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Canadian To America: Time to Bring in the Death Panels

Glove

If Sarah Palin had leveled her accusations of death panels at Canada and not America, she apparently would have been right. That’s the thesis of new piece in Slate by Adam Goldenberg. It outlines how Ontario has a tribunal that is legally empowered to overrule family members trying to keep their relatives on life support alive. Goldenberg argues that this “death panel” offers a good solution to the problem of medical resource scarcity:

When taxpayers provide only a finite number of acute care beds in public hospitals, a patient whose life has all but ended, but whose family insists on keeping her on life support, is occupying precious space that might otherwise house a patient whose best years are still ahead [...]

Modern medicine increasingly allows us to extend life indefinitely, and so the question is no longer whether we can “play God,” but when, how, and who should do so. When humanity demands haste, and justice demands expert knowledge, Ontario’s death panels offer a solution—whatever Sarah Palin says.

What happens in Ontario might not seem immediately relevant to the US, but the problem of resource scarcity that Goldenberg builds his case upon will increasingly plague American health care. The aging of the boomers combined with expanding access to health care (through the ACA) will put more pressure on an already stressed system. Luckily there is lots that can be done to ease this pressure, including reforming service delivery, expanding the pool of competent end of life caregivers by giving nurse practitioners more autonomy, and expanding hospice programs.

That is, instead of pivoting right to rationing, something the American public is unlikely to look favorably upon, we can work on rationalizing the health care system. We’ll still have to have a national conversation about if and how to ration at some point, but there’s plenty to do in the meantime.

If and when that conversation does happen, however, there are some general principles that should guide it. In the Mead family, we recently went through the kind of harrowing end of life decision making that often comes as the life of a loved one comes to a close. Fortunately for us all, my mother gave us explicit guidance about how she wanted these decisions to be made. If additional medical treatment, even aggressive treatment, offered a reasonable prospect for recovery, she was willing to give it a try. But if medicine offered no real hope, then she wanted to spend her remaining time without painful and intrusive medical treatments as nature took its course. If she was unable to make this decision for herself, she named the person she trusted to carry out her wishes. When the time came, we did as she had asked, and both the family and the medical professionals respected my mother’s wishes.

The end of life often comes amid confusion and uncertainty. Some choices are harder than others and whatever formal system the country adopts will not provide neat and clean answers in every situation that comes up. But this does not mean that a rigid system of bureaucratic death panels is going to be needed. Few of us really want to end up with breathing tubes down our throats, summoned heroically back from the margin of death by repeated aggressive and heroic efforts, when all hope of recovery is lost.

The best answer for most end of life questions isn’t about health care rationing or bureaucratic mechanisms whatever they are called. If most Americans are mature and responsible citizens who reflect thoughtfully and carefully on the questions surrounding end of life treatment, most of the time patients and their families will make sound decisions. If we don’t have that kind of society, then neither life itself nor the end of life will be very wisely arranged.

How we deal with the end of life is more a test of character than a test of bureaucracy. The effort to empower a bureaucracy to make decisions that Americans (or Canadians) can’t or won’t make on their own may be necessary under certain circumstances. The frequent resort to such a system would, however, be a sign of a profound and serious social weakness whose consequences will be felt in many ways.

[Glove image courtesy of Shutterstock]

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  • Tim Godfrey

    The main flaw in the Canadian system is that individuals are not allowed to make spending choices for themselves. i.e. if keeping a dead person alive for philosophical reasons is important to the family they should be entitled to pay for it themselves.

    I suspect most families when faced between paying for their kids college or keeping grand-dad alive for a little longer would go for the college.

    This debate over death panels is yet another example of how healthcare is broken because no country is able provide a system that provides proper price signals to the people demanding care.

  • vepxistqaosani

    My wife and I, being Christians, believe with Clough that “Thou shalt not kill; but needst not strive / Officiously to keep alive”. Not everyone shares our faith; and some of those who do not will demand such things as cryogenics, uploads to massive servers, and whatever other expensive miracles the Singularity brings.

    Will the ACA pay for such things?

  • Palinurus

    If I understand Canadian law correctly, the state won’t put you to death for the most heinous murder or rape, but it will effectively end your life for occupying a hospital bed that might be more efficiently allocated to someone else?

    I guess I can see the logic. For the last hundred years or so, “justice” for liberalism has come less to mean the protection of the individual person and his property and more to mean the redistribution of wealth and other resources to further the ends of the state. Accordingly, the most heinous crimes against one’s person are no longer capital offenses, but a certain sort of inefficiency is.

    One wonders if this could lead to the reintroduction of capital punishment in the criminal justice system if prisoners serving terminal or long sentences were understood to be wasting scarce prison space.

    • Corlyss

      “the state won’t put you to death for the most heinous murder or rape,”
      Massively ironic, ain’t it. Same in Europe.

  • Jacksonian_Libertarian

    “problem of medical resource scarcity”

    Where demand is infinite, as it is in a socialist medicine system, there will never be enough supply to meet that demand. In a free market medical system, where the patients and their families are responsible for paying for medical treatment, the life or death decisions are placed where they should be, in the hands of those it most affects.

  • jeburke

    I think the scenario of the 90 year old doomed to quick demise without heroic measures being taken off life support by a “death panel” is something of a red herring in the discussion about rationing. The far more serious issue will be whether we allow a panel of medical bureaucrats at CMS to decide that Medicare will not cover invasive heart surgery for an 80 year old threatened by imminent death from congestive heart failure to give him a shot at living to 85; or not cover expensive cutting edge chemotherapy for a 75 year old with advanced cancer that might give her a chance to see her 80th birthday.

    A cold-hearted cost-benefit analysis might compel the conclusion that these, too, are “heroic” efforts that aren’t cost effective, given the applicable life expectancies. But isn’t the possibility of life extension in such cases one of the greatest benefits of the advances in health care?

  • Corlyss

    “Ontario has a tribunal that is legally empowered to overrule family members trying to keep their relatives on life support alive.”

    Forever the state got in you’re way if you decided to pull the plug on an elderly or incapable (what used to be called defective) human that was consuming resources at light-speed. Then one fine day, the caring legislators said, “Okay. We get it. People don’t have unlimited resources and they shouldn’t have to spend themselves into the poor house to care for said drains. We’ll ‘let’ the state take over the payments.” Now all of a sudden, legislators are saying, “Hey, wait a minute. WE don’t have unlimited resources either! What if a lot of drains need this vanity support? We can’t afford it.” This business of keeping people alive who will never be contributors, will never produce anything, will never pay 1 penny in taxes until they die a natural death is absurd. The living and the useful enslaved by the virtually dead and useless. What kind of rational behavior is that?

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