May 7, 2012

Beyond the “R Word” Equals Gov’t Euthanasia

Call it rationing, government euthanasia, or even death panels, but the issue is alive and well in Washington, D.C., and politicians are using the “R word” very frequently of late. They see this as a way of stopping fiscal ruin. Some are quietly using the term “allocation of scarce resources” to avoid the term rationing. I prefer to call it government euthanasia and others will insist on using the term death panels.

Two articles appeared in the New England Journal of Medicine on May 2, 2012 about the “R Word” and the need to consider this that is making the rounds in our nation's capital. I will quote from the article by Howard Brody, M.D., Ph.D., “Whereas the “R word” is a proverbial third rail in politics, ethicists rush in where politicians fear to tread. The ethics of rationing begins with two considerations. First, rationing occurs simply because resources are finite and someone must decide who gets what. Second, rationing is therefore inevitable; if we avoid explicit rationing, we will resort to implicit and perhaps unfair rationing methods.

The main ethical objection to rationing is that physicians owe an absolute duty of fidelity to each individual patient, regardless of cost. This objection fails, however, because when resources are exhausted, the patients who are deprived of care are real people and not statistics. Physicians collectively owe loyalty to those patients too. The ethical argument about rationing then shifts to the question of the fairest means for allocating scarce resources — whether through the use of a quasi-objective measure such as quality-adjusted life-years or through a procedural approach such as increased democratic engagement of the community."

This discussion is not new, but is becoming more earnest as our nation tries to cope with the run-away spending of the current administration. Lest you think I am picking on one political party, this has cut across both political parties in the past and been carefully debated on both sides of the isle. It just happens that the current administration has forced the issue because of its financial overspending.

Much of this started in the 1990s with the advent of HMOs and the furor they caused with denying treatments. Then in 2000, the Supreme Court said, “inducement to ration care goes to the very point of any HMO scheme,” it acknowledged what health plans had not. The Court allowed such “inducement” under the federal law governing employee benefits. And, this does not go away under the current health care law that has been termed Obamacare. Expect to see more lawsuits if the law is not overturned and those wanting to prevent rationing start filing their objections.

What to do? I urge you to read carefully both NEJM articles and the comments posted with each. Think about your feelings and then avail yourself of every means to write your congressional representatives and senators and let them know what you think. There may be no way to undue this if we wait.

The link to the first article is here and the second article is here.

No comments: