Thomas Wictor

An apolitical look at “death panels”

An apolitical look at “death panels”

I just read an article titled “Canada has Death Panels—and That’s a Good Thing,” by Adam Goldenberg.

My plan is to avoid expressing political opinions. It’s not hard, because politics has become astonishingly negative and destructive. This is truly a shame, and it’s shameful. There are lots of things I’d like to talk about.

We should be able to discuss Operation Iraqi Freedom without it turning into a political hate-fest. As someone interested in the military, I should be able to praise Sergeant Leigh Ann Hester of the 617th Military Police Company, Kentucky Army National Guard, the first woman to be awarded the Silver Star since World War II and the only woman to be cited for valor in close-quarters combat. I should be able to discuss her incredible bravery without it devolving into an ugly fight.

But everything is politicized, so we can’t have those discussions. They attract insane people. Mentioning Sergeant Hester resulted in me being called a warmonger, a racist, a redneck, a Bible-thumper, and someone who ought to be murdered. I’ve never seen Mom angrier.

KIDDING.

She wasn’t angry at all when she said those things.

This death-panels piece made me angry, so I decided to write about it. I owed it to my parents, the many doctors who tried to save them, and Tim. Adam Goldenberg makes lots of assumptions about health care and gets a lot of things wrong, in what I think is a deliberate attempt to mislead. The article is about how the Supreme Court of Canada ruled that a governmental body—Ontario’s Consent and Capacity Board—can now overrule family members’ wishes and terminate care for a patient.

There’s only one relevant question in the entire piece: “Should taxpayers foot the bill for [a] family’s indefinite goodbye?”

That’s all that matters. Goldenberg goes on to say that, “The Hippocratic Oath’s promise to do no harm still applies,” but then he makes this absolutely accurate observation:

“When taxpayers provide only a finite number of acute care beds in public hospitals, a patient whose life has all but ended, but whose family insists on keeping her on life support, is occupying precious space that might otherwise house a patient whose best years are still ahead.”

Goldenberg is spelling out everything very clearly. In Canada the government decides who lives and who dies. The government gets to do that, because the government is paying the bills. That’s what happens when the government picks up the tab for everybody’s health care. If the citizens agree to let the government pay, then I see nothing wrong with putting the government in charge of treatment. To paraphrase H.L. Mencken, in a democracy the voters should get what they want, and they should get it good and hard.

What is wrong is not telling us the truth about how things work. In Europe doctors take the Hippocratic Oath. That doesn’t matter when doctors work within a system that constrains the oath. In France and Germany, doctors in ambulances try to stabilize the patient at the scene. Why? I’ve never read a coherent reason. But what happens is that people—like Princess Dianna, for example—die because their injuries or afflictions are too severe for them to be saved with ambulance-borne equipment.

In the US the policy is to get patients to the hospital as quickly as possible, where they’ll be stabilized. Princess Dianna would’ve lived if she’d had her accident in the US. She was conscious and alert when the ambulance arrived. The American system is called “scoop and run,” while the European is known as “stay and play.” A cynic could argue that stay and play saves the government money by allowing more people to die at the scene.

Goldenberg should’ve made it clear that government can make the Hippocratic Oath meaningless. He also writes the following:

“In the United States, keeping an all-but-dead patient alive on life support in a hospital bed generates income for the hospital, for as long as its bills get paid.”

That didn’t happen in either Mom or Dad’s case. We were pressured relentlessly to get them out of the hospital and into nursing homes or hospices. Hospital stays in the US are being cut to the bone. Also, each time Mom was admitted to the hospital, the first thing we were asked about was her advanced-care directive, and they unambiguously recommended that we sign a “do not resuscitate” order. Goldenberg is—I believe—lying in order bolster his agenda.

“Ontario’s Consent and Capacity Board provides an objective process for resolving these difficult, end-of-life dilemmas,” Goldenberg writes.

When Mom was dying, her oncologist, her primary-care physician, her pulmonologist, and her cardiologist all disagreed on her treatment. How will a bunch of government bureaucrats be more knowledgeable and more objective than the doctors involved directly with the patient? We all know the answer: They won’t. There’s only one criterion they’ll use, because there’s no such thing as “objective medical opinion.”

They’ll base their decision on cost. They’ll have to. Goldenberg tells us not to worry about that:

“The board is instructed by law to focus on the patient’s best interests, not the health care system’s, or the government’s bottom line.”

Right. And the IRS is instructed to not target groups or individuals, the NSA is instructed to not vacuum up everyone’s information without having FISA warrants, the armed forces are instructed to not sexually assault female service members, and the ATF is instructed to not let straw buyers purchase guns for criminals. Government workers are all saints who scrupulously follow the law.

Goldenberg’s most offensive claim is this:

“When humanity demands haste, and justice demands expert knowledge, Ontario’s death panels offer a solution—whatever Sarah Palin says.”

This is the classic logical fallacy of “begging the question”: You use what you’re trying to prove as the proof. There’s no evidence whatsoever that Ontario’s Consent and Capacity Board will provide humane solutions, justice, or expert knowledge. That’s just an assertion. It’s an opinion, nothing more. But Goldenberg shows his hand by bringing up Sarah Palin five years after her FAILED run at the vice presidency.

Sarah Palin has become a touchstone for me. My own completely subjective view is that people who still talk about her are mentally ill. The real Sarah Palin bore no resemblance to the hated and feared caricature. It’s like the people who say, “We destroyed Iraq and stole its oil.” At some point reality must intrude, as painful as it is. Baghdad has malls now. And the Chinese got all the oil deals.

When the Iraqis told us to leave, we did. We were unable to negotiate a status of forces agreement, so we just pulled out. Are you seriously arguing that we plundered, stole, raped, and murdered with impunity, and then after eight years, the Iraqis finally said, “Stop! Get out!” and we just hung our heads, mumbled, “Okay,” and shuffled off?

Reasonable, intelligent, well-intentioned, well-informed people opposed Operation Iraqi Freedom. But only idiots say, “We destroyed Iraq and stole its oil.”

Reasonable, intelligent, well-intentioned, well-informed people opposed Sarah Palin. But only rabidly partisan lunatics still talk about her.

Adam Goldenberg says that government should pay for all health care. It’s an entirely legitimate position to have.

What I don’t understand is that if death panels are indeed a good thing, why does Goldenberg have to withhold information, distort, make assumptions not based on facts, make assertions not based on facts, and then bring in the most reviled bête noire of modern American political history?

Goldenberg is the reason I never discuss politics. He’s not arguing in good faith. His agenda is not what he states. He cares nothing about humane, just solutions to terrible dilemmas, the kind that Tim and I lived for nine straight months. Having seen my elderly parents through their indescribably awful deaths, I can’t stomach any talk of this unless the person is completely honest and sincere.

In the third paragraph of his piece, Goldenberg writes his biggest untruth:

“I use that term [death panels] advisedly. Former Republican vice presidential candidate Sarah Palin made it famous in the summer of 2009, when Congress was fighting over whether to pass Obamacare. As Republicans and Democrats continue to spar over health care, we should pause to wonder why millions of Canadians have come to accept the functional equivalent of an idea that almost sank health care reform even though, in this country, it was imaginary.”

That famous conservative Governor Howard Dean M.D. disagrees that American death panels are imaginary:

“One major problem is the so-called Independent Payment Advisory Board. The IPAB is essentially a health-care rationing body. By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them.”

Goldenberg is interested only in empowering government, not alleviating suffering. Now more than ever, I despise liars.


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