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My “Top Ten Stories of the Decade” in Bioethics
Friday, January 8, 2010, 11:56 AM
Wesley J. Smith

The first ten years of the 2000s (please, no arguments over whether the first decade really ends this year) brought bioethics front and center into national and international prominence as never before.  Since this is the time for creating “top ten lists,” I pondered the matter over my eggnog over the holidays and compiled for NRO, the ten most important stories in bioethics of the last decade (in descending order), with commentary.  From my piece, “Technological Morality:”

10: The ascendance of an anti-human environmentalism...Radical environmentalism appears to have morphed into anti-humanism, the result of which could be a new impetus for eugenics and radical population control.

9. The growth of biological colonialism. Desperate and destitute people are increasingly being exploited for their body parts and functions…

8. The increase in American pro-life attitudes. In the last decade, polling showed a dramatic increase in the number of people who identify themselves as pro-life…If this trend continues, it could eventually shake the Roe regimen off its foundation.

7. The struggle over Obamacare. The political brouhaha over Obamacare was the bioethics story of 2009, not only in the U.S. but throughout much of the developed world…The debate will not end with the passage or failure of a bill, and health-care reform will likely be one of the most important stories of the coming decade.

6. Legalization of assisted suicide in Washington...[T]he Washington victory boosted the morale of assisted-suicide activists, who promise to wage an energetic legalization campaign in the coming decade.

5: The success of adult-stem-cell research...For example, in early human trials, adult stem cells have helped diabetics get off insulin, restored sensation to paralyzed people with spinal-cord injuries, helped heal unhealthy hearts, and provided hope to patients with autoimmune diseases such as multiple sclerosis. These and other amazing advances in adult-stem-cell research provided one of the few pieces of truly good news in a sour decade.

4. “Suicide tourism” in Switzerland. Over the last decade, Switzerland became Jack Kevorkian as a country, its suicide clinics catering to an increasingly international clientele…Alas, as was the case with Kevorkian in the 1990s, audacity was rewarded. In the face of a wave of high-profile suicide-tourism stories, England’s head prosecutor published guidelines that, in essence, decriminalized family and friends’ assisting the suicides of the dying, disabled, and infirm…

3. IVF anarchy... IVF has led to childbirth as manufacture, with our progeny chosen for their genetic makeup. It is likely that babies will soon be created with three parents. What comes next is anybody’s guess.

2. The Bush embryonic-stem-cell funding policy. When Pres. George W. Bush signed an executive order restricting federal funding of embryonic-stem-cell research to lines already in existence on Aug. 9, 2001, he set off a nearly decade-long firestorm…But the real poke in the eye for the Science Establishment and liberal media was that Bush’s policy sent a clarion message that embryos — which are, after all, nascent human life — matter, thrusting his policy into a buzz saw involving our most touchy cultural issues, particularly abortion.

1. The dehydration of Terri Schiavo. The emotionally wrenching tug of war over the life of Terri Schiavo, covered sensationally by the international media and culminating in her slow death, was — hands down — the decade’s most important story in bioethics (as well of one of the most important stories of the early 2000s). Who hasn’t heard her name? Who doesn’t have an opinion about what happened?

There is much more to say about all of these stories than I could in the abridged version presented here or in the entire article.  But I think it is very clear now: bioethics is important.  Soon, I’ll write up what I consider to be the ten biggest stories in bioethics of the coming decade.


More on Palliative Sedation Including Letter in NYT by Yours Truly
Monday, January 4, 2010, 12:24 PM
Wesley J. Smith

I have today’s lead letter in the New York Times reacting to the paper’s palliative sedation article (thanks NYT!), about which I wrote more extensively here.  From my letter:

Bravo to The New York Times for its in-depth reporting on palliative sedation. When death is imminent, sedating a patient if nothing else can be done to ameliorate severe suffering is a legitimate medical intervention. Those who confuse palliative sedation with euthanasia — either out of ignorance or with intent to blur crucial distinctions for political reasons — do suffering patients a profound disservice. Since any medical intervention can have unintended lethal side effects, we should no more consider palliative sedation euthanasia than when a patient dies during heart bypass surgery. Indeed, it would be a terrible thing if patients in need refused or were denied this humane medical treatment because they or their physicians mistakenly confused it with mercy killing.

