and health care reform
Since I first started writing about medical ethics and serving on hospital ethics committees, I have seen ethics discussions
evolve from "what is right?" to "what is legal?" to "how can we tweak the rules to get the result
we think is best?" This attitude is not very reassuring when we are considering a massive overhaul of the US health-care
candidate Sarah Palin has been ridiculed for coining the term "death panels". But it resonated with me. In 1983
my daughter Karen was born with Down syndrome and a severe heart defect. Even though Karen's father and I were told that her
chances for survival were 80 to 90 percent after open-heart surgery, we were also told that the doctors would support us if
we refused surgery and "let" Karen die. We refused to allow such medical discrimination against our daughter.
Later on we were shocked to learn that one doctor
had written a "do-not-resuscitate" order for Karen without our knowledge, because she thought I "was too emotionally
involved with that retarded baby".
In later years, I was asked if I was going to feed my mother, who had Alzheimer's disease. And, after my
oldest daughter died by suicide from a drug overdose, I was told that it is usually a waste of time to try to save people
who attempt suicide.
evil people say these things? No. These doctors and nurses were otherwise compassionate and caring health-care professionals.
But they are just as vulnerable as the general public to the seductive myth that choosing death is better than living with
terminal illness, a serious disability, or presumed poor "quality of life".
If or when government committees and accountants take over health care, will
we get - or even deserve - better than this?
Common sense and ethics
Health care does not occur in a vacuum. Real people - patients, families and health care providers
alike - are affected when economics and new ethical rationales trump basic needs. The Good Samaritan did not ask whether the
man lying on the road had health insurance. The Hippocratic Oath established a sacred covenant between doctor and patient,
not health-care rationing protocols. I strongly disagree with ethicists who contend that new technologies and economics demand
I am tired of hearing
some of my medical colleagues talk about patients who "need to die". I am saddened to hear many of my elderly, frail
patients fret about being an emotional and financial burden on their families. I am outraged when I read editorials arguing
that those of us who refuse to participate in abortion or premature death should find another line of work.
I recently attended a 40th-anniversary nursing-school reunion.
We remarked on how much has changed. Some things are better - uniforms, equipment and technologies, for example. But some
things are worse, especially ethics.
People are often surprised to learn that even back in the late 1960s, we had "do-not-resuscitate" orders,
and spoke to families about forgoing aggressive medical treatment when patients seemed to be on the terminal trajectory to
But, unlike today, we
did not then immediately ask the family members whether we could withdraw food, water, antibiotics, etc., to get the sick
person's death over with as soon as possible. Back then, we were often surprised and humbled when some patients recovered.
Today, when doctors and nurses are too quick to give up hope, too many patients don't even get a chance to recover.
In those days, medical ethics was easily understood.
We would never intentionally cause or hasten death. We protected our patients' privacy and rights. We were prohibited from
lying or covering up mistakes. We assumed that everyone had "quality of life"; our mission was to improve it, not
to judge it unworthy.
treatment was withdrawn only when it became futile or excessively burdensome for the patient - not for society. Food
and water was never referred to as "artificial", even when it was delivered through a tube rather than from a spoon.
Doctors and nurses knew that removing food and water from a non-dying person was as much euthanasia as a lethal injection.
"Vegetable" was a pejorative term
that was never used in front of patients or their families. And suicide was a tragedy to be prevented, not an alleged constitutional
right to be assisted by doctor and nurses.
But things are different today.
We now have ethics committees developing "futility guidelines" to overrule patients
and/or their families even when they want treatment continued.
We have three states with legal assisted suicide and terminal sedation is supported by some ethicists
as an already legal option for euthanasia in any state.
We have non-brain-dead organ-donation policies with some ethicists even arguing that we should
drop the dead-donor rule.
We are now asked to sign living wills and other advance directives with check-offs to eliminate even basic medical care
for conditions such as being unable to regularly recognize relatives.
We are willing to sacrifice living human beings at the earliest stages of development to fund
research for cures for conditions like Parkinson's rather than promote research on ethical and effective adult-stem-cell-therapies.
We are inspired by the Special Olympics, but
support abortion for birth defects.
We now talk about a newborn child as yet another carbon footprint instead of as a blessing and sacred responsibility.
I could go on and on but I think you get the
idea. These are "death panels" already at work, even if we don't call them that. And they have been created by apathy,
misplaced sympathy, a skewed view of tolerance and an inordinate fear of a less-than-perfect life.
In the famous words of the comic strip character Pogo,
"We have met the enemy and he is us."