Wesley Smith discusses the pressure Obamacare will put upon the elderly not to receive end-of-life care. (See also here.) Under Obama's bill, the elderly would be encouraged (I haven't yet been able to find out just how strongly they would be pressured) to receive end-of-life counseling every five years or even more often. The "even more often" option would be triggered not simply by their being diagnosed with an illness that gives them less than three months to live (!) but even by a "chronic, progressive, life-limiting disease." Life-limiting, huh? How do you spell "life unworthy of life"? Is your life limited? Let's get you quick as can be to someone to counsel you on refusing antibiotics in case you get an infection.
Think I'm kidding? We're just talking about super-costly interventions, right? About extraordinary care, right? About things no sensible person would want, anyway, right?
Wrong. Antibiotics and artificial nutrition and hydration are expressly listed as items people are going to be counseled about refusing. So, for example, if you are diagnosed with MS, why, then, a utilitarian "expert" will be right on hand to counsel you on how your miserable life, so limited by your disease, could be ended if you just wrote down that you don't want antibiotics if you catch pneumonia.
This is bad stuff, folks. This is not something any pro-lifer should be endorsing. As Wesley points out, the pro-suicide Compassion and Choices will be only too happy to offer their services as such counselors. But even if the counseling comes from someone else, there is no question that the intent is to pressure the elderly into refusing normal care on the grounds of a lack of quality of life. It isn't the care that's so expensive. We need to face the fact that it's their lives that are being regarded as too expensive.
And, as a doctor points out, it is entirely contrary to the Hippocratic oath to put doctors in a situation where they are supposed to be trying as hard as they can to cut costs rather than trying to recommend what is actually best for their patients.
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 deliberation - 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.
(Cited as from Hastings Center Report, Nov-Dec. 1996. If anyone can locate an electronic link to the full text of the article, please e-mail me with it.)
Welcome to the Brave New World.
[After some careful thought, I have decided to close comments on this post. I do not have time to monitor and engage in another large-scale discussion about healthcare. Nor am I interested in bantering with liberal drive-bys. My goal is to inform my conservative readers and blog colleagues about what rationing really means and is really going to mean to the elderly in terms of end-of-life care. I want to ask all of you to take this information into account in your own rhetoric and recommendations regarding healthcare and in your own evaluations of the President's plan.]
Update: Here is the link to Emmanuel's whole article. Thanks to a reader for sending the link.