What Does Ezekiel Emanuel Really Believe About Rationing? Age, Maybe. Quality of Life, Yes

I have been doing a little reading about Dr. Ezekiel Emanuel, the head bioethicist at the NIH and brother of the president’s chief of staff. He is a supporter of health care rationing, which is relevant to the current health care debate. In a Lancet article earlier this year, he suggested that age be a proper method of allocating scarce resources, and indeed, stated that age based allocation is not invidious discrimination. From his piece:

Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years. Treating 65-year olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not.

He seems to be saying, be ageist, just call it something different.

Still, as I read the article closely, it was not about health care rationing in the general sense, but rather, concerned situations of extreme resource scarcity. Thus, while I think it is fair to say that Emmanuel is clearly laying the intellectual groundwork for an age-based rationing regimen, he doesn’t take the final step, writing:

Accepting the complete lives system for health care as a whole would be premature. We must first reduce waste and increase spending.

Some might say that is just a hedge to avoid the heat. And indeed, bioethicists often promote radical ideas they advocate generally by using extreme situation hypotheticals to make their intellectual points, thereby allowing them a path of retreat if the blowback becomes withering. Still, unlike some others who have commented about this piece in the current health care reform debate, I don’t think he explicitly advocated a system of health care rationing now based on age, at least not in this particular article.

The same can’t be said of an article he wrote in the Hastings Center Report, in which he explicitly advocates rationing based on what appears to be a quality of life measurement. From the piece:

This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity-those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.

A lot of people are frightened that someone who thinks like Emanuel is at the center of an administration seeking to remake the entire health care system. Having read these two articles, I think there is very real cause for concern.

Thanks for the post.

Do you know if this is the guy that said that a fetus should be watched for 33 months to see if it will be a contributing member of society, and if not it should be "aborted" up until that age?

Thanks

Here's some more stuff about this guy

Dr. Ezekiel J. Emanuel. Chicago Mob enforcer and Obama "hit" man Rahm Emanuel's brother.

Here is some information about him.

Dr. Ezekiel Emanuel: Cutting Costs, Costing Lives

FREEDOM EDEN Jul 15, 2009, 4:14 am

Dr. Ezekiel J. Emanuel is as scary as his younger brother, Rahm. Actually, he may be scarier.

R. Emmett Tyrrell Jr., the Washington Times, writes that you better get sick now or you may be sorry.

If you have any sense that you may be getting sick in the years ahead, I suggest you get sick immediately. If you will need of surgery or any medical procedure, do it now! If not immediately, be certain that you hand yourself over to the health care professionals before Oct. 15. That is the date on which President Obama hopes to sign his health care bill once it has gone through the congressional baloney grinder.

At the heart of Mr. Obama's plan is his stated goal to cut medical costs. That might sound good to you, but it means cutting services, nurses, technicians, medical tests and, most prominently, the use of expensive technology. The president's top medical advisers are quite frank about this.

Dr. Ezekiel J. Emanuel, brother of White House Chief of Staff Rahm Emanuel and a health-policy adviser in the Office of Management and Budget, has chided Americans for the expense of their "being enamored with technology." Dr. David Blumenthal, another key Obama adviser, charges medical innovations as being responsible for fully two-thirds of the annual increase in health care spending. Their solution is to limit expensive innovations. A 2008 Congressional Budget Office report agrees with their cost analysis but concludes happily that such innovations "permit the treatment of previously untreatable conditions." As I shall show, there are more humane ways to cut health care costs.

Also at the heart of Mr. Obama's plan is the restriction of services for older people, people 65 and older who, by vir
...

Read the entire post here.

The following has been composed by Ezekiel 'Dr Death' Emanuel -- a special adviser to Budget Director Peter Orszag and older brother of White House Chief of Staff Rahm Emanuel -- heads up the White House's health care reform efforts. Obama has appointed Dr. Ezekiel Emanuel to a top-level position as one of his top-level advisors, and Czars on health care reform.

*Special Note: the term allocation refers to rationing.

"PRINCIPLES USED FOR ALLOCATING SCARCE MEDICAL INTERVENTION"

Coauthored by Dr. Ezekiel Emanuel

Allocation of medical interventions is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.

Nazi Genocidal Intent of Obama's Proposed Healthcare Reforms Exposed; Dr. Ezekiel Emanuel (Rahm's brother) Escapes when Confronted

Moms For Life Jul 26, 2009, 2:41 pm

Panelists warn of the revival of eugenics under Obamas modern healthcare through the denial of care to millions of elderly, terminally-ill, and poor people, who would be judged not fit to live, just as in Nazi Germany. This would save, as President Obama says, $2-3 million, by taking lives not worthy to be lived.
Dr. Ezekiel Emmanuel, health policy advisor to President Obama and leader of a propaganda movement for euthanasia headquarted at The Hastings Center,

believes in witholding medical care from the elderly for the greater good.

Related Stories: Obama's Nazi Doctors and Their 'Reforms'

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