Sunday, July 17, 2011

Death Panels

This morning Jennifer Rubin responded to the David Brooks’s column I posted about yesterday. In the column Brooks hinted that the elderly and infirm should do the budget deficit a favor and commit suicide.

Brooks is not wrong in the abstract,. With longevity comes an increased possibility of being infirm. If you have to choose between living forever in a decrepit state and dying, most people would choose the latter.

He is also correct to say that end-of-life care is enormously expensive, perhaps beyond what we can afford. And yet, as I wrote, it is not so easy to know which lives are worth extending and which are not.

Dudley Clendinen might feel that he would rather commit suicide than endure the last stages of Lou Gehrig’s disease, but Tony Judt chose to live out his days productively while suffering from the same illness.

As Rubin reminds us today, Brooks seems to have a hidden agenda. By refusing to acknowledge the great progress that medicine has made over the past decades, he seems to be opening the door to rationed medical care.

A well-known politician once called them “death panels” and one would be hard put to suggest that Brooks is not laying the groundwork for something similar.

After reading Brooks’s decidedly bleak vision of modern medical progress-- a glass-is-half-empty vision if ever there was one-- Rubin called Peter Pitts, from the Center for the Public Interest.

It is amusing that a self-proclaimed expert on cognitive neuroscience like David Brooks would have failed to notice that the glass is half full.

While medical advances have allowed us to live longer, and thus to be vulnerable to more diseases, they have also allowed us to live healthier lives. Diseases that had been death sentences a decade or two ago can be treated effectively... to the point where sufferers can live productively.

Medical advances have improved the chances of surviving heart disease and have done wonders in increasing the survival rates for many types of cancer. Thanks to modern medicine AIDS has become a treatable condition.

This does not mean that we should not be discussing how to allocate our limited resources. We should. The real question is whether the debate should be settled by government bureaucrats or by free individuals in the free market.

Rubin concludes: “By all means we should have the debate over public and private resources. Let’s come up with market solutions that increase competition and reduce cost. Let’s minimize out unnecessary, external costs (e.g. malpractice insurance). And for the record, I am in favor of living wills and allowing those with terminal illnesses to refuse care. But let’s not kid ourselves.

“Anyone, for example, who has had an elderly parent, a friend with cancer, or an experience with mental illness knows the difference our health-care system, warts and all, has made in the lives of millions and millions of Americans. Who of us would choose to receive only the medical care available 20 years ago? And, from where I sit, I’m not ready to throw in the towel on my loved ones (or anyone else’s) because they can’t walk the dog.”


Anonymous said...

(I left the second comment on the original reference to Mr. Brooks's editorial.) I believe that Mr. Brooks has made an unfounded inference. He starts with a “true fact:” a largish percentage of total U.S. medical costs occurs in the last years of Americans' lives. Because all this money is spent on the who die anyway he (and others) concludes that it is wasted.

There are a few more conditions required to draw that inference from the initial true fact. The most important being that one would have to be able to easily distinguish between the dying and the curable. Granted there are cases were this might be the case. Going back to the case of my two Uncles their early treatments appeared to be at least partially successful. They went home, and back to the hospital, and back home. Now that they are dead, we know for a fact that the this treatment was spent in the last years of their lives.

The statistics Mr. Brooks notes are not detailed enough to separate out the hopeless cases from the all the deaths. Focusing on the hopeless cases might be good rhetoric but poor logic.

Stuart Schneiderman said...

Excellent point... namely, that you cannot really know what is or is not end of life until after death.

Another excellent point... Brooks is indulging in excellent rhetoric and weak logic.

Of course, much of the public debate these days has been stronger on rhetoric than on logic.

David said...

Indeed, how is "last years of life" defined? If a 22-year-old is in a bad car wreck and requires extensive emergency room and critical care before finally succumbing, then he was in his "last year of life" at the time the expenses were incurred.

People don't often think very clearly about chains of causation. I remember reading about a light-airplane accident that occurred because the pilot ran out of fuel. Viewing the damage, the local fire chief observed "It's sure a good thing there wasn't any fuel in the tanks when the crash happened, because then there would surely have been a fire."

Some other amusing stories of fuzzy thinking here.

Anonymous said...

I wouldn't have guessed that only 67 years later that a Jew, Ms Rubin, would want the one way boxcar ride for the infirm, degenerate or dissolute; for the good of The Reich und der Volk, she argued.


Anonymous said...

No, dumbass, Jennifer responded to Brooks. Read a little closer before making such an incendiary charge, Gray.

Brooks I expect that out of....