Victor Davis Hanson (at around 14:00):
What Thomas Friedman would need to do is get on a bicycle and go across rural China, and then compare that with biking across Nebraska, and see which society is more resilient and stable.
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Well, you will pull the plug on grandma, but only after grandma has signed the document the doctor explained to her long before she got into the situation she’s in now, back when it seemed like autonomy and control.
“Using unwanted procedures in terminal illness is a form of assault,” [said Dr. Donald M. Berwick, administrator of the Centers for Medicare and Medicaid Service].
The question is what do patients want and how what they want will be determined. It seems to me that the effort is to get people to commit in advance to death-hastening choices, by getting everyone to sign these documents. Now, all the new regulation seems to do is to authorize Medicare reimbursements for the time health care professionals spend counseling patients about the value and importance of signing the document. It’s hard to see what’s wrong with that. If treatments are covered but advice about forgoing treatment is not covered, then there’s an incentive to do expensive things.
In a recent study of 3,700 people near the end of life, Dr. Maria J. Silveira of the University of Michigan found that many had “treatable, life-threatening conditions” but lacked decision-making capacity in their final days. With the new Medicare coverage, doctors can learn a patient’s wishes before a crisis occurs.
Treatable? You have a condition that can be treated, but you can’t think well enough anymore to decide whether you’d prefer to die? If you’ve signed the document, the answer is you’d rather let the condition kill you, because you allowed the doctors to “learn [your] wishes before” this “crisis” occurred. You didn’t know what the crisis would be or how you would feel when it happened, but you had “wishes” then and these will be taken as your “wishes” now.
(Many of the comments are also worth reading, particularly the one by Bender at 10:21 AM on 12/26/10 and the one by Ann Althouse at 2:21 PM on 12/26/10.)
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* Why do those who object to tampering with the environment approve of tampering with the economy? Isn’t the economy also a fragile ecosystem where a sudden change can trigger a devastating chain reaction?
* Isn’t the latest economic crisis such a chain reaction?
* Aren’t most of today’s social ills the result of tampering with social ecosystems?
* Why is bioengineering bad, but social engineering good?
Glad to see Oleg is getting recognition he deserves. I got his book as a present and leafed through; will move it higher in my book stack now.
Thinking more of Oleg suggestion (of asking questions as a strategy) – I don’t think this would work. Look, f.i., at this “conversation”. There is no point in playing fair with gangsters who will not.
When it comes to “who makes decisions” I can’t think of anyone better qualified than a government bureaucrat to decide whether elderly baby boomers should hdie now, cheaply or have expensive treatment that robs the poor of food.
Patients have been asked to sign advanced directives for at least 30 years now. Since DRGs appeared in 1986, some hospitals have kept a record of how much a doctor’s patients “cost” the hospital with the obvious implication that they didn’t want those patients and/or that doctor. These things have been coming a long time. Patients, if they knew what is happening to the practice of medicine, would be very worried about the conflict of interest that doctors face now.
There is a long history of doctors and patients and families coping with this in private. Now, we have lawyers to do this and that, of course, will be much more equitable.
Last night I was walking by the tv and didn’t get the full context but a pro-Obamacare was arguing with an anti (I think it was on O’Reilley with someone else hosting – but could be wrong). Anti argued death decisions shouldn’t be between government and patient. Pro said it wouldn’t be but rather the patient’s choice guided by a doctor. And doctors are the people who know life and death issues.
Doctors are not family and they are likely to be pressured in numerous bureaucratic ways. And knowing the difference between breathing and not is not the same to most of us as the difference between choosing death or life. The exchange was chilling. And partially because of its inappropriate understanding of physician/patient body/soul distinctions. Not unlike abortion & stem cell controversies. I appreciate my more religious friends’ perspective more and more each day. Of course Sarah Palin was not wrong – not that what she said wasn’t pretty obvious. And the cavalier approach to science (perhaps “science”) yet privileging of it of this administration doesn’t give confidence.
The best way to explain to a leftists the concerns that non-leftists have about “end of life” documents, just say, “What if private insurance companies did this?”
Suppose all the private insurance companies required doctors to talk to their patients about whether they wanted the expensive heroic measures that the insurance company would have to pay for. The leftists would instantly see that as a conflict of interest. When talking about end of life care, the insurance company clearly has a financial incentive for old people to pull the plug on themselves.
What leftists can’t see is that when government pays for health care, it acquires the same incentives as the private insurance company. Government has the same incentives to rid itself of non-taxpaying, resource consuming old people as a private company would.
Leftists intuitively believe that the pursuit of profit is corrupting while the pursuit of power is ennobling. They really believe that people in the government, from elected officials on down, don’t respond to financial, career or other incentives. They think its all about noble altruism.