Emmanuel’s statement that doctors treat the Hippocratic Oath as “an imperative to do everything for the patient” was made in specific reference to end-of-life care. All too often, the dying have left no instructions, and doctors order extreme measures to keep their bodies functioning.
H.R. 3200 would merely mandate that Medicare offer, and pay for, end-of-life counseling — NO ONE would “required” to sign a living will. Given the opportunity, though, most elderly patients would. How many people really want their corpses kept breathing and digesting at the price of $100,000 a day? Do we really need to re-hash the story of Terri Schiavo and her shrunken brain-stem?
Bachmann zeroes in on the word “communitarianism” because it sounds like communism; it’s a dog-whistle. Her quote comes from this article (PDF) at the National Center for Policy Analysis. Dr. Emmanuel opens the article by distinguishing two modes of prioritizing health care: basic health care services which are guaranteed (the communitarian model), and discretionary services (the “retail” approach). Sorry, there’s nothing in the article about government death panels.
In fact, reading Emmanuel’s full paragraph below, he clearly recommends the opposite (Bachmann’s selective quote in red, boldface emphasis mine):
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 less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason. Clearly, more needs to be done to elucidate what specific health care services are basic; however, the overlap between liberalism and communitarianism points to a way of introducing the good back into medical ethics and devising a principled way of distinguishing basic from discretionary health care services. Perhaps using this progress in political philosophy we can begin to…discuss the goods and goals of medicine.
In its context, Emmanuel’s statement only suggests that taxpayers should not be stuck with the bill if Michelle Bachmann can’t bring herself to pull the plug. Judging from studies of death and dying, her father-in-law would probably prefer the plug be pulled.
Bachmann’s next Emmanuel quote comes from a different article (PDF). I present the opening paragraph for your consideration:
Allocation of very scarce medical interventions such as organs and vaccines 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 , maximizing 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 prioritizes younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.
In case you didn’t catch that, Emmanuel and his co-authors are writing about one specific subject: donated organs. Because they are always in shorter supply than patients who need them, deciding who gets them has always been an ethical dilemma. Too often, that dilemma gets resolved this way:
(U)nlike discrimination by sex or race, allocation by age is not invidious discrimination. Every person lives through different stages of life rather than being a single age. Even if a 25-year old received priority over 65-year olds, everyone who is 65 now was previously 25.
Still no government death-panels, though. In fact, the very next paragraph says exactly the opposite:
Ultimately, the complete lives system does not create ‘classes of Untermenschen whose lives and well being are deemed not worth spending money on,’ but rather empowers us to decide fairly whom to save when genuine scarcity makes saving everyone impossible. (Emphasis mine)