Palliative Care's Merciless Twist

July 30, 2009 09:00 AM

There’s never been an idea that couldn’t become a millstone around someone’s neck. That’s just the way it works due to man’s condition as a mere mortal who has, admitted or not, many flaws in his character. We all have the condition; some simply use it in inhumane ways.

Such is the case with the push to incorporate palliative care into national healthcare reform. What is palliative care? To get a correct response, given the current anti-life climate, we visited the Life Tree web site for an accurate explanation: 

Originally billed as "symptom management at the end of life," palliative care is now aggressively marketed as everything from pain relief for the public, to a cost-saving tool for hospitals, nursing homes and insurance companies.

Many pro-life advocates had hoped that palliative care would prove to be the ultimate antidote to the assisted suicide movement. The theory was sound: if patients are offered adequate pain and symptom relief, they will not request assisted suicide as a means to alleviate discomfort. Traditional palliative care—symptom relief when death is imminent—might have accomplished that mission.

However, over the past ten years, palliative care training and certification has been gradually co-opted by the very same right-to-die advocates that palliative care was meant to counter.

A good example would be Diane Meier, M.D., director of the Center to Advance Palliative Care (CAPC), who was invited to the Obama White House on June 18 for a healthcare reform stakeholder meeting. The meeting was focused on healthcare reform in the context of prevention and costs. According to the CAPC, “Meier told the panel that preventing the wrong care can help save the health system money that can be used to pay for wellness and prevention.”

The CAPC sent out an action alert out yesterday, telling its constituents,

What is important for health care reform and for the ninety million Americans living with serious illness is that care is focused on quality of life, management of the symptoms that accompany serious and chronic disease and facilitation of care that reflects patient goals and values.

The problem with the terms in this single paragraph, taken from a much longer e-mail alert, is that elasticity and subjectivity set the parameters for phrases such as “quality of life,” “patient goals and values” and the ever-evolving meaning of “management of the symptoms.” Such terms can mean one thing if money is not a problem for the healthcare provider and another if value judgments defining who lives and who dies are in play.

As a matter of fact, in the CAPC-supported Senate Bill 1150, entitled Advance Planning and Compassionate Care Act of 2009, we find this definition of palliative care:

The term ‘palliative care' means interdisciplinary care for individuals with a life-threatening illness or injury relating to pain and symptom management and psychological, social, and spiritual needs and that seeks to improve the quality of life for the individual and the individual's family.

A government that condones killing preborn children really should not be using a word like “compassion” in the first place. Moving on past the fluffy, feel-good terms, it is important to have a clear understanding of the goals of people in government and in the death industry. Such knowledge is of great urgency as this nation faces the possibility of dramatic changes in the way health care is addressed, particularly for those who are ill, disabled or dying. As we have come to learn recently, far too many in policy-making positions are increasingly committed to saving money by shortening lives. One of their favorite mantras is their supposed concern for a patient’s “quality of life.”

Quality of life is a term representing a utilitarian evaluation of who should live and who should die. It’s a sliding scale of values based on opinions and personal value judgments. When decisions about one’s QOL are being made by the wrong people, comparing the estimated life expectancy of someone who is ill with the cost involved in caring for that person can become the final arbiter. This can have the same effect as directly killing a patient through an overt act of euthanasia.

But ethicist Louise Mitchell exposes this brand of specious thinking:

Some people are too old, some are handicapped. Where do we draw the line? How do we decide that you should be euthanized but not your neighbor? Who is to decide that a person seventy-five years old is too old but someone sixty-five years old is not? That Down's syndrome is okay but cerebral palsy is not? Every human being has imperfections of varying degrees and severities. That is why we have doctors and dentists and even medical insurance. These imperfections are overcome every day. We naturally expect them: we naturally believe we can overcome them: and we do overcome them. The choice we make here is not between death and a handicap or old age. Yet, euthanasia makes a choice in quality of life, saying this quality deserves continuance and this does not.

There is deception in this choice. Death does not improve life or the quality of life: it ends life completely and irrevocably. Euthanasia is not making a choice between suffering, handicaps, and age, or death. The choice is between life and death, between a lower quality of life and the killing of an innocent person, between a good that is always good no matter the circumstances and an evil that is evil no matter what the circumstances.

The CAPC’s use of the term “patient goals and values” is another example of the application of subjective opinions that could be employed to hasten death, rather than relieve the patient who is suffering but certainly not dying. At the end of the day, such terms are easily twisted when the wrong decision makers are empowered. This is what has become so troubling about the healthcare discussions on Capitol Hill.

Who should be making these decisions? Does it really make sense to rely on the United States Congress to tell us, through legislative fiat, what type of treatment can be provided and/or who can be treated and at what age treatment should be denied? 

Margaret Sommerville, director of the Centre for Medicine, Ethics and Law at McGill University, makes a salient point in this regard: 

The proper goal of medicine and physicians is to kill the pain. It is explicitly not their role to kill the patient with the pain—to become society's executioners—which is what euthanasia entails, no matter how merciful or compassionate our reasons.

While Sommerville is absolutely correct, the problem with state or federal mandates regulating such treatment is that physicians will not be making the final judgment; federal guidelines will.

When Dame Cicely Saunders founded the hospice movement in 1959, it is safe to assume she had no idea how her vision to aid the dying would encounter so many twists and deadly turns. In her early years, she once wrote,

  You matter because you are you.
You matter to the last moment of your life,
and we will do all we can,
not only to help you die peacefully,
but also to live until you die.

Hopefully, many Americans will wrestle with the idea of government programs determining who will live or die. Hopefully, each American will let his or her elected officials know that it is never the proper role of government to sanction killing at any time during a human being’s life. No matter how the words are parsed, nuanced or twisted,

[a] man, even if seriously sick or prevented in the exercise of its higher functions, is and will be always a man ... [he] will never become a "vegetable" or an "animal." The intrinsic value and personal dignity of every human being does not change depending on their circumstances.


Pope John Paul II, 2004 

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