many paragraphs that are informative and clear, is the rather ominous notion: Veteran’s lives might, at some point, no be worth living.

Yes, you read that correctly.

A powerful branch of the Obama Administration, the VA, is now clearly in the business of helping citizens decide whether they should live or die.

Lest I be accused of “fishy thinking,” let’s go to the actual document, p. 21, where your government asks our sick veterans:

What makes your life worth living?

Think I’m stretching things? Read on.

After asking this question, What makes your life worth living?, the document tries to “help” Vets answer it. To do this, the VA thoughtfully provides a series of sub questions to be answered on a scale from

Difficult, but acceptable, to

Worth Living, just barely, to

Not worth living.

Here’s a sample of the sub questions to be answered through the scale above:

d. I am in severe pain most of the time.

p. My situation causes severe emotional burden for my family (such as feeling worried or stressed all the time).

q. I am a severe financial burden on my family.

I am not making this up.

Go just two pages later to the section entitled “Hope of Recovery” (p. 23). Here the quality of life issue is raised again in terms of chances for recovery from a serious illness.

(Sidebar: It doesn’t say a terminal illness, just that you won’t get back to where you were before your turn for the worse):

Imagine that you are seriously ill. The doctors are recommending treatment for your illness, but the treatments have very severe side effects, such as severe pain, nausea, vomiting, or weakness that could last for 2-3 months.

I would be willing to endure severe side effects if the chance that I would regain my current health was:

high (over 80%) [Yes, Not sure, No]

moderate (50%) [Yes, Not sure, No]

low (20%) [Yes, Not sure, No]

very low (less than 2%) [Yes, Not sure, No]

There's plenty more of the same in its 54 pages.

It's not unreasonable, based on the document, to observe at least some of the Obama Administration's thinking:

1. Life is not always worth living.

2. We can help you decide if life is not worth living.

3. Your life might not be worth living because your being alive may be a burden to others.

4. Your life might not be worth living because some treatments are painful, have side effects, and might only provide a small chance of “getting healthier.”

There have been other governments who have defined groups of their citizenry as having lives not worth living.

Is the current administration populated by a bunch of Nazis? No, the only people who were Nazis were the Nazis.

However, there’s no question that our government, at least as far as its war heroes go, officially acknowledges that under a whole bunch of circumstances, some citizens’ lives might not be worthy of living.

I wonder which group will be next?

Because, for governments unchecked, there’ll always be a next group, trust me.

Caution: House Healthcare Bill 3200 Means What It Says

President Obama, ever-present in every form of media imaginable, continues to struggle mightily to articulate what exactly he means by healthcare reform.

I’m not impressed, because I don’t think the President knows what he means - the messages are just too garbled.

Ditto his cabinet and top party officials, who routinely issue statements that are quite contradictory, both to each other, and to the President, and are then followed by the usual retractions, clarifications, or by attacking the messenger.

This message mess is understandable, because the President has delegated what his reform means to the lawmakers who have drafted several sets of legislation both in the US Senate and the House.

The proposal drawing the most interest has been H.R. 3200, which aims to:

To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

Unlike my President and many lawmakers, I’ve read the bill. It’s not that difficult to understand, and no, you really don’t need to be a lawyer to understand it. It’s boring reading, but hardly incomprehensible.

Many of us don’t like what we see.

But proponents keep insisting that what the bill actually says is, well, not what it says, and that many of us who know exactly what it says (and implies) are perpetuating “myths” or “misinformation.”

Really? Let’s look at just one example:

Proponents of H. R. 3200 insist that the now-notorious Section 1228 of the bill, beginning on p. 424, describing ‘advance care planning consultation,’ is not mandatory. It’s simply, so they say, that the bill provides for people to discuss their end-of-life preferences with their doctor, and that this consult will now be paid for by the government.

I searched the bill. The word “voluntary” appears 7 times.

Now, that leads me to think that the word “voluntary” is written those 7 times because the bill means for those particular parts of the bill to be, well, not mandatory. Ergo, voluntary.

However, there’s absolutely no “voluntary” mention in the section related to ‘advance care planning consultation.’

In fact, at the very least, even if we can explain away the rest of the “voluntary’ canard in the bill, read this, from page 428 (italics mine):

(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.

See any mention of ‘voluntary’ in Section B?

