Posted on 05/16/2009 11:07:26 AM PDT by wagglebee
Editor's Note: This article was originally published on the Disability Matters blog site. It is reprinted here with permission.
There's been very little attention paid to an interview President Obama did with the New York Times the day of his major speech at Georgetown University on April 14. I was especially interested in the section of the interview dealing with health care, and to learn of the President's perceptions of end-of-life issues. It's not pretty. Read on.
For starters, President Obama opined:
I have always said, though, that we should not overstate the degree to which consumers rather than doctors are going to be driving treatment, because . . . when it comes to medical care; I know how to ask good questions of my doctor. But ultimately, he's the guy with the medical degree. So, if he tells me, You know what, you've got such-and-such and you need to take such-and-such, I don't go around arguing with him or go online to see if I can find a better opinion than his.
Well, yes and no.
But the President's slant is immediately concerning, because there's a fine line between medical expertise and Doctor Power. What if the doctor says, "Well, you've got two weeks to live, and your quality of life is very poor, and all the expensive care we can give you will not help a bit, but assisted suicide is legal, quick, and very inexpensive?' Should I then accept this pronouncement because he's "the guy with the medical degree?"
If you think I'm stretching things a bit, it's because of what came next from the President:
And part of what I think government can do effectively is to be an honest broker in assessing and evaluating treatment options. And certainly that's true when it comes to Medicare and Medicaid, where the taxpayers are footing the bill and we have an obligation to get those costs under control. And right now we're footing the bill for a lot of things that don't make people healthier.
Not too hard to see the spin here. Now we'll get the government saying, "OK, seeing that we pay for your medical care, we're going to decide what care you get and what care you can't have."
And, more darkly, the specter of futile care emerges, because what the President was saying was, "If we're paying for stuff that doesn't make you healthier, we need to reconsider whether we want to pay for this treatment."
Note the phrase is "to make you healthier" - not to alleviate your symptoms, or provide you with comfort care because you're never going to get healthier.
Simple: If treatment makes you healthy again, you get it. If it can't, you can't have it, because we need it for people who can get healthy again.
Pure, unadulterated futile care.
Here's what will happen, trust me:
The government already knows that medical care in the last weeks of life is where most medical dollars get spent. Same goes for money spent on people with significant, although not necessarily terminal disabilities. Marry that to the President's commitment to cut health care costs, a society that increasingly thinks helping people die is just dandy, and a medical profession that is increasingly utilitarian, and you have the perfect plan to make people with severe medical problems, including those with disabilities, into Useless Eaters.
It got worse.
The President:
So when . . . I talk about the importance of using comparative-effectiveness studies as a way of reining in costs [which] . . . is an attempt to say to patients, you know what, we've looked at some objective studies out here, people who know about this stuff, concluding that the blue pill, which costs half as much as the red pill, is just as effective, and you might want to go ahead and get the blue one. And if a provider is pushing the red one on you, then you should at least ask some important questions.
Ah, "comparative-effectiveness," "objective studies."
Science in the service of deciding who lives and who dies. Seems like we've heard this somewhere before.
Allow me to paraphrase my President:
Doctor to patient: "You know, what, we've looked at some objective studies out here, people who know about this stuff, concluding that there's no point in treating you any further. We've concluded that the blue pill, which will keep you comfortable until you die, is very expensive. The red pill, that costs a tiny fraction of the blue pill, can end your suffering quietly, effectively, and with dignity."
Don't believe me? See what happened to Barbara Wagner in Oregon, where the state refused an expensive treatment to help her live our her days, but offered to pay the pennies it would cost for her to commit assisted suicide.
But the President went even further, using a personal example when asked about end of life care:
. . . my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip . . .So now she's in the hospital, and the doctor says, Look, you've got about - maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that - you know, your heart can't take it. On the other hand, if you just sit there with your hip like this, you're just going to waste away and your quality of life will be terrible. And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just - you know, things fell apart . . .
OK, a very difficult situation, with difficult, but very common health decisions that needed to be made. BUT, then the President went on, back to setting us up for official pro-death thinking:
Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else's aging grandparents or parents, a hip replacement when they're terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn't have a hip replacement and she had to lie there in misery in the waning days of her life - that would be pretty upsetting.
See? Old, lying in misery in an expensive hospital bed, with a broken hip.
Pretty upsetting. Expensive, too.
What's a grandson to do?
The President:
Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that's part of why you have to have some independent group that can give you guidance. It's not determinative, but I think has to be able to give you some guidance. And that's part of what I suspect you'll see emerging out of the various health care conversations that are taking place on the Hill right now.
Just so you know: Pro-death is going to be more than law. Here's the plan:
Have "conversations" with the public under the guise of measured reasonable argument. Subtly (and not so subtly) use doctors, scientists and ethicists who are pro-death to lead the way. Shape public opinion to utilitarianism, futile care, people as pure economic entities, and then the resistance to assisted suicide, and, eventually, euthanasia, will crumble.
Is Obama our first pro-death President?