Some of the other letters brought up important points. A hospice physician notes that other palliative techniques can result in a sedation effect, to which I add, so do disease processes.  He then makes an important point that Dr. Eric Chevlen and I also noted in our book, Power Over Pain: How To Get the Pain Control You Need:

Second, the article perpetuates the myth that death is hastened by pain relievers and sedatives in these circumstances. Sufficient research exists to contradict these concerns and suggests that far from hastening death, such interventions appear to have a neutral effect on survival and may actually prolong life while relieving suffering. How so? A patient with uncontrolled pain is under severe cardiovascular stress from the pain itself. A rapid heart rate, shallow breathing and agitation will themselves shorten life as death nears. Relief of the pain calms the heart and helps the patient breathe more effectively.

A hospice nurse correctly points out that PS is a rarely needed last resort:

Too often, palliative sedation is used as a first-line therapy rather than a therapy of last resort. In some units, palliative sedation is used on one-third to one-half of patients. That is far too often. Most expert providers will use palliative sedation extremely rarely in a 20- to 25-year career. Further, expert providers do not use palliative sedation lightly. They consult with colleagues to make sure that all other means of symptom management have been tried.

And assisted suicide advocate Barbara Coombs Lee, ever obsessed with the Catholic Church, brings up religion and contends that there is no difference with mercy killing, which she euphemistically refers to as easing dying:

Candid and thorough, your report on terminal sedation demonstrates the problem when the legal status of a medical procedure rests on whether a doctor’s primary thought and intention is to treat suffering (legal) or ease dying (illegal). The arcane [Catholic] theological doctrine of double effect creates a thought crime and ignores the patient’s wishes altogether. Terminal sedation treats suffering and eases dying. We should learn to acknowledge and honor both effects.

Lee is a lawyer. She knows intent is a crucial issue in determining whether a crime has been committed.  Her letter illustrates an important point about her advocacy: Always remember that in her deepest heart, Lee is an assisted suicide ideologue who will use every means at her disposal to conflate proper medical care with killing. In this regard, it is worth noting that her group was behind AB 2747 that, had it passed as originally written, would have redefined palliative sedation to death on demand by induced coma and dehydration, for patient with a year or less to live and without regard to symptoms or suffering not otherwise capable of being relieved.


Schiavo and Houben: It Isn’t the Neurology, It’s the Ethics
Saturday, December 5, 2009, 7:23 PM
Wesley J. Smith

I am hearing some back stage grumbling that I included Terri Schiavo in my Weekly Standard article about the Rom Houben situation when they had different neurological conditions. There is no question in my mind that Terri was not in a locked in state and that Houben is. But so what? I was not comparing or conflating their neurological conditions. I was focusing on ethics and the morality of taking food and fluids away from people because of quality of life judgmentalism.

I mean think about it: Had Houben’s family lived in the USA and elected dehydration (I don’t know the law about that matter in Belgium), before the PET Scans revealed he is fully aware,  there is no question that he would have been dehydrated. Indeed, if Houben had come before Judge Greer in a similar situation as Terri, I believe he would have issued the same order, and might have refused a request for a PET scan, just like he did in Terri’s case.

But even that wasn’t the point of my piece.  What I find interesting is how our society remains emotionally immersed in the Schiavo case, which I believe is based on the moral weightiness of removing food and fluids from people who are not otherwise dying.  That is why whenever these “awakening” cases come into the news, Terri Schiavo and what happened to her leaps immediately to mind.

In other words, the issue isn’t over.  And thank goodness for that!


Rom Houben: “The Long Awakening” and Continued Angst About Terri Schiavo
Saturday, December 5, 2009, 1:47 AM
Wesley J. Smith

I have an article in the current Weekly Standard on the Rom  Houben case. I find it fascinating that Terri Schiavo–and what happened to her–is the subtext of the entire event. From my article:

The case of Terri Schiavo–who died five years ago next March, deprived for nearly two weeks of food and water, even the balm of ice chips–continues to prick consciences. That may be one reason the case of Rom Houben, a Belgian man who was misdiagnosed for 23 years as being in a persistent vegetative state, is now receiving international attention.

When Houben was injured and misdiagnosed, the idea of dehydrating him was unthinkable.  No more:

During the years that Houben was thought unconscious, society changed. Bioethicists nudged medicine away from the Hippocratic model and toward “quality of life” judgmentalism. Today, when a patient is diagnosed as persistently unconscious or minimally aware, doctors, social workers, and bioethicists often recommend that life-sustaining treatment–including sustenance delivered through a tube–be withdrawn, sometimes days or weeks after the injury.