Yes, folks, even if you can somehow dodge the end-of-life consultation while you’re at home, once you’re admitted to a medical facility that is reimbursed by Medicare, you’re going to get it whether you like it or not.

Is it really too much of a stretch to think that if something, in proposed legislation, is meant to be voluntary, that the legislation so stipulates, and that where something is not voluntary, that the word “voluntary” (or the clear implication of voluntariness) is absent?

If you think it is, indeed too much of a stretch, go read the bill.

Show me where it stipulates, in black and white, that the ‘advance care planning consultation’ is voluntary.

Palin’s "Death Panels" Are Already Here

Former Alaskan Governor Sarah Palin made some comments on Friday that seem to have gotten the pro-death healthcare reform side in a bit of a dither.

Here’s what Palin said:

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.

Apparently the pro-healthcare reform lobby took exception to Palin’s assertion of a “death panel.”

Now, I’m not sure what else you call proposals for government apparatchiks to monitor and control the treatments doctors hand out, and who may well refuse to allow doctors to use some treatments, thereby resulting in the death of some of their patients.

But, as much as I think Palin’s comments are right on the money, let’s remember that we already have such death panels operating in hospitals all over the country.

And we’ve had them for quite a while.

Exhibit A: Texas.

When former President George W. Bush was Governor of Texas, he signed into law the Texas Advance Directives Act of 1999, the provisions of which allow exactly what Palin suggested – a panel that decides if some patients should die.

Here’s what the law allows: Any hospital can, legally, give notice that it is stopping all patient treatment 10 days after the decision has been conveyed to the patient’s loved ones.

The reason for stopping treatment? The hospital has decided that any more care is considered futile. That is, any more care is essentially useless and wasteful, because the patient will never get better.

This decision is made exclusively by the hospital panel. Loved ones have no say in how this is decided.

Not a word.

This decision can be made even if the family is able and willing to pay for all care themselves, and the law overrides any advance directives the patient may have had, saying, for example, that all treatment should be continued until death.

Utilitarian? As Palin might say, you betcha!!

The logic’s pretty simple, actually:

You’re not getting healthier; it’s a waste of money to spend any more treatment on you. We will use those expensive treatments on people who will have a better chance of getting better.

In other words, hurry up and die.

That’s what happened in the fight to keep treatment going to poor Emilio Gonzales in 2007, and to many others like him across the country.

In the interests of fairness, of course, loved ones, once informed of the hospital’s decision, may then “appeal.” That means hiring lawyers to get a court injunction to delay the end of treatment.

Yes, folks, in Texas you will need to hire a lawyer to prevent the hospital from killing your loved one.

If this isn’t a version of a “death panel,” I don’t know what is.

President Obama’s Medicare Welcomes the Grim Reaper, Part II

The healthcare debate is gathering momentum because people are beginning to understand what the government is intending.

What the government is intending, of course, is controlling who lives and who dies, who gets treatment and who doesn’t.

I’ve already addressed this intention via the President’s repeated public statements, and how certain phrases are repeated, mantra-like, so that they will become embedded in the public mind.

That’s why the President is constantly in media-blitz mode, repeating the same themes time after time. He does that because he wants you to believe certain things and not believe other things. He’s intent on bending public opinion to his will.

My favorite propaganda theme? Well, the President has a way of explaining things about healthcare in terms of “making people healthier.” Over and over again, in print, all over television, town hall meetings, and YouTube chats, the drumbeat is healthier is the administration's goal.

However, as far as I can tell, nobody has ever challenged the President with this question, so let me try:

President Obama, you repeatedly emphasize how your heathcare proposals will “make people healthier.” What does that mean for people who have no hope of becoming healthier? What of people with chronic conditions, disabilities, and the elderly?

I’m not holding my breath for an answer.

So, we need to look for clues. Let’s say among people on Medicare (the elderly, people with disabilities, and those with chronic health conditions).

Let’s go to HR 3200, the 1,017 behemoth healthcare bill that many of our public representatives arrogantly admit to not reading.

Despite what some of our representatives say, the language of the bill is quite plain. The clues are there, but you must read carefully not only for what is said, but for what is not said.

