Wednesday, September 24, 2014

Culture of Death, part 2.

Useless eaters should self-liquidate for their own good, says the designer of Obamacare.

In other news, that "rightwing panic" about Death Panels is just nonsense.

//Emanuel also addressed the social aspects that come along with an increase in longevity. Longer lives mean that children end up caring for their parents for extended periods of time, possibly creating some social and familial issues in the process.

“Living parents also occupy the role of head of the family. They make it hard for grown children to become the patriarch or matriarch. When parents routinely live to 95, children must caretake into their own retirement,” Emanuel wrote. “That doesn’t leave them much time on their own — and it is all old age. When parents live to 75, children have had the joys of a rich relationship with their parents, but also have enough time for their own lives, out of their parents’ shadows.”

As for his own health, Emanuel, 57, said he plans to stop taking major efforts to prolong it once he inches toward the 75 mark.

At 65, he said he’ll stop having colonoscopies and, at 75, he said he will refuse treatment if he falls ill with cancer; he’ll also stop having stress tests, will refuse pacemakers, won’t have reparative heart surgery — and will even stop taking antibiotics.

“At 75 and beyond, I will need a good reason to even visit the doctor and take any medical test or treatment, no matter how routine and painless,” he said. “And that good reason is not ‘It will prolong your life.’”

Emanuel, a well-respected doctor whose views on health and patient care have been scrutinized by some critics, was careful to note that he isn’t judging those who wish to live as long as possible and that he, as a physical, has regularly helped the elderly find resources that enable them to do so.//

Dr. Emanuel sounds like the medical professionals who were advising the sterilization of the "feeble minded" and "socially inept" at the beginning of the 20th century.


Anonymous said...

"Dr. Emanuel sounds like the medical professionals who were advising the sterilization of the "feeble minded" and "socially inept" at the beginning of the 20th century."

Did you read the quote in your own post? Did you read the full article he wrote? He was describing what he felt his own personal choices will be as he ages. You know, the choices we'd all like to make for our ourselves without interference from government. Your transparent attempt to link a really heartfelt and well presented essay on how one individual, one who has extensive knowledge of end of life and end of life healthcare, plans on dealing with himself as he ages to some sort of right wing vs. left wing political fantasy used to influence ignorant voters is really pathetic.
What doctor Emanuel is advocating for himself sounds like taking self-responsibility and NOT letting big government make such decisions (hmmm you think maybe a bit to the right of center?). Its muzzy right wing and left wing logic as presented in your post that keeps us as a society from calmly and intellectually discussing much of anything. Congrats to Peter Sean Bradley, who thinks discussing tax policy is class warfare, who thinks discussing serious personal and societal healthcare issues is advocating death panels, and who thinks discussing policy alternatives for our engagement with the mess that is the middle east reflects nothing but muzzy liberal logic. On the greatness, America!

Anonymous said...

This is really how you want to have an evaluation of healthcare spending and related priorities for the United States; reduce everything to meaningless artificial phrases such as "death panels." Perhaps you'd prefer that all care demanded by every individual is provided no questions asked and with no consideration for who pays for it and how much benefit there actually is. Better yet, the government should just mandate exactly what end of life care is required in all circumstances. Better yet, the government should mandate that all health insurance provide birth control . . . oops, can't do that. "Muzzy logic" strikes again.

Peter Bradley said...

It is interesting how historically the "personal opinions" of members of the elite rapidly turn into social pressure and legislation.

Eugenics began as a matter of "personal initiative" and then when the elites realized what a really "good" idea it was, it became something that should be prescribed for the lower classes.

Dr. Emanuel is one of the elite. He drafted Obamacare. He is not offering this highly public announcement simply to share with the world his purely private opinion. If it was purely private, he would have kept it private. Rather he intends to shape public opinion, perhaps by encouraging others to follow in his wake, or to open a public debate about what he considers rational health care rationing.

If you had read books on the early Eugenics movement, you would find statements by earnest and serious doctors who advocated sterilization of epileptics with the same terms.

Anonymous said...

Sorry PSB, your case is not reasonable or responsible.

The history of the eugenics movement, while potentially cautionary, is not a valid comparison to a reasonable discussion about the appropriateness of variance approaches to end of life care. Its a reasonable topic of discussion, debate and analysis. In this specific case, the essay in the Atlantic was responsible and informative. To argue such a discussion is always invalid or inappropriate based on development of the eugenics movement in the 19th and 20th century is really quite bogus.

The simple fact is, end of life care, both on a personal level and on a societal level, is a massively significant issue because we all face it personally (and its personally such a difficult thing to deal with) and because such care is extremely expensive to our society. To offhandedly dismiss rational discussion on the issue is, well, irrational.

Your use of the word 'elites' is just another bogeyman used by those on the far left and far right to stymie such discussions, just like claiming 'racism' to stop a discussion on social policy or 'class warfare' to stop a discussion on federal tax policy. Four legs good, two legs baaad.