I discuss the notorious Haleigh Poutre case, (about which I wrote more extensively here),  the little girl who would have been dehydrated but for the time it took to get the Massachusetts Supreme Court’s approval, allowing her the time to wake up. I discuss the controversy over whether he is not actually communicating.  And I point out something that I think is just beneath the surface of the entire discussion:

In any case, why the sour response to a good news story? It is hard to shake the feeling that the emotional crosscurrents stirred by Terri Schiavo have been stirred again. Time reported that Schiavo-type “legal fights are likely to become more common as classifications of brain-injury severity are revised.” According to ABC, Schiavo’s family “felt both heartbreak and vindication” about the story.

And so, it seems, Terri Schiavo remains very much with us. Indeed, every time we hear about the newest “miraculous” awakening, we find ourselves wrestling again with the moral import of all that happened; haunted it seems, by her beautifully smiling face.


“Pulling the Plug on Conscience”
Thursday, November 19, 2009, 1:30 PM
Wesley J. Smith

I have a long piece out in this month’s First Things on the conscience clause issue.  I believe that the Culture of Death brooks no dissent and we are witnessing the beginning of requirements for health care professionals to either participate in medical procedures that end human life–or be complicit in them by requiring them to refer–the current abortion law in Victoria, Australia.  The piece is too long to present fully here, but here are a few exerpts

First, I set up the problem.  From the article:

Over the past fifty years, the purposes and practices of medicine have changed radically. Where medical ethics was once life-affirming, today’s treatments and medical procedures increasingly involve the legal taking of human life. The litany is familiar: More than one million pregnancies are extinguished each year in the United States, thousands late-term. Physician-assisted suicide is legal in Oregon, Washington, and, as this is written, Montana via a court ruling (currently on appeal to the state supreme court). One day, doctors may be authorized to kill patients with active euthanasia, as they do already in the Netherlands, Belgium, and Luxembourg.

The trend toward accepting the termination of some human lives as a normal part of medicine is accelerating. For example, ten or twenty years from now, the physician’s tools may include embryonic stem cells or products obtained from cloned embryos and fetuses gestated for that purpose, making physicians who provide such treatments complicit in the life destruction required to obtain the modalities. Medical and bioethics journals energetically advocate a redefinition of death to include a diagnosis of persistent vegetative state so that these living patients—redefined as dead—may be used for organ harvesting and medical ­experimentation. More radical bioethicists and mental-health professionals even suggest that patients suffering from BIID (body-integrity identity disorder), a terrible compulsion to become an amputee, should be treated by having healthy limbs removed, just as transsexuals today receive surgical sexual reassignment.

I acknowledge the comity that currently exists in the USA, where no doctor is forced to perform an abortion or participate in assisted suicide. But the times, they are a’changing. I quote articles, a court decision, medical professional ethics decisions, etc., pointing toward forced participation by health care workers in life-terminating medical procedures.  I then turn to what I think conscience clauses should look like:

If Hippocratic medicine is to be salvaged, the rights of medical conscience need to be expanded and made explicit. With the understanding that there may be nuances in specific circumstances not discussed here, I suggest that the following general principles apply in crafting such ­protections:

  • Conscience clauses should be legally binding.
  • The rights of conscience should apply to medical facilities such as hospitals and nursing homes as well as to individuals.
  • Except in rare and compelling circumstances in which a patient’s life is at stake, no medical professional should be compelled to perform or participate in procedures or treatments that take human life.
  • The rights of conscience should apply most strongly in elective procedures, that is, medical treatments not required to extend the life of, or prevent serious harm to, the patient.
  • It should be the procedure that is objectionable, not the patient. In this way, for example, physicians could not refuse to treat a lung-cancer patient because the patient smoked or to maintain the life of a patient in a vegetative state because the physician believed that people with profound impairments do not have a life worth living.
  • No medical professional should ever be forced to participate in a medical procedure intended primarily to facilitate the patient’s lifestyle preferences or desires (in contrast to maintaining life or treating a disease or injury).
  • To avoid conflicts and respect patient autonomy, patients should be advised, whenever feasible, in advance of a professional’s or facility’s conscientious objection to performing or participating in legal medical procedures or treatments.
  • The rights of conscience should be limited to bona fide medical facilities such as hospitals, skilled nursing centers, and hospices and to licensed medical professionals such as physicians, nurses, and pharmacists.

Then, I conclude:

It is a sad day when medical professionals and facilities have to be protected legally from coerced participation in life-terminating medical procedures. But there is no denying the direction in which the scientific and moral currents are flowing. With ethical views in society and medicine growing increasingly polyglot, with the sanctity of human life increasingly under a cloud in the medical context, and given the establishment’s marked hostility toward medical professionals who adhere to the traditional Hippocratic maxims, conscience clauses may be the only shelter protecting traditional morality in medicine.