Exhibit 1: Advocates insist that the bill says absolutely nothing about end-of-life counseling being “mandatory.” Well, the bill first describes what this ‘advance care planning consultation’ will look like, and then says this:

the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) [doctor, nurse, or nurse practitioner] regarding advance care planning, if . . . the individual involved has not had such a consultation within the last 5 years . . . An advance care planning consultation with respect to an individual may be conducted more frequently . . . if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), hospice program.

So, if you’re “healthy,” such a consultation will be every 5 years. If you get less healthy, you might have more consultations as your state of health declines.

Here’s the deception that the pro-death lobby doesn’t want you to understand: If this bill becomes law, there is no way that it will not be a mandatory requirement.

Why??

Because nowhere in the bill does it say that the “consultation” is OPTIONAL.

Now, if a law says something is not optional, then there’s only one other way to interpret its legal intent: Yes, mandatory.

Wouldn’t surprise me at some point, if this becomes law, and people finally wake up, they might hear the administration say the following:

Well, we never said it would be mandatory, I think we can all agree on that. We just made sure that it wasn’t optional.

Gotcha!!!

Doublespeak is not new, but it’s still chilling.

President Obama: Potential for Getting Healthy? You Win!!

Let’s be clear: President Obama’s push for healthcare reform will significantly change the way people with serious medical conditions, especially among the elderly, those with disabilities, and the terminally ill, will be treated.

Well, not treated, actually.

There’s no doubt that the President’s message, hammered relentlessly at every turn, is made in starkly economic terms – that medical care is very expensive, costs need to be controlled, and resources have to be allocated in new ways.

That’s half the pitch.

Here’s the other half: Because of this problem, it’s important to see which groups of people disproportionately consume the lion’s share of medical care dollars.

We already know: People with disabilities, people with serious chronic illnesses, the terminally ill, and the elderly.

The president hasn’t gotten around to making his economic case about people with disabilities yet, but he has in terms of the elderly and the terminally ill. My take is that among the targeted groups, it’s the disability community that will raise stiff opposition. The elderly and the terminally ill are more vulnerable, and are less likely to protest.

Let me put the president’s strategy more bluntly:

"Medical care is expensive. Some people get a lot of care, others very little. Many people who get a lot of expensive care are the elderly, those with disabilities, and those who are probably not going to ever be as healthy as they used to be. We don’t have the money to pay for every expensive procedure for everyone, so we need to decide who gets the care that’ll give us most bang for the buck."

The President doesn’t say it this way, instead he uses a euphemism it’s hard not to like: Health. We must give medical care to make people healthier.

Note what’s not said: If you have no prospect of getting healthy, then the government needs to step in and decide whether or not you are worth getting the treatment.

President Obama drive this point home in his interview to the New York Times in April (all italics are mine):

And part of what I think government can do effectively is to be an honest broker in assessing and evaluating treatment options. And certainly that’s true when it comes to Medicare and Medicaid, where the taxpayers are footing the bill and we have an obligation to get those costs under control. And right now we’re footing the bill for a lot of things that don’t make people healthier.

The president drummed the “Health” theme again in his ABC News Health Care Forum at the White House last week:

But here's the problem that we have in our current health care system, is that there is a whole bunch of care that's being provided that every study, every bit of evidence that we have indicates may not be making us healthier.

And later:

And in terms of how doctors are reimbursed, it's going to be the same system that we have now, except we can start making some changes so that, for example, we're rewarding quality of outcomes rather than the number of procedures that are done. And this is true not just for doctors, it's also true for hospitals. One of the things that we could say to hospitals is, reduce your readmission rate, which is also often a sign that health outcomes have not been so good.

Now, we've put forward some specific ways of paying for the health reform that we talked about. About two-thirds of the cost would be covered by re-allocating dollars that are already in the health care system, taxpayers are already paying for it, but it's not going to stuff that's making you healthier.

Prediction: If the President has his way, expensive medical care will be redirected to the winners in this money game, those who have the potential to be healthier.

If you have a disability, if you’re elderly and in poor health, or if you have a severe chronic or terminal condition, you lose.

Is Obama the First Pro-Euthanasia President?

There’s been very little attention paid to an interview President Obama did with the New York Times the day of his major speech at Georgetown University on April 14. I was especially interested in the section of the interview dealing with health care, and to learn of the President’s perceptions of end-of-life issues. It’s not pretty. Read on.

