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I think we need to define terms. Insurance companies have utilization review boards who look at cases, treatment given, and ask these questions:

Why is this person still in the hospital?

Can this be done in an outpatient setting?

Is the treatment proposed experimental?

Could the complications have been prevented?

Here in CA there was a huge uproar that caught the attention of the state media involving a teenage girl with leukemia, whose chemotherapy had destroyed her liver. The doc wanted as a last ditch effort to do a liver transplant. The problem is that chemotherapy and transplants are oil and water in a way. If you have one, you cannot do the other because of the issues of rejection, immunosuppression etc. The insurance denied it. There was a great amount of wailing and gnashing of teeth over the decision. Was this a “death panel”?

I also have seen cases of severe anoxic brain injury where the patient is extremely unstable, and also depends on a ventilator and dialysis. The family cannot understand why God let this happen and demand maximum treatment. Months pass and we need to address placement. The only facilities that can take her 200 miles away. The families refuse the placement. Should they pay for the extra days of stay? Is the ethics committee a death panel because they try to show the families the futility of the treatment? What if the nephrologist decides on his own to stop dialysis? The patient is on medi-cal and they will not pay for any of the dialysis alternatives that have been brainstormed. Is that a death panel?

I’m not making any of this up, it all happens. I’m not trying to argue with you either. It is just that we throw around these volatile terms like death panels for shock value without realizing it is already happening in one way or another. The biggest factor is who is going to pay for all of this.