I have been doing a little reading about Dr. Ezekiel Emanuel, the head bioethicist at the NIH and brother of the president’s chief of staff. He is a supporter of health care rationing, which is relevant to the current health care debate. In a Lancet article earlier this year, he suggested that age be a proper method of allocating scarce resources, and indeed, stated that age based allocation is not invidious discrimination. From his piece:
Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years. Treating 65-yearolds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not.
He seems to be saying, be ageist, just call it something different.
Still, as I read the article closely, it was not about health care rationing in the general sense, but rather, concerned situations of extreme resource scarcity. Thus, while I think it is fair to say that Emmanuel is clearly laying the intellectual groundwork for an age-based rationing regimen, he doesn’t take the final step, writing:
Accepting the complete lives system for health care as a whole would be premature. We must first reduce waste and increase spending
Some might say that is just a hedge to avoid the heat. And indeed, bioethicists often promote radical ideas they advocate generally by using extreme situation hypotheticals to make their intellectual points, thereby allowing them a path of retreat if the blowback becomes withering. Still, unlike some others who have commented about this piece in the current health care reform debate, I don’t think he explicitly advocated a system of health care rationing now based on age, at least not in this particular article.
The same can’t be said of an article he wrote in the Hastings Center Report, in which he explicitly advocates rationing based on what appears to be a quality of life measurement. From the piece:
This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. 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. Conversely, 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.
A lot of people are frightened that someone who thinks like Emanuel is at the center of an administration seeking to remake the entire health care system. Having read these two articles, I think there is very real cause for concern.
July 31st, 2009 | 2:00 am
[...] What Does Ezekiel Emanuel Really Believe About Rationing? Age, Maybe. Quality of Life, Yes – W… [...]
July 31st, 2009 | 11:35 am
Thoughts that come to mind: it seems that most of those who think like this do not believe in God, do not believe in individual worth. They also are usually evolutionists. Being evolutionists, you’d think that if they were consistent, they’d also believe in survival of the fittest. Instead, they seem to believe that the fittest in our society should be penalized and those who are least fit should be coddled and given the benefits accumulated by the fittest.
I wonder at the inconsistency.
August 1st, 2009 | 5:32 am
Well, hopefully when Mr. Emmanuel get’s old, he will be the first to volunteer to forgoe life saving treament, for the good of society, since he wants to force others to do this.
August 1st, 2009 | 11:36 am
[...] Ezekiel Emanuel, a high health care adviser, wants to ration health care based on quality of life (and perhaps against the elderly) and has asserted we all have a moral obligation to be experimented [...]
August 1st, 2009 | 12:01 pm
[...] NIH bioethicist supports health care rationing by age and quality of life In another article from Secondhand Smoke sent to me by ECM, Wesley J. Smith writes about Ezekiel Emanuel, [...]
August 1st, 2009 | 6:06 pm
SINCE WHEN DID HEALTH CARE BECOME A “SCARCE RESOURCE?”
August 2nd, 2009 | 10:27 pm
But, who determines this etereal idea of “quality of life?”
Nearly 8 years ago, on Sept. 11, we were informed that the child we were expecting had a birth defect. That birth defect was life threatening. We saw many doctors over the next several months and, while each visit seems seered into my memory, one stands out. This doctor, a neonatalogist, gave our baby a slim chance at survival. And, even if he did live, the child would have severe problems that would hinder him for the rest of his life.
Our son was born Jan. 7 and had surgery to correct his birth defect (a diaphragmatic hernia) at 4 days. We spent six weeks in the NICU and as I observed this doctor over that time I noticed something disturbing, namely, everything was bad. I secretly called him Dr. Death, because his prognoses were always filled with doom and gloom.
Today my son is a healthy, happy, normal 7yo boy going into the 1st grade. He runs, jumps, climbs (like crazy), has been dancing on stage since he was 3, loves teasing his brothers, and causing trouble. He has no real lingering problems.
When I read people who believe this, people who can look you in the eye and tell you things like, “services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed,” my blood runs cold and I wonder…”What if? What if a doctor like that is in charge of making the decision?”
Of course, the real answer to my question is: Whoever is in power will decide who gets treatment and who is denied, ultimately, who lives and who dies. This reminds me of something…vaguely…
August 6th, 2009 | 8:00 pm
[...] his Lancet paper and his views on rationing against elders here. Now here’s more from Secondhand Smoke, quoting from another of Emanuel’s papers (emphasis added): Substantively, it suggests [...]
