By Elizabeth D. Wickham, Ph.D.
(Part Three—continued from yesterday)
Critical Juncture in Health Care
We are at a critical juncture in health care as funding moves from private to public sources. For “third path” proponents, end-of-life care has always included making ends meet within a nationalized health care system. It would appear that this new version of palliative care may be emerging as the “glue” that holds our reformed health care together.
Prior to the passage of the national health care legislation, the unanswered question for the “third path” people had been, “If we build a field of palliative care, will anyone come?” How to convince the American public to accept the curtailment of services? Listen carefully now as they use the marketing technique of selling value. But it will be value based on quality, and quality measured in cost containment.
Let’s look at where we are today. Who are some of the “chosen” leaders?
It is no surprise that the person tapped to define “quality” EOL care in the new reformed health care system and to head the Centers for Medicare and Medicaid (CMS) is Don Berwick—the guy made famous by his “rationing with our eyes open” statement.
1. Institute for Healthcare Improvement and Joanne Lynn
Berwick has been defining “quality” for twenty years. He is past president and CEO of IHI, the international Institute for Healthcare Improvement.
IHI focused on end-of-life care from the start. It specializes in bringing together health care organizations to produce guidelines. RWJF funded their Collaborative on End-of-Life Care which set forth three objectives:
1) Institute advance care planning discussions within 24 hours of hospital admission and document the plan in a patient’s chart
2) Reduce the number of transfers to the hospital in the last 2 weeks of life and reduce emergency room utilization
3) Begin bereavement assistance and support for the family and friends before a patient’s death
Berwick chose Joanne Lynn who had directed the SUPPORT Study to chair his IHI End of Life Care Collaborative. Lynn was on the board of Concern for the Dying and made her mark in the 1980s by developing guidelines for withdrawal of treatment. In a Hasting Center Symposium on May 20, 2008, she said, “We need to build a social consensus drawing on a new paradigm that tailors care to the new reality of dying—which is after a long, chronic illness. Not only is it the right thing to do, it makes good business sense.”
We look back to a June 1997 NY Times story to get a better description of what Lynn believes about total sedation and withholding and withdrawing life sustaining treatment. “When a patient is ready to die, I can stop nutrition and hydration, I can stop insulin and ventilation, I can sedate them. I can creatively collaborate with the forces of nature. But if they really want to control being dead tomorrow at 10, I cannot promise that.”
2. National Priorities Partnership and Christine Cassel
Until his appointment to the Centers for Medicaid and Medicare this summer, Berwick was co-chair of the National Priorities Partnership convened by the National Quality Forum. NPP is a collaborative effort of 28 major national organizations to identify a set of National Priorities and Goals and to help find high leverage areas—those with the most potential to result in substantial “improvement” in the health care system. In 2009/2010 the Partners identified palliative care and end-of-life care as one of the top five priorities for “improvement.”
Berwick put Christine Cassel in charge of this Palliative Care and EOL working group. Who is Christine Cassel? Cassel is a proponent of physician assisted suicide. She is also president of the American Board of Internal Medicine. With Timothy Quill and Diane Meier, she coauthored a 1992 New England Journal of Medicine article entitled, “Care of the Hopelessly Ill: Proposed Clinical Criteria for Physician Assisted Suicide.”
With funding from George Soros, Cassel and Diane Meier cofounded the Center to Advance Palliative Care (CAPC as it is known). CAPC aggressively markets the new sub-specialty of palliative medicine and trains people at nine Palliative Care Leadership Centers around the United States.
Let’s go back to the Euthanasia Society of America chart. Byock, Lynn, Cassel and Meier were all members of Choice in Dying and Concern for Dying. Where are they today? Lynn and Cassel are working with Berwick, Meier is advising a special Senate committee and Byock is blogging at the New America Foundation and giving high profile interviews with the media.
Given this clear agenda, it is no longer safe to assume that palliative care is still just about treating a patient’s symptoms. If that were so, why would there be a need for an entirely new subspecialty in medicine administered by a multidisciplinary team? Why must there be palliative care centers? What do they teach in these centers?
In closing, I would like to address the concerns of those who simply find it hard to believe that palliative care could be one of the reasons things are going wrong in the field of medicine.
I don’t think we can ignore the evidence of the funding and the stated agenda of the recipients of that funding.
Let me conclude with another quote from the 2005 Hastings Center Special Supplement Report written shortly after Terri Schiavo died. The author of the Preface complained: “What progress has been made is now in danger of being undone. The framework of principles for legitimate decision-making at the end of life built by the courts, the legislatures, and in professional and ethical literature has not been embraced—indeed, it has been rejected, at least in large part—by increasingly powerful and vocal minorities; and political support for this framework, as well as its intellectual justification, seems to be eroding. This is a CRITICAL PROBLEM.”
And so I say to everyone here today: Continue to be part of the problem! We are making a difference. Become more educated and stay firm.
The Natural Law, which values respect for each life as a unique gift from God, is etched into our hearts by our Creator. Through education, prayer and surrender we can identify and resist the moral pitfalls placed in our way by “third path” proponents who are working to create and institutionalize a palliative care paradigm that does not adhere to the Divine Plan. This will require vigilance and firm adherence to moral principles.
In a culture which truly respects each life, death will never be imposed. In a culture which values life only on a utilitarian scale and in which resources become scarce, each person who faces a life-threatening or chronic condition will find that life endangered. This will be especially so among the elderly, as imposed death will be offered as the morally ethical choice. We must arm ourselves with the truth so that we are able to reject EVERY effort to impose death.
Elizabeth D. Wickham attended the University of Kansas where she graduated Phi Beta Kappa with honors in Economics. She received a Ph.D. from the University of Rochester studying mathematical economics and international trade theory. She has taught at four state universities and has published in various professional journals. For two years she was Assistant Ombudsman at the University of Tennessee–Knoxville. Dr. Wickham is a cofounder and Executive Director of LifeTree, Inc. She and her husband, Doug, have two children and two grandchildren.
This talk was originally presented at the 2nd annual Life Conference in North Carolina and is based upon the extensive research of Ione Whitlock, LifeTree’s chief of research. It has been reprinted with permission of LifeTree and Dr. Wickham. For more information on LifeTree, please visit http://www.lifetree.org/.