In a Slate article entitled “Canada has death panels, and that’s a good thing,” Yale law student Adam Goldenberg applauds the idea.

Canada Death Panels Slate Title Only

The “experts and wise community members” (Goldenberg’s words) who make up Ontario’s Consent and Capacity Board have the final say and can overrule a family’s decision about whether to continue life support for an ill member if there is a dispute between the family and the patient’s doctors.

Who are these people, and why are they given that power? The group is a government-appointed board heavy with lawyers (and not necessarily those whose practice involves relevant areas of law), psychiatrists, and an assortment of others from the community with a great range of professions, many of them seemingly unrelated to the task at hand. All the physicians on the board appear to be psychiatrists, which is most likely a reflection of the fact that the bulk of its business (80%) involves issues of involuntary commitment to mental institutions and/or decisions about mental capacity to consent to or refuse treatment, rather than its work as a “death panel.”

Goldenberg notes that at present in Canada and the US, many disputes over end of life care are decided by judges:

When these family members disagree with a patient’s doctors, and when the doctors are nonetheless determined to act, the dispute generally goes to court, where it can take months or even years to resolve. That is how it works in other Canadian and American jurisdictions, anyway.

But in the US such disputes have mostly been between family members about end-of-life decisions, a la the Schiavo case.

Unlike the Ontario case that sparked Goldenberg’s article, the type of disputes that end up in US courts are not ordinarily between the family and doctors. When doctors enter the arena in the US, it is nearly always over medical issues such as the definition of death or chronic vegetative state, even in the US case that most closely parallels the recent one in Canada that Goldenberg discusses.

An exception is in the State of Texas where, due to a controversial statute known as the Advance Directives Act, doctors have more power to overrule a family or patient’s wishes and there have been a few court cases pitting families against hospitals. The Act “allows a health care facility to discontinue life-sustaining treatment ten days after giving written notice if the continuation of life-sustaining treatment is considered futile care by the treating medical team,” unless a transfer can be arranged to a facility that will take the patient. The doctors’ decision must be based only on a medical determination to stop treatments that would increase suffering when there is no hope of recovery, and ability to pay cannot be taken into consideration.

However, reimbursement for such care will always be an issue in any medical system (unless the patient’s family is independently wealthy), whether payment be through Medicare, Medicaid, private insurance, charity, or special funds set aside by hospitals for that purpose. But because of the way the Canadian single-payer health care system is currently structured, the government of Canada has a special interest in avoiding the monetary cost of keeping the patient alive. Goldenberg makes this clear, writing that, “In Canada, with our single-payer health care system, [such situations have] a very public bottom line: Should taxpayers foot the bill for [a] family’s indefinite goodbye?”

That’s the slippery slope down which conservatives are especially wary of sliding.

Goldenberg ends his piece with a swipe at Sarah Palin:

When humanity demands haste, and justice demands expert knowledge, Ontario’s death panels offer a solution—whatever Sarah Palin says.

Ah, but Palin never indicated that death panels don’t offer a solution. She’s well aware that they do, and are an almost inevitable outcome of the liberal mindset plus increasing government control of health care. She thinks they are the wrong solution, an unconscionable intrusion by a state into decisions that should be up to the individual and the family, and the patient’s doctors.

Of course, as health care has gotten more and more expensive, and technical advances have increased our ability to keep people alive even if comatose or brain-dead, some entity will be making more of these hard decisions as time goes on, because even if the family wishes it, resources and abilities are not infinite. But there is something especially repellent about a government entity with a pecuniary interest in ending the patient’s life having the final say.

(Featured image taken from an Ontario Consent Board video of  Mock Hearing to overcome family and doctor decision making — wmv. file download)

[Neo-neocon is a writer with degrees in law and family therapy, who blogs at neo-neocon.]


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