The Medical Establishment continues to try and misdirect the conversation on the pending threat of “death panels” under Obamacare. They pretend it is about “end of life discussions.” But even though Sarah Palin mistakenly made that allusion when she first coined the term, she quickly corrected her mistake–as we noted here.
“Death panels” really refer to the threat of health care rationing and centralized cost/benefit bureaucracies deciding that efficacious treatments will not be covered based on quality of life invidious discrimination–as occurs already in the UK, Canada, and Oregon’s Medicaid rationing law.
But they keep pretending. Latest example: In the Annals of Internal Medicine, a physician named Mark Vierra recounts an experience from his practice in which a woman decided to take her dying husband home to die rather than keep him maintained on machines in the ICU. He concludes with an allusion to death panels. From “Death Panels” (no link, 6 March 2012 )
Recently, we have been warned that government “death panels” would knock us off. The provision in the new health care legislation, which said that private, end-oflife discussions between a patient and his or her physician would be reimbursable every 5 years, somehow became a sinister governmental strategy to kill us quickly and save resources. It disappeared from the President’s health care legislation, was quietly added back as a Medicare provision, but disappeared again when the new Medicare guidelines came out. Can this sensible, thoughtful proposal really be so objectionable?
“I want to take him home.” I am so grateful to this man’s brave wife, who knew exactly what her husband would have wanted. She didn’t need me to tell her what kind of man her husband was, to discuss with her the meaning of life or the nuances of medical futility. What she needed was someone to help her see what was about to happen in the world of medicine—a world that was foreign to her but one in which I travel every day. These conversations are difficult for me. They are so much harder than explaining the rationale for an operation, the side effects, or the risks; I don’t feel that I am very good at them. But every one of my patients is going to die one day. Like it or not, I should have these conversations earlier, more often, and more comfortably. If that makes me part of a death panel, well, I suppose I can live with that.
Of course, that doesn’t make Vierra part of a death panel. It is part of the job.
But rather than playing hide the ball by discussing a non death panel issue, I wish Vierra had addressed the real threat of death panels, e.g., a similar situation in which a different wife wants to keep her husband in the hospital to extend his life–and government bureaucrats and cost/benefit schedules tell her she can’t. Or, they refuse to cover chemotherapy because it will only likely extend life for several months. and the Obamacarians decided that benefit wasn’t worth the price. Or, how doctors/bioethicists are already refusing wanted life-extending treatment based on Futile Care Theory protocols.
Those are the very real threats about which the death panel polemic properly applies. Pretending otherwise won’t make the issue go away.