Yes, he is an 'elite.' So is everyone in Congress and the Senate, as are all of our presidents, cabinet members and their direct reports, most doctors, many lawyers, and everyone that makes big bucks at major corporations. Are we really to dismiss outright their opinions and input on healthcare and every other major issue because "historically the 'personal opinions' of members of the elite rapidly turn into social pressure and legislation."

Your concern that he is proposing healthcare be rationed is odd given healthcare is already one of the most rationed activities in the United States. We literally do not have the healthcare resources to provide everyone the same level of care that the typical individual receives who is covered by quality private insurance. Those who can pay (or whose insurance company can pay) get the best care. Those who can't pay get inferior care or, in many cases, no care at all. Given the resources available are limited, doesn't it make sense to continually evaluate how they are allocated?

Lastly, you have no idea what books I have read. That's a high school debate approach and really quite beneath you. Actually, its really only a high school hallway argument approach.

Peter Bradley said...

There was a lot of misdirection in your response, but you didn't interact with what I've said so much as waive your hands, e.g., Emanuel is an elite and it is a "bogeyman" to talk about elites.

Really? Pick one.

I'm trying to "stymie" discussion by using the term elite, but your accusations is not an attempt to stymie discussion? So, you're trying to dictate what words I can use, even though you admit that my statement is accurate, which, again, is not an attempt to misdirect the discussion into form rather than substance?

You wrote a lot, but you never came to grips with the fact that this particular person drafted national health care policy and has a particular view about the prudence of directing health care resources to the not very elderly. You also ignored my point that this man is trying to influence policy discussions and that he has a far more significant amount of influence on that area than the other elites you've mentioned.

You may think that there is no elephant in the room on that point, but perhaps you might recognize that other people can dissent from your conclusions.

As for your knowledge of the dialectics of early 20th century eugenics, you've said nothing that suggests that you have any knowledge on that area. When you do, I will acknowledge it.

Anonymous said...

Look, I don't assume either of us are saying the other can't have an opinion or make whatever conclusions he chooses. I assume by creating and actively managing such a well designed website addressing "interesting" issues and encouraging comments on your posts, you are seeking alternative points of view, not just support from Internet toadies.

Personally, I don't think its valid to dismiss this man's input because he is an "elite." With regard to healthcare, he's extremely well educated and has more direct experience than most of the population. Yes, he's drafted legislation and promoted it in the legislature. He's also taken care of actual patients as a doctor. His views deserve careful consideration, not casual dismissal as elitist. Its interesting as well that his actual work in the Obama administration was focused on granting people access to better healthcare, not limiting their access. This focus irked a lot of people (republicans, neoconservatives, catholic) who didn't want to expand access generally or who wanted to ration or limit access because they had negative religious views of certain procedures and treatments.

End-of-life care in the U.S. continues to be characterized by aggressive medical intervention and runaway costs. As a commentator reported in the Wall Street Journal a few days ago:

"Many patients and families are understandably confused and conflicted when it comes to end-of-life care. In America, we have a "more is better" philosophy, coupled with a (literal) "never say die" attitude. In some cases, this bias toward aggressive care is appropriate, but I have been struck over the years by the many, many times in which we end up providing care to patients that turns their final days into a medicalized version of torture. Not only is this inhumane, it is wildly expensive for families and the health-care system."

I do not believe this is an issue that should be politicized. Its not an issue that should fall into the typical democrat vs. republican high school debate or adversarial courtroom conflict with the central goal being winning the argument (versus seeking the best answer). We need the best answer.

By the way, do you really believe that healthcare is not rationed now? Money provides access. Medical professionals (oh my god, elites) evaluate cost / benefit across the broad spectrum of medical procedures to establish medical norms. Individual doctors (those elites again) evaluate individual patients and make decisions regarding access to or denial of specific treatments.

If us non-elites are not educated, not exposed to information and views like those presented in this essay, we and our families will be subject 100% to the whims, views and control of those elites who actually provide our care in hospitals and medical facilities. Its one thing when relatively young and healthy to consider tenuous links to the historical proponents of eugenics when evaluating approaches to end of life care, its another thing to consider receiving aggressive chemotherapy treatment with really powerful chemicals when one is 75 and already in ill health.

Anonymous said...

Quote form the piece by Ezekiel J. Emanuel:

"Nor am I talking about waking up one morning 18 years from now and ending my life through euthanasia or suicide. Since the 1990s, I have actively opposed legalizing euthanasia and physician-assisted suicide. People who want to die in one of these ways tend to suffer not from unremitting pain but from depression, hopelessness, and fear of losing their dignity and control. The people they leave behind inevitably feel they have somehow failed. The answer to these symptoms is not ending a life but getting help. I have long argued that we should focus on giving all terminally ill people a good, compassionate death—not euthanasia or assisted suicide for a tiny minority."

Who links to me?