You'd think by now that no matter how front-loaded the bias is in a story, I'd not be shocked. But the lead paragraphs in Cathy Lynn Grossman's "Life and death: Hospital ethics panels help families decide" in Thursday's USA Today is a real corker.
"An infant is born with no functioning brain. A teen is ravaged in a car wreck. A 90-year-old with dementia and pneumonia lies unconscious in intensive care.
"Medical and moral decisions must be made. But there's no written directive for guidance. Family and physicians disagree. What now?"
Is it really even marginally fair to talk about medical decision-making in the context of the most extreme imaginable cases? Is that lead intended to engage the reader in a thoughtful dialogue or to persuade her to take off her thinking cap?
Newspapers and news magazines have crusaded for advanced directives for decades. National Right to Life offers a counterbalance--a life-affirming "Will to Live," which makes clear what you would want done to take care of you, not what you wouldn't want.
Typically, the ethos that runs through most quoted sources in most stories is that these "experts" understand what makes a life "worthy" and ought to have a larger role in end-of-life decision-making, especially when confronted with overly-emotional family.
For example, Dawn Seery offers this frightening comment in today's story: "We have failed to educate the public on how to discern what is worthwhile, what is not. How far do we go? Do we keep someone in a hospital bed just because they choose it? We're all in death denial." [Seery is "chairman of the ethics committee that provides consultation service for five San Antonio hospitals under the Methodist Healthcare System."]
To be fair, in this and Grossman's second story, she presents other views. Grossman quotes one self-described "bedside ethicist," Robert Orr, who told her what usually happens is that "we continue treatment unless we believe it causes unrelenting and unmanageable pain -- or it's futile."
"But I hate that word 'futile,'" Orr adds. "Do you mean no treatment or therapy will work at all? Or that there's just a 1% chance something would help? Who makes the call? Or does it mean that while it might prevent death, the worth of the life it provides is questionable? How does the patient define 'worthwhile'?"
These articles are written in the context of the ongoing health care "reform" debate. In one of her stories Grossman quotes someone who caricatures comments made by former Alaska Gov. Sarah Palin.
But the life-and-death issues raised in the back-and-forth to Palin's argument can not be so cavalierly ignored for two important reasons.
First, there is the kind of language that is still lurking in various legislative proposals that is intended to cut costs by the promotion of advance directives.
Aside from the many stand-alone bills related to advance directives in both houses, there are three separate provisions dealing with advance directives in the House legislation. There is the main provision of HB 1233. There are also two other amendments, one requiring private and public health care plans to give potential enrollees the option to establish advance directive; and the other to empower the Secretary to spearhead a public education campaign, toll-free telephone hotline, and clearinghouse to promote advance directives and other advance care planning.
Pro-Life Senator Jon Kyl
What is particularly disturbing about this "cost-savings" provision of the bill is that it appears to follow President Obama's call this past spring for "a very difficult democratic conversation" about "those toward the end of their lives [who] are accounting for potentially 80 percent of the total health care bill out here."
It is also extremely troubling that Compassion and Choices, the principal group that promotes physician-assisted suicide throughout the country is not only aggressively promoting these provisions, but claims responsibility for the inclusion of the main provision.
Second, there is what NRLC aptly describes as the "death spiral." As the Wall Street Journal pointed out in an editorial yesterday, "Beginning in 2015, Medicare would rank doctors against their peers based on how much they cost the program--and then automatically cut all payments by 5% to anyone who falls into the 90th percentile or above. …
"Since there will always be a missing chair when the music stops, every year one of 10 physicians will be punished if he orders too many tests, performs too many procedures or prescribes too many drugs--whether or not the treatments result in better patient outcomes," the editorial continued. "The 5% fine is substantial given that Medicare's price controls already pay only 83 cents on the private dollar."
This does not involve ancient developments. Less than two weeks ago, the Senate Finance Committee defeated an amendment proposed by Senator Jon Kyl (R-Az.) to eliminate that proposal.
Just as we are continually being falsely assured there is nothing to promote abortion in health care "reform," so, too, are we lectured that we are over-reacting in this area as well. We are not. Be sure to keep up to speed by going to http://powellcenterformedicalethics.blogspot.com.
Contact: Dave Andrusko
Source: NRLC
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