I believe that medical conscience is going to be one of the most intense and bitter bioethical issues of the next ten years. The time to prepare to wage the debate is now.


What Kind of Prophet Am I?
Thursday, November 19, 2009, 12:28 AM
Wesley J. Smith

Each fall the CBC asks me to predict what will happen in the coming year in bioethics/biotechnology. To say the least, I have a mixed record.  I was more worried about 2009 than turned out to be warranted by events especially about assisted suicide which moved the ball not at all in the USA.  (The UK was a different story altogether.).  The stem cell predicting the demise of the Bush ESCR funding policy was a gimme, but Obama stepped over the line of expectation–and destroyed a good and uncontroversial policy–by revoking Bush’s 2007 order requiring non embryonic pluripotent stem cell research to be federally funded. That’s when I really knew–I already had suspected–that Obama was not a great compromiser, much less a committed uniter–he is an ideologue.

In any event, here are a few more matters I got right, wrong, and missed altogether.  From my column, “2009–A Not so Dark Year After All:”

Miscellaneous

I made several predictions in other bioethical fields, and proved pretty prescient, but not infallible.

Abortion. I predicted that the Freedom of Choice Act (FOCA) – which would erase all state laws limiting abortion – would not pass. Not only did the bill not pass, no efforts were made to move the bill. However, I was wrong that federal funding for abortion would be permitted by the end of the year. That remains a goal of the Administration and the leaders of Congress, but as of now, it remains an unrealized goal.

Conscience Clauses. A great bioethical battle is coming over whether medical professionals who do not wish to be complicit in life-ending activities – such as abortion or assisted suicide – will be driven out of health care. I predicted that the “Bush Conscience Clause” protecting such dissenting health care workers would be overturned by the Obama Administration. I was certainly right that the effort would be made. Indeed, the effort was one of Obama’s first official acts. But bureaucracy being what it is, as of this writing, the revocation has not been published in the Federal Register. Meanwhile, a Ninth Circuit Court of Appeals ruled in a contraception case that a Washington regulation requiring all legal prescriptions to be filled did not violate the right to freedom of religion. If this case sticks, not only would Washington pharmacists with a religious objection to contraception be required to dispense birth control, but also to provide lethal prescriptions for use in assisted suicide…

Futile Care. Alas, I was right that Texas would not rescind its law legalizing medical futility in 2009. I was wrong that a major lawsuit in the field would make big news. Other than a temporarily stalled attempt to legalize futile care in Idaho, the field was generally quiet in 2009.

Biological Colonialism. I worried that despite legal attempts to restrict the exploitation of the world’s destitute for their body parts, biological colonialism (such as buying organs), would increase in 2009. While there were no reliable studies published about this, it is clear that at the very least, the problem remained undiminished.

Missing the Story of the Year

My greatest failure – and it’s a whopper – was missing the entire brouhaha over Obamacare. I expected health care reform to be introduced. But I never anticipated it would bloat to a 2000-page bill or that Congressional leaders would try and push the behemoth through with such scant opportunity for democratic debate. And because I missed the ruthlessness of Obamacare’s pushers, I also failed to predict the commitment and resiliency of the resistance. In other words, I wrote not a word about what turned out to be the biggest story in bioethics of the year. Why I still have this predictor gig is beyond me.

I am a bit chagrined about not seeing the approach of the big debate over Obamacare. Perhaps I thought he would learn from Hillarycare and not try to do a complete makeover.  No such wisdom.

Jennifer Lahl tells me I am still the in-house prophet, so next month, I’ll sacrifice a bull and examine its intestines to tell you what 2010 will look like.  Hey, if it was good enough for the Romans…


WJS Debating Assisted Suicide in Scotland, Speaking in London
Thursday, November 5, 2009, 7:27 PM
Wesley J. Smith


Next week I will be in Scotland debating against the legalization of assisted suicide.  The following are the planned events:

Scotland:

November 11, I will be debating at the Scottish Parliament in Edinburgh versus Jeremy Purvis MSP,  Time: 13.00 – 15.00 hrs. Subject: “Should Assisted Dying be Legalized in Scotland?” I believe this event is by invitation only.

November 12: Glasgow University Union, 32 University Avenue, Glasgow, G12 8LX,  Title of event: ‘Should assisted dying be legalised in Scotland?’ Time: 19.00-20.30 hrs, versus Dr. Alasdair Maclean, MBBS, M.Jur., PhD – Dundee University School of Law.

November 13: “Assisted Dying: A Good Death or a Choice Too Far?” Time: 19.30 hrs versus Dr.Libby Wilson: Friends at the End.  Church of Scotland General Assembly Hall, Mound Place, EH1 2LX, Centre of Edinburgh. Tickets: Normal Price £ 5, Concession £ 2.

London

After that, it is off to London where I will  be giving one lecture on Monday evening, November 16. Time, 6:00 PM.  Title:  “The Culture of Death in the United Kingdom: A Perfect Storm.” Location, the Cadogan Hotel, Sloane Street, SW1X, 9SG.

I may be doing various media and perhaps, other events to be announced.

I hope SHSers in Scotland and England can attend. I would very much like to meet you.


Discard Human Exceptionalism and You Discard Universal Human Rights
Saturday, October 31, 2009, 1:24 PM
Wesley J. Smith

I  am very concerned that too many of us complacently believe that the reigning societal value under which we were raised–the sanctity/equality of human life–continues to control society. But that is no longer true. We are in the midst of an attempted coup de culture that seeks to supplant human exceptionalism with a toxic mix of utilitarianism/hedonism/radical environmentalism-scientism as the sources of our personal values and public policies.

Thus, I take every chance offered to issue the warning.  Today, I have a piece up over at the Church Report, in which I assert that rejecting human exceptionalism is to reject human freedom. From “Knocking Human Beings Off the Pedestal of Exceptionalism:”

Society’s belief in the unique moral value and importance of human life is under unprecedented assault. Most people still believe in human exceptionalism and are unaware that powerful social and cultural forces are working diligently to dismantle the sanctity of life ethic as the fundamental value of our social order.  But the time has come to pay attention.  If human life is knocked off the pedestal, universal human rights will be impossible to sustain.

I get into issues many people don’t dwell upon; bioethics and personhood theory, animal rights “panience,” materialistic Darwinism’s “species differences are irrelevant,” and radical environmentalism’s casting of us as the villains of the planet–all of which we have discussed here at SHS.  Then, I close with this warning:

These, and other, attacks on human exceptionalism are profoundly dangerous to human life and liberty. It is our unique moral status in the known universe that gives rise to both universal (human) rights. It is the sanctity of life ethic that compels us to care for the weak, vulnerable, and elderly among us.

Either we all matter equally, simply and merely because we are human—or our value becomes relative, our rights, and indeed, our continued existence—determined by the reigning power structure of the day.  After all, if we are merely another animal in the forest—or worse, the planet’s enemies—why should any of us be treated as if we have any special meaning at all?

I’m tellin’ y’all, I know what I am talking about here. Let us hope that forewarned is forearmed.


Barbara Coomb Lee Lies About Wesley J. Smith
Thursday, October 22, 2009, 2:24 PM
Wesley J. Smith

Barbara Coombs Lee, head honcho at the assisted suicide advocacy group Compassion and Choices, has written a column in the Huffington Post that lies about me.  She doesn’t mention my name, perhaps because that would permit people to look me up and find out for themselves about whether what she writes about me is actually true.  She references my recent National Review cover story on assisted suicide–“A Myth is as Good as a Mile”–but without the courtesy of linking it so that her readers can see whether she told the truth about what I wrote.  There’s a reason for that. In the article, I exposed the “Oregon Myth” that assisted suicide there has been without abuses in that state.  Letting people have easy access to my piece would, thus, be shall we say, inconvenient to shoveling the propaganda.

Coombs Lee is free to link or not link, grapple with my actual criticisms or pretend they don’t exist, as she chooses. In fact, not doing so is par for the course with this crowd.  The assisted suicide movement doesn’t like to engage with their opponents’ actual arguments.

But she is not free to lie about my positions on unrelated issues.  From her post.

As one might expect, the writer opposes personal choice in most important life decisions. A believer in intelligent design, he opposes contraception, stem cell research and choice in dying.

I don’t oppose “stem cell research,” but I don’t want to take the space to get into the nuances of that.  I am not involved in intelligent design, and indeed, have repeatedly written that for my purposes of human exceptionalism, it doesn’t matter whether we were created, designed, or evolved by happenstance.  Not only that, whether or not I accept ID is irrelevant to assisted suicide and thus, is merely a clumsy way of knocking down a straw man in the eyes of people who might think ID is theocracy–which it isn’t, but as I said, that is irrelevant to my work.

