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Slip sliding towards death panels, eh?

Slip sliding towards death panels, eh?

Import Canadian oil, not death panels.

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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Not A Member of Any Organized Political | October 28, 2013 at 10:20 am

Ah those crafty “experts and wise community members”..
….They also made up ALL the concentration camp planning and executive committees executing Germany’s
“final solution.”

The same people who tell us having death panels are a good thing are likely to be the same people who tell us putting murderers to death for their murders is a bad thing.

Any time people have started thinking about human life in the same sentence as “utility”, the results have been horrifying.

Every time.

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

And so we head back into the realm of Aktion T-4

“Reich Leader Bouhler and Dr. med. Brandt are charged with the responsibility of enlarging the competence of certain physicians, designated by name, so that patients who, on the basis of human judgment, are considered incurable, can be granted mercy death after a discerning diagnosis”

Do you want individuals and their families to decide their own healthcare and their own fates or do you want the government to do so?

If the latter you are necessarily going to do the same kind of things the Europeans were doing a few generations ago to rid themselves of “useless eaters”.

    Ragspierre in reply to 18-1. | October 28, 2013 at 11:58 am

    Oh, the Nazis were late to the ball!

    American Progressives had been playing with eugenics for decades before that.

It would be useful to have some information about how often it could occur that the taxpayer would have to fund what could be irrational decisions by a family (artificially keeping alive the tissue of a person who is in fact dead). Examples? I just read the Slate piece. “Coma” is not tantamount to “brain dead” or “hopeless”.

    david7134 in reply to janitor. | October 28, 2013 at 3:02 pm

    From my experience, you can say that each doctor will face a family that has unreasonable expectations at least once per day. The problem that we run into is that families do not want to make a decision to stop giving care, even when that care is about the same a the torture that we read about for terrorist. In fact, the things that we do to patients who will never recover would not be tolerated if the public could see what happens. I am against our government stepping into this and would prefer for them to be out altogether. Instead, we need doctors to step up and make the decisions that are necessary and protect them from the inevitable legal ramifications that would occur.

odd how no comments are allowed on that slate article.
just odd huh????

Neo-Neocon wrote: “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.”

Just curious: What percentage of the Consent and Capacity Board’s decisions are in favor of the family and not the doctors? What percentage of their decisions are on the “drop dead” side? Does the great diversity of Board members’ occupations include any Christian ministers, Catholic priests, or Jewish rabbis — that is, people whose philosophy is deeply rooted in the sanctity of human life?

When my mother’s health suffered (the direct result of a poor treatment decision made a physician new to her care), her healthcare team advised me to face the fact that she was a goner, although they were a bit more diplomatic in saying so. A rehab center kept her for awhile, doing little to improve her physical condition while billing Medicare the maximum. When I put her in private care, at my own expense, she began a real recovery. She regained weight and recovered enough strength to sit up and then to walk — by all accounts, a medical miracle. I think it was a miracle only in the sense that providing good care instead of token care is a miracle. She was not on life support or other end-of-life care, so no formal review board or death panel was involved, but I consider the restrictive rules for Medicare reimbursement to be the same in principle.

Government will cut off medical treatment and rehabilitation services for people who actually could benefit from it. The deciders (who won’t be you) will be just as impersonal as an auto insurance company that decides to total a repairable car because they don’t like the cost. You still love your mom and want her to stick around for awhile longer? You want to repair and keep a paid-for car and not have to buy a new one with payments that insurance will never come close to covering? It’s all the same. You lose and the bean counters win. For awhile, you will still have the right to use your own money to seek private care. Eventually, if Canada and the UK are a guide to government brutality, even private-paid care will be banned.

Suppose there’s a drug that costs $500,000 and will extend your life another 6 months but you’ll die of cancer regardless. This drug isn’t covered under your insurance plan.. would you sell everything to live a few more months? Should the insurance company or tax payer be footing the bill for this?

    If you (or the insurance company which you have paid into all those years) decide to pay for it, what difference does it make what WE decide?

    That’s why you don’t WANT the government to be in charge of health care – THEY get to decide.

    under ACA IPAB if that drug was rare and in demand even if YOU could pay for it you would not be allowed to have it.

Sarah Palin’s nuts for thinking socialized medicine has “death panels.” And it’s a good thing socialized medicine has death panels.

I want to be on the Consent and Capacity Board that has the final say and can overrule Congress’s decision about whether to continue life support for the deathly ill Obamacare.

Knowing liberals, they’ll name their Death Panel “The Life and Longevity Advocacy Board”.

To J Motes:

If you follow the link in the piece on the words “the group,” you’ll find that it leads to a list of the members of the Board and includes short bios. The list is very long (approximately 90 people, by my quick count) and so my impression is that they don’t all sit on the Board simultaneously for any decision, but rotate in and out on some basis. If you go to the link, though, you can get a very good idea of the Board’s makeup. My estimate on a quick perusal is that about a third are lawyers and close to a third psychiatrists, the rest a smattering of professions. I believe there is one minister.

    J Motes in reply to neo-neocon. | October 28, 2013 at 1:28 pm

    Thanks, neo-neocon! I will follow the link as you have recommended. I will also keep looking for information about the ratio of “thumbs up/thumbs down” decisions the Board (and others like them) make.

Prime candidate for organ donation should be the proponents of death panels.

That’s a very ‘unfortunate’ photo.

Sorry Grandma, but you are in your 228th trimester and this is all about choice.

