Stranger Than Fiction Deadlier Than Infection

January 23, 2009 09:00 AM

We have all heard it said that some viral infections like Ebola frequently cause death if not treated immediately and aggressively.  But some of the policies being considered by the medical profession and the Obama administration could prove to be even deadlier.

For example, one of my favorite commentators, Wesley J. Smith, has recently explained that incoming Secretary of Health and Human Services Tom Daschle wants to create a U.S. agency to control costs based on the UK's Orwellian-named National Institute for Health and Clinical Excellence.  What makes this particular blog interesting is that Smith was warning about this long before Daschle actually got interested in proposing it. Smith wrote in 2005,

"[Under NICE standards, an] assessment is made of the cost of the treatment per additional year of life which it brings, and per quality adjusted life year (QALY) . . . which takes into consideration the quality of life of the patient during any additional time for which their life will be prolonged. The clinical and cost effectiveness of the treatment under review is then used as the basis for a recommendation as to whether or not . . . the treatment should be provided in the NHS..." In other words, medical care is effectively rationed by the National Health Service under guidelines set by bioethicists based on their beliefs about the low quality of life of patients whom they have never met. While the views of patients and families are to be taken into account when deciding whether to provide treatment, they are not determinative.

Or it will be the medical team deciding who should live and who should die based on totally subjective criteria. In fact, when the Wall Street Journal wrote on the latest wrinkle from Daschle, the article was crystal clear:


Mr. 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.

Such calculations can't account for all the variation in disease and patient preference that drive medical decisions. So it's no surprise that in Britain there's vocal dissent against NICE constraints, especially among cancer patients who are denied many effective new drugs that, for now, are widely prescribed in the U.S. The rich, of course, are able to opt out of the British controls. But the rest of the country has to appeal to politicians -- rather than their doctors -- to gain access to restricted medicines.

Once could describe this proposal as budget cutting executed over many dead bodies. But that's not all.

Bioethicists are also working on new definitions of death that will serve the growing need for fresh organs at the expense of other people's lives. In fact,

the President's Council on Bioethics issued a new report that defines brain death as the cessation of engagement with the world.

The report overturns the current neurological death standard's reliance on an outdated notion of the brain as the body's control center for physiological processes….Taking organs from a living person is ethically unacceptable. Easing standards—focusing purely on higher brain functions, and designating as dead people who are still able to breathe on their own—would also be, to many people, unethical. And reverting to cardiac death standards would require doctors to wait for hearts to stop beating before removing organs.

Pro-life ethicist Nancy Valko, R.N. intends to do a complete analysis on this, so I will leave the intricacies to her. But suffice it to say, every human being who has concern over their own fate when death comes calling should be diligently working on ways to protect one's life from the philosophical meandering that is continuously redefining what it means to be dead! To turn anything that is black and white into an area of gray sufficient to placate the organ harvesting industry appears to be the philosophical goal of more than a few sycophants of the organ harvesting business. Obviously, the actual practice cannot be far behind.

Weighing in on this very question, I found that the American Medical Association has a different perspective. In a recent commentary entitled Redefining Death: A new ethical dilemma, we read a variety of opinions on what the clinicians should be doing about the determination of death. Of interest in this article is the honesty of Robert Truog, M.D. who doesn't mess around with any sort of philosophical mumbo jumbo:


Dr. Truog has long argued for what he admits is a "radical departure" from the current definition of norms for death. He disagrees that brain death is actual death, noting that major life functions continue. Brain-dead patients have given birth, for example.

Dr. Troug argues that vital organ donation does cause patients to die, and to say otherwise misleads patients and families. But dying patients on life support and their families have a right to consent to such donations, even if it causes death, he said.

Dr. Truog wants patients to be aware that if they wish to donate a vital organ, the taking of that organ is going to kill them. Then they can choose what to do. The problem with that is that nobody has a right to commission someone else to kill them. It's just another name for physician-assisted suicide, even though it would make the transplant experts very happy indeed.

And then there's the remarkably astute Dame Mary Warnock of Great Britain, the country which has a health care system that Secretary Daschle finds "NICE"! Warnock recently said "…doctors who refuse to cooperate in assisted suicide are 'genuinely wicked.'"


Following a theme of previous comments in which she said that the elderly and people with dementia have a "duty to die," Warnock said, "There are doctors, we know, who don't pay any attention [to a patient's desire for suicide].

"But that seems to me a genuinely wicked thing to do – to disregard what somebody had quite explicitly said, that he wants to die – not to be resuscitated in certain circumstances and in certain circumstances to be helped to commit suicide.

 I guess Dame Warnock would be the right person to help sort out the dilemma in Washington State. A recently passed assisted suicide law allows doctors to help people commit suicide once they've determined that the patient has only six months to live. But writes one reporter,


The law has deeply divided doctors, with some loath to help patients end their lives and others asserting it's the most humane thing to do. But there's one thing many on both sides can agree on. Dr. Stuart Farber, head of palliative care at the University of Washington Medical Center, puts it this way: 'Our ability to predict what will happen to you in the next six months sucks.'"


All in all, it seems to me that perhaps Warnock would be better at helping Daschle, since he loves the idea of regulating which patients can be treated in the first place and Warnock has a penchant for insulting people who actually respect life and understand that a living, breathing human being has dignity even when he is dying.

The next four years should be interesting. Of that there is no doubt. Apparently, if some kind of disease doesn't get you, denial of treatment or announcement of your premature death just might!
 

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