Lee might excuse this by saying I am affiliated with the Discovery Institute, best known for promoting ID.  Let’s give her that for the sake of argument. But that justification doesn’t excuse the flat-out-lie that I don’t believe in contraception, a claim for which there is absolutely no basis by any stretch of the imagination. I have never publicly opposed contraception.  (Nor has the DI.)  Indeed, I don’t oppose contraception.  She just made it up whole-cloth. Again, par for the course. The lie furthers the cause, so who cares about intellectual integrity?

Coombs Lee’s mendacity illustrates something people need to know about her: Truth doesn’t ultimately matter in her advocacy. What counts is the emotional narrative–including outright fear mongering and libeling doctors as “torturers”–and winning by any means necessary.

But you should ask yourselves, if Coombs Lee so easily fabricated the falsehood that I oppose contraception, if she could lie so easily about something that simple and basic–what else isn’t she telling the truth about?

Update: Barbara Coombs Lee acknowledged her error here (see comments), but as of 3:26 Pacific Time, has not corrected her post over at the Huffington Post. Moreover, I wrote a comment to the post correcting the record, and the HP has not allowed it to be posted.

Update 2: Despite Barbara C. admitting on this blog that she was wrong, her piece at the HP still falsely claims that I oppose contraception. I have twice tried to post on the comments section that she is in error, and neither have apparently survived moderation.  It would thus appear that the HP doesn’t care about truth and factual accuracy, and apparently, BCL isn’t much interested either. But I already knew that.

Well, two can play that game. Barbara Coombs Lee believes in drowning kittens! Yea, that’s the ticket.

Update 3: More than 24 hours have passed since I twice tried to get the HP to correct a factual error in BCL’s column. No go. Clearly, the HP doesn’t care about accuracy, but in the propaganda value of statements.  That’s fine with me.  Confirms what I suspected.

But, as I said above, two can play that game.  Barbara Coombs Lee believes in drowning kittens and puppies!  The Huffington Post has editorialized that Bernie Madoff did nothing wrong! Hey, this is fun.


Obamacare: “Harardous Pathway,” The Road to Death Panels
Tuesday, October 20, 2009, 11:04 AM
Wesley J. Smith

I have a piece in today’s NRO about the Liverpool Care Pathway, which we have discussed here previously at SHS. From my column:

The United Kingdom continues to provide vivid warnings about the dangers of centralized health-care planning — a real possibility under Obamacare. Within the last few years, the U.K.’s notorious rationing board, the National Institute for Health and Clinical Excellence (NICE), urged hospitals, nursing homes, and hospices to follow an end-of-life protocol known as the Liverpool Care Pathway. The Pathway’s guidelines instruct doctors to put patients thought to be near death into a drug-induced coma, after which all food and fluids, as well as medical treatments such as antibiotics, are withdrawn until death.

The problem with such a protocol is that no matter how well motivated — and undoubtedly, the Pathway’s creators had good intentions — follow-the-dots medical protocols often lead to patients’ being treated as members of a category rather than as individuals. At that point, nuance often goes out the door, and mistakes, neglect, and even oppression frequently follow.

I get into some of the horror stories, such as the man put into a coma and dehydrated who turned out not to have cancer.  And then I tie the Pathway into Obamacare:

This is precisely the paint-by-the-numbers medical approach that Obamacare threatens to bring across the pond to our shores. Indeed, former senator Tom Daschle — whom the New York Times called the most influential adviser to the president in the health-care debate — has long urged that America adopt NICE-style centralized medical planning. Indeed, according to Scott Gottlieb, writing in the Wall Street Journal, Daschle “argues that the only way to reduce spending is by allocating medical products based on ‘cost effectiveness.’ He’s also called for a ‘federal health board’ modeled on the Federal Reserve to rate medical products and create central controls on access.”

Chillingly, current Obamacare plans call for the creation of many cost/benefit/best-practices boards, the full power of which won’t be fully known until the bureaucrats promulgate tens of thousands of pages of regulations between now and 2013, when the law would go into effect. Making matters more alarming, these boards would not only govern treatment provided in any public-option health plan, but would also be empowered to set the standards of care paid for by private insurance. Unless the final version of Obamacare is amended explicitly to prohibit such centralized health planning, don’t be surprised if an American version of the Liverpool Care Pathway comes soon to a hospital or nursing home near you.

Obamacare is intent on cutting costs. The great danger is that while the government will never ration its own spending, never cut its own perks, never decide that a program has outlived its usefulness, it will readily cut the most vulnerable among us out of life itself.

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