Freddie Sykes | October 28, 2013 at 1:58 pm

Schiavo was denied food and water under the penalty of address and the compassionate talking heads recounted that dying of hunger and thrist was really kind of pleasant. I believe the words most often used was “euphoric”!

I wrote a long comment the other day about what to expect in terms of language that would be used in place of death panels. I will now give several other phrases.

As before, I said that “quality of care” will be the term used to limit your ability to obtain procedures and exposure to specialty physicians that can do more than your LMD and generally order testing or preform procedures that are expensive.

Another phrase that is used in doctor language is “what is best for the patient”. Any time you hear or see that, it is pure bullshit. This is especially used by academics and doctors in power situations. It usually means they don’t want to pay for care.

Finally, a phrase you have heard an number of times, “Medicare Fraud”. I heard Bill O’Reilly (who is a jerk) say that most billing constituted 25% fraud. That is wrong, medical billing is 100% fraud. Most attorneys do not know the definition of Medicare fraud and think that it is similar to criminal fraud. It is not. I commit Medicare fraud daily as I do my billing and write my note. Lets say I dictate a note send it to be typed, but it is lost. In the meantime, I have billed for what I did. I just committed fraud that could send me to jail or incur a big fine without a court appearance. I once knew a doctor in Mississippi that thought he would end the Medicare hassle by billing the lowest amount on the schedules (something developed by Jindal which makes him a liberal). He landed in jail for doing this. And heaven forbid that you give free care, doing so is against the law and is fraud. So are there bad doctors? You bet, but that is not who they are talking about with fraud and they use the term to manipulate the physicians to do what they desire.

In the UK, the NHS is changing the definitions in several regions due to cost problems. The new regs will enable physicians to terminate those deemed a waste of resources without so much paperwork and review.

In the Netherlands, physicians are now empowered to make the euthanasia decisions on their own without consulting the patient or family at all, and without any higher sanction, review, or approval. Doctor Death indeed, just in time for Halloween!

It’s a slippery slope we trope, although I see no moral objection to pulling the plug on Adam Goldberg. Does anyone read Slate for any reason other than to find stupid articles worthy of ridicule?

Catastrophic Shipwreck ObamaCare: ‘Yoots are rightly ignoring it(and many other things, as well)and Medicaid applicants are expanding as are job losses due to O-Care.
How about we try Death Panels…?…OH…Ooohhhhhhhhh..!

Henry Hawkins | October 28, 2013 at 6:23 pm

Slip slidin’ away…
Slip slidin’ away…
The nearer your destination
The more you’re slip slidin’ away.


I had a dream last night and in that dream I dreamt I was an old man, maybe 85, maybe 90 years old, and my very life was in hearing before the Death Panel, who would judge whether the medical costs of saving my life was worth what they think of as ‘their’ money. Neither my own testimony nor that of my family would be heard or considered. My representative congressman was unavailable for comment. I was scared, not of death, my you, but that a sounder of hogs called the Death Panel would decide when it would happen.

From the balcony of my dream I looked down as I sat in a chair and tried to be patient, tried to be at peace while strangers for whom I exist only as a ledger went about deciding my fate. I got scared. Sure, I understood their sick logic on it, but saw no moral value in it, indeed, it is flagrantly immoral to assign a worth in dollars to a life – and without that life’s permission.

In my dream I wished they could know that most of us out here in Peasantville, USA see it differently. We see it as the government not being happy enough with taxing all our money away, they’ve found a way to legally translate human life into a dollar amount that is subject to a different sort of death tax, Obamacare being specifically designed to allow death panels to take that life by taking away the money for its medical care, and yes, they use the pronoun ‘it’ in my dream.

I grew restless in my dream as the fear grew inside me and my anger rose. I would wake to damp sheets twisted around my body. What had I done to be treated this way? Growing old or infirm is a crime to be punished? Or is it really just an accounting device to monetize life and move it around in the form of fungible funds? You know, like stocks and bonds or human slavery?

That’s what I thought in my dream and that’s what got me so mad. They’d given me no choice, backed me in a corner, treated me, quite literally, like a piece of livestock that may or may not be worthless, they’d decide. Anger. How like gods they must feel themselves to be.

So, I would likely lose my life due to some Darwinian accounting math scam, an algorithm to change life into money then taken as a tax. Leave a man neither choice nor hope and he no longer has anything to lose. He may resign himself to it, or he may now be a very dangerous man.

So hard to watch yourself cry in a dream, but I did, and did, but not so much for myself though I had loved my life, but for the sadness of a government so callous as to do as I had learned they would do. I understood how a judge could sentence to hang a man who had slaughtered an entire family, but what had I done? I am hardly unique in my old age and infirmities, and so, not the only one facing a death panel. How could they sleep at night after such a decision? Damn the math, is there no shame? Is even the sanctity of life now a relative matter? Has ‘first, do no harm’ been replaced by ‘first, remember our budget’? So angry in a dream.

It was then I remembered one right they hadn’t yet stripped away, and in my dream I reached over and patted my ‘leetle frien’ holstered under my arm beneath my cardigan. I dream-wondered if there was anything I could do to add to the testimony they’d be considering. Within the dream my mind strained to recall the blog posts I’d read decades ago concerning self defense laws. Just then a nurse stepped out and somberly asked me to enter the hearing chamber, the death panel had rendered its verdict.

Right then the damn dog woke me up pulling on my sock. I can’t wait to go back to sleep tonight, see what I do.

Tell me the creepy cryptkeeper lady at the top is not in charge of a death panel.

Why does she have two different eyes? The expressions don’t match each other. Lazy eye? Stroke? Is she an alien?