I see no evidence that he's not.
Mark Mostert, H.E.D., M.Ed., Ph.D., currently serves as director of Regent University School of Education's Institute for the Study of Disability & Bioethics.
Note the phrase is "to make you healthier" - not to alleviate your symptoms, or provide you with comfort care because you're never going to get healthier.
Simple: If treatment makes you healthy again, you get it. If it can't, you can't have it, because we need it for people who can get healthy again.
Pure, unadulterated futile care.
Perfect analysis!
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Don’t call it euthanasia. It’s enhanced late term abortion.
In Socialism your the state responsibility but your also state property...When people are property of the state ...the state starts thinking you can be condemned like property for the same reason... not generating revenue to the good of “the people” (the group)
After all the state is beholden to the good of “the people”
In Capitalism all they can to is fire you
I.e., let them suffer and die, even though they can still mentally make their own decisions re: what tx they do or do not want.
Can't wait to see how she feels when her (older) husband gets old. Of course, he's rich so that's a whole 'nother ballgame.
This would not be surprising. Obama is not about to become the first Marxist dictator to value human life.
What a ignorant self serving comment. People DIE because of misdiagnosis. People lose limbs because of misdiagnosis. One guy lately had two mastectomies based on a misdiagnosis.
Keep this guy away from me. I get sick to my stomach when I read anything he comments on. The only difference between Biden and Obama is one is a smooth talked and the other comes off like a loon. Both are idiots who were given power they are abusing out of stupidity.
Baby Boomers beware...we are about to become a burden and not a money making asset.
Well, they aren’t calling it euthanasia, it’s now, assisted suicide. Don’t you think that it’s ironic that just as we learn that 51% of the people identify themselves as pro-life, we are discussing killing senior citizens as a cost cutting measure?
I have a couple of demands that I would force on Obama, if he is going to persist in this rationalized health care system. Obama wants to limit care conditions that can be linked to behavior such as smoking and obesity. Ok, then he must also limit care for conditions that can be linked to risky behavior such as homosexual sex, like AIDS and stds. Drug addiction should not be treated as an illness. Actually, I think assisted suicide would be a proper treatment for drug addiction under Obamacare.
The liberals always like to talk about what’s fair. Well, I think it’s only fair to treat all risky behavior equally.
I have a lot of mixed feelings concerning this issue working in health care. I certainly do see the hip procedures with the patient dying 2 weeks later because of other terminal conditions. I think reasoned decisions could be made about such cases but I also fear the “point of spear” effect in that groups and political pressure advocates will attempt to push a more generalized policy of early termination/euthanasia/ denial of treatment based on the “broken hip, terminal grandma” scenario.
At bare minimum I would like to see it illegal for RN’s to “broach” the subject of denial of care or disconnection of life support without first a written doctor’s order. If family brings the subject up first, the RN should contact the MD’s in charge for either permission to speak with the family or to let them know that the family would like to speak with the physicians involved. The discussion with the doctors should include a discussion of patient’s prognosis
I see fellow RN’s jumping the gun, and pushing for DNR’s, and disconnects. I saw an argument where the Doctor was quite upset that the nurses had “induced” the patient to go no code when the doctor felt there were options she wanted to try. The doctor’s issue was that “RN’s” were making medical judgments regarding the patient’s prognosis
and the doctor found her-self sand-bagged in caring for her patient when “trigger happy pull the plug quickly” RN types jumped in to “pursuade” the famly just how “futile” the patient’s situation. The doctors had certainly not broached the subject with the patient, the nurses had!
Interesting post. I didn’t realize the RNs had the authority to start making these decisions; judging by your description of the doctor’s reaction, it seems as if perhaps they don’t, but they just seized it because they’re there and the doctor’s not.
I do not think that it is appropriate for ANY medical professional to broach these subjects. People realize what their options are, the duty of medical professionals is to treat the patient PERIOD.
Doctors should say, "we can do A, B or C and the probable outcomes are X, Y or Z."
I am not saying this to be offensive (my mother is a retire nurse, but never dealt with patients in terminal conditions, my father-in-law is a physician and the majority of his patients are terminal), but many in the medical profession have an attitude that their medical expertise somehow makes them experts in moral issues and this is false. No medical professional knows if a patient "should be allowed to die", that decision should rest solely with the patient and those who the patient wishes to be involved in the decision.
What a ignorant self serving comment. People DIE because of misdiagnosis. People lose limbs because of misdiagnosis. One guy lately had two mastectomies based on a misdiagnosis.
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That’s right. I am very close to someone who wanted some tumors removed because she had a gut feeling they were cancer, and that particular cancer had been seen before in her family. The doctor assured her she was being silly; that kind of cancer was rare; none of the tests he’d run indicate blah blah blah.....
For the next couple of years she became sicker, trusting the reputation of this doctor.
One day she got fed up and went to another doctor. The result? Surgery and the finding the cancer had spread.
I am astounded that anyone in their right mind would want the government involved in their health care. Simply and utterly astounded.
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