For starters, President Obama opined:

I have always said, though, that we should not overstate the degree to which consumers rather than doctors are going to be driving treatment, because . . . when it comes to medical care; I know how to ask good questions of my doctor. But ultimately, he’s the guy with the medical degree. So, if he tells me, You know what, you’ve got such-and-such and you need to take such-and-such, I don’t go around arguing with him or go online to see if I can find a better opinion than his.

Well, yes and no.

But the President’s slant is immediately concerning, because there’s a fine line between medical expertise and Doctor Power. What if the doctor says, “Well, you’ve got two weeks to live, and your quality of life is very poor, and all the expensive care we can give you will not help a bit, but assisted suicide is legal, quick, and very inexpensive?’ Should I then accept this pronouncement because he’s “the guy with the medical degree?”

If you think I’m stretching things a bit, it’s because of what came next from the President:

And part of what I think government can do effectively is to be an honest broker in assessing and evaluating treatment options. And certainly that’s true when it comes to Medicare and Medicaid, where the taxpayers are footing the bill and we have an obligation to get those costs under control. And right now we’re footing the bill for a lot of things that don’t make people healthier.

Not too hard to see the spin here. Now we’ll get the government saying, “OK, seeing that we pay for your medical care, we’re going to decide what care you get and what care you can’t have.”

And, more darkly, the specter of futile care emerges, because what the President was saying was, “If we’re paying for stuff that doesn’t make you healthier, we need to reconsider whether we want to pay for this treatment.”

Note the phrase is “to make you healthier” - not to alleviate your symptoms, or provide you with comfort care because you’re never going to get healthier.

Simple: If treatment makes you healthy again, you get it. If it can’t, you can’t have it, because we need it for people who can get healthy again.

Pure, unadulterated futile care.

Here’s what will happen, trust me:

The government already knows that medical care in the last weeks of life is where most medical dollars get spent. Same goes for money spent on people with significant, although not necessarily terminal disabilities. Marry that to the President’s commitment to cut health care costs, a society that increasingly thinks helping people die is just dandy, and a medical profession that is increasingly utilitarian, and you have the perfect plan to make people with severe medical problems, including those with disabilities, into Useless Eaters.

It got worse.

The President:

So when . . . I talk about the importance of using comparative-effectiveness studies as a way of reining in costs [which] . . . is an attempt to say to patients, you know what, we’ve looked at some objective studies out here, people who know about this stuff, concluding that the blue pill, which costs half as much as the red pill, is just as effective, and you might want to go ahead and get the blue one. And if a provider is pushing the red one on you, then you should at least ask some important questions.

Ah, “comparative-effectiveness,” “objective studies.”

Science in the service of deciding who lives and who dies. Seems like we’ve heard this somewhere before.

Allow me to paraphrase my President:

Doctor to patient: “You know, what, we’ve looked at some objective studies out here, people who know about this stuff, concluding that there’s no point in treating you any further. We’ve concluded that the blue pill, which will keep you comfortable until you die, is very expensive. The red pill, that costs a tiny fraction of the blue pill, can end your suffering quietly, effectively, and with dignity.”

Don’t believe me? See what happened to Barbara Wagner in Oregon, where the state refused an expensive treatment to help her live our her days, but offered to pay the pennies it would cost for her to commit assisted suicide.

But the President went even further, using a personal example when asked about end of life care:

. . . my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip . . .So now she’s in the hospital, and the doctor says, Look, you’ve got about — maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that — you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible. And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just — you know, things fell apart . . .

OK, a very difficult situation, with difficult, but very common health decisions that needed to be made. BUT, then the President went on, back to setting us up for official pro-death thinking:

Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.

See? Old, lying in misery in an expensive hospital bed, with a broken hip.

Pretty upsetting. Expensive, too.

What’s a grandson to do?

The President:

Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.

Just so you know: Pro-death is going to be more than law. Here's the plan:

Have “conversations” with the public under the guise of measured reasonable argument. Subtly (and not so subtly) use doctors, scientists and ethicists who are pro-death to lead the way. Shape public opinion to utilitarianism, futile care, people as pure economic entities, and then the resistance to assisted suicide, and, eventually, euthanasia, will crumble.

Is Obama our first pro-death President?

I see no evidence that he’s not.