Update: Ed Koch has questions about Zeke Emanuel and rationing and ‘Death Panels’…Health Care as Social Justice: Rahmbo’s brother and rationing health care…
Has anyone reported Mayor Koch for ‘fishy’ questions?
Most alarming for people like me, who at 84 years of age recently needed a quadruple bypass and aortic valve replacement, are the pronouncements of President Obama’s appointee, Dr. Ezekiel Emanuel, brother of Obama’s Chief of Staff Rahm Emanuel, who, according to a New York Post op ed article by Betsy McCauley, former Lt. Governor of the State of New York, stated, “Savings, he writes, will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, ‘as an imperative to do everything for the patient regardless of the cost or effects on others’ (Journal of the American Medical Association, June 18, 2008).”
He also stated, “…communitarianism’ should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those ‘who are irreversibly prevented from being or becoming participating citizens…An obvious example is not guaranteeing health services to patients with dementia.’ (Hastings Center Report, Nov.-Dec. ’96). “
Opponents of Obama’s health care proposals raise the specter of a panel making decisions on who should receive health care. I am not aware of any proposed panel. However, an article in today’s New York Times, referring to a Senate bill, stated, “The legislation could have significant implications for individuals who have bought coverage on their own. Their policies might be exempted from the new standards, but the coverage might not be viable for long because insurers could not add benefits or enroll additional people in noncompliant policies.”
So, where lies the truth? I don’t know. But I do know that I want the continued right to purchase and have available insurance that will permit me, no matter my age and physical condition, to purchase with my own money all the medical care I can afford….
Damned right Ed!
Original Post: July 7, 2009:
Update, Emanuel’s CV here pdf , courtesy of Tollhouse, another savvy commenter on BelmontClub. Notice it is LONG on academics and ethics boards and short, in fact almost totally devoid of any actual practice in caregiving. Many scholarly articles, on managed care in cost containment, and a majority of articles on ..surprize EUTHANASIA!! The end of the circle of socialized medicine rationing and early death. Good Gawd, call your critters. Notice on the chart of care under their ‘soopergenius’ rationing system below, theBAMABOT voters age group is ensured the most treatment, coinkydink or planning? You make the call, to your CongressCritters!
Via a comment from Tynian at Ace, important enough to lift it entirely:
346From The Belmont Club:
Ezekiel Emmanuel MD, Rahm Emmanuel’s brother, who is Barack Obama’s “Special Advisor for Health Policy”, is described by the Huffington Post article as engaged in a very important mission: redesigning the US health care system.
. . .
Emmanuel recently authored an article in the Lancet describing the various models of non-market health care rationing. Titled “Principles for allocation of scarce medical interventions”, its is co-authored with Govind Persad and Alan Wertheimer. In it the authors simply review the pros and cons of the various ways of deciding who gets treated and who doesn’t.
. . .
The authors are not very satisfied with the current metrics used for making medical decisions based on saving the most life-years. . . . They write:
Because none of the currently used systems satisfy all ethical requirements for just allocation, we propose an alternative: the complete lives system. This system incorporates five principles: youngest-first, prognosis, save the most lives, lottery, and instrumental value. … When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated … the complete lives system is least vulnerable to corruption. Age can be established quickly and accurately from identity documents. Prognosis allocation encourages physicians to improve patients’ health, unlike the perverse incentives to sicken patients or misrepresent health that the sickest-first allocation creates.
Under this system, patients would receive scarce care according to the graph shown below.
[Look at that the graph -- it's terrifying]
. . .
The paper concludes: “the complete lives system combines four morally relevant principles: youngest-first, prognosis, lottery, and saving the most lives. In pandemic situations, it also allocates scarce interventions to people instrumental in realising these four principles. Importantly, it is not an algorithm, but a framework that expresses widely affirmed values: priority to the worst-off, maximising benefits, and treating people equally. To achieve a just allocation of scarce medical interventions, society must embrace the challenge of implementing a coherent multiprinciple framework rather than relying on simple principles or retreating to the status quo.”
There goes that word ‘just’ again, that social justice is redistribution of health just like wealth….
. . .From an astute commenter discussing the Lancet article authored by Ezekiel Emmanuel:
Another juicy bit from the paper:
In a public health emergency, instrumental value could also be included to enable more people to live complete lives.
The definition of instrumental value, for those of you scoring at home, is:
Instrumental value allocation prioritises specific individuals to enable or encourage future usefulness.
where a specific person is genuinely indispensable in promoting morally relevant principles, instrumental value allocation can be appropriate.
So, in a public health emergency, “genuinely indispensable” people will get treated first. Like, say, elected officials, government staff, and (of course) medical ethicists.
I guess that means we’ll be living in a state of perpetual emergency.
In more ways that one…
This is really scary stuff.
If the shit hits the fan the government will officially blow you off for anyone deemed genuinely indispensable in promoting morally relevant principles.
We’re gonna be living Animal Farm really soon.
Posted by: Tinian at July 07, 2009 04:01 PM (7+pP9)