Text Patterns - by Alan Jacobs

Tuesday, August 11, 2009

a digression on health care

Somewhat outside the scope of this blog — though central to the concerns of The New Atlantis — is this interesting essay on upcoming health-care proposals by Lee Siegel. It’s worth meditating on even if you don't agree with it. Here’s a lengthy excerpt:

End-of-life treatment is still under consideration and would be a tiny sliver of Obama’s health-care package. But it is a highly volatile sliver. Betsy McCaughey, who singlehandedly killed the Clintons’ health-care initiative 15 years ago with her infamous and infamously inaccurate cover story in The New Republic, claims that this small passage in the bill “would make it mandatory—absolutely require—that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner.” Not quite. But — painful as it is to concede anything to an ideological hack like McCaughey — it’s uncomfortably close.

The section, on page 425 of the bill, offers to pay once every five years for a voluntary, not mandatory, consultation with a doctor, who will not blatantly tell the patient how to end his or her life sooner, but will explain to the patient the set of options available at the end of life, including living wills, palliative care and hospice, life sustaining treatment, and all aspects of advance care planning, including, presumably, the decision to end one’s life.

The “presumably” here is a sticking point. And what is meant by “ending one’s life”? I doubt that American doctors are going to hold out suicide as an option anytime soon, though I expect it to happen eventually — and almost certainly by the time I am elderly (should I make it that far). But that doctors trained in cost-cutting measures should nudge patients in the direction of palliative care seems nearly certain:

The shading in of human particulars is what makes this so unsettling. A doctor guided by a panel of experts who have decided that some treatments are futile will, in subtle ways, advance that point of view. Cass Sunstein calls this “nudging,” which he characterizes as using various types of reinforcement techniques to “nudge” people’s behavior in one direction or another. An elderly or sick person would be especially vulnerable to the sophisticated nudging of an authority figure like a doctor.

Bad enough for such people who are lucky enough to be supported by family and friends. But what about the dying person who is all alone in the world and who has only the “consultant” to turn to and rely on? The heartlessness of such a scene is chilling. . . .

One of Obama’s most alluring traits has been what some see as a literary bent that relishes complexity, irony, and even the mystery of the human personality. Let him turn toward that part of his nature and leave the sterile precincts of utilitarian social and legal theory behind. He should immediately and publicly declare his commitment to not placing economic hurdles in the way of people who want to prolong their life, or the life of their loved ones. In that way, he would take the air out of charlatans like McCaughey. And he would calm the fears of people who, far from being right-wing fanatics, are in clear-eyed possession of perhaps the only universal truth there is. No one wants to die.


  • I stirring sentiment. It depends, however, on Lee Seigel having ascertained correctly the "real" nature of Obama.

    It's always sweet to see believers op for the poetry and not the prose, but what do we have if, with Obama, there is no connect?

    The sentiment, it seems to me, is yet another example of Obama as a mirror in which we see, not the real man, but the reflection of ourselves in our best light.

    Deep down, Obama may really feel that a program suggesting suicide for the terminally ill is a noble social goal.

    The point is we don't really know, do we?

  • Michael Straight said...

    I don't think that "palliative care" (i.e. choosing hospice care instead of aggressive, most-likely futile treatment) is part of a slippery slope that leads to physician-encouraged suicide.

    Physician-assisted suicide is evil, but I think the place to oppose it is in debates over whether physicians may kill their patients, not in debates about whether the government can pay for you to talk to your doctor about possible treatment plans if you become terminally ill.

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