August 7th, 2009 | 12:33 pm
[...] I think that many of his major appointments, such as Cass “Let Animals Sue” Sunstein, Ezekiel “Dismantle Hippocratic Medicine” Emanuel, and John “Let Trees Sue as We Impose Eugenics” Holdren, his repeal of the Bush [...]
August 8th, 2009 | 3:57 pm
[...] As America’s largest generation ages, we have no time to lose.” () On the empathic left Ezekial Emanuel (brother of the gentle soul, Emanual): “Conversely, services provided to individuals who are [...]
August 10th, 2009 | 6:23 pm
At NRO online, you criticize Palin for literary hyperbole:
“But the admittedly awful health-care reform bills currently being debated don’t come near to earning that opprobrium.”
But then you say:
“The legitimate fear is that such boards, regardless of their benefits, would impose rationing based on invidious categories — such as age, disability, or other “quality of life” measurements. In other words, the boards would deny certain categories of patients treatment available to other categories of patients.
Palin is not being paranoid.”
I would say you are a semisubstantive hyperbolist. You write of differences which make no difference. At what point does state involvement in care become “evil”? Is it semi evil until the law passes, then evil?
Mrs. Palin wasn’t writing a position paper for Philosophy 209. She wrote a plain speaking heartfelt common sense response to a health care plan which is evil. It is, by definition. Just because the liars promoting it say it isn’t so, doesn’t make it so.
Frankly, I welcome more plain speaking from politicians, not less. In any event, you seemed to be praising her with faint damnation, so that’s something, I suppose.
August 10th, 2009 | 6:49 pm
[...] Rahm’s Brother August 10, 2009 Posted by Cory Franklin in Uncategorized. trackback Is not the guy I want making the decisions [...]
August 11th, 2009 | 12:41 am
[...] This argument is about who gets to decide – the individual, their family, or a doctor answering to a government bureaucrat. Especially when the bureaucrats have a history of making statements about eugenics and cutting corners. [...]
August 11th, 2009 | 12:19 pm
What Dantes said…
August 12th, 2009 | 12:53 am
Dr. Zeke says “…life-saving care can simply be denied to the elderly and costs will be saved. This will be painless, supposedly, if the patient is unconscious and is starved to death.”
—starvation was one of the first methods used by the Nazis before gas. Also, I think the gal who was unconscious and died a horrible death of starvation in FL would disagree.
The best way to lead a nation astray of its values is to keep it ignorant of its history. Get d’Clu at http://getdclu.wordpress.com
August 12th, 2009 | 4:55 pm
[...] for health policy to the director of the White House Office of Management and Budget”, has already suggested that it might make sense to prioritize the young over the old in rationing, on the grounds that the [...]
August 19th, 2009 | 9:05 am
As head ”bioethicist” at NIH, the differences between that title, ”comparative effectiveness” (the actual name of the federal council) and “eugenics” are superfluous.
Lady in FL is Terri Schiavo, and most people who remember the Holocaust would object to any procedures even appearing similar to those used by the Nazi monsters.
The board’s life-or-death decisions would proceed without possibility of objection from victims or voters. Does this sound like dictatorial tyranny?
Read more at http://wp.me/pzfHB-4G
August 27th, 2009 | 10:15 pm
[...] had been in the background of the health care debate until reporters started looking at some of his writings on the subjects of end-of-life care and treatment of the [...]
September 3rd, 2009 | 11:18 am
[...] Longtime medical ethicist Wesley J. Smith has a nuanced look at Dr. Emanuel here. The post concludes: [H]e explicitly advocates rationing based on what appears to be a quality of [...]
September 3rd, 2009 | 2:18 pm
I used to know one of the foremost oncologists in southern California and met with him twice in his office on business matters. It meant that I sat for a bit in the reception room and as we all do, “people watched.” It is a ghastly memory.
When I asked him how he managed to do what he did he answered, “It’s the science. I keep it to science.”
That may be a salvation for some but I think it is also one the items that drive costs for all of us: the experimentation that is done in the search for a cure is financed by those living and paying in fees and insurance for a future rid of some or another disease. Something to consider but not to recommend government control.
Yesterday I heard a doctor on the radio complain about insurance companies and pose his thought that they are unduly restrictive of treatments. It turned out that he is a specialist in “drug dependency alleviation” or something like that and his real complaint is that his specialty isn’t compensated by most insurance policies as is the setting of a broken limb.
That’s really the crux of the expense side of medical treatment. Too many people with gold plated policies being paid for with OPM — other people’s money — and guaranteeing that everything from a boob job, to orthodontics and acne will be covered.
That’s crazy, but not as crazy as Emanuel’s ideas.
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