Simple Facts: The Truth About “ObamaCare”, Dying and Health Care Rationing

I am not an expert on health care rationing and end-of-life questions. But I know how to find experts, and the leadership of LifeTree , a pro-life Christian educational ministry, certainly qualifies. Executive director Elizabeth Wickham, Ph.D. and her associate, Ione Whitlock, have dedicated their lives to these matters. LifeTree’s Medical Decisions at the End of Life brochure provides the following answers to frequently asked questions:

What is palliative care?

Traditional palliative care is symptom management at life’s end. Symptoms such as nausea, shortness of breath, and pain can usually be mitigated or "palliated." Unfortunately, some palliative care groups are now training physicians to introduce palliative care (comfort care rather than cure) very early in the diagnosis of a chronic condition or terminal illness. This trend blurs the distinction between ordinary pain control and end-of-life care (palliative care). Moreover, terminal sedation and withholding hydration (see below) are often part of the mix.

When should food and water be withheld?

Death by starvation and dehydration is painful and inhumane. Withholding food and hydration is imposed death, unless the food/water cannot be assimilated, as when death is imminent—when the patient is actively dying, and death is expected within 24–48 hours.

Nancy Valko, RN, notes: “When people are truly [actively] dying and the body’s organs begin to shut down, we often see people lose their appetite and desire to drink much. This is a process that can protect a person from suffering from fluid overload at the end and the dying person remains comfortable. But this is very different from a deliberate decision to ‘fast’ to death.”

What is terminal sedation?

Not to be confused with control of physical pain, the goal of terminal sedation (TS, also known as “palliative sedation” or “total sedation”) is “to induce a state of decreased or absent awareness (unconsciousness) in order to relieve the burden of intractable suffering.” TS is controversial, and has been called a legal alternative to assisted suicide. Too often TS is used when a patient is not actively dying , and is combined with removal of food and fluids. Withholding food and water can only lead to death. To offer total irreversible sedation to a patient might convey the idea that he or she is a burden, or that his or her life is probably not worth living.

Should I be an organ donor?

Pope John Paul II’s 2001 address to the International Congress of the Transplantation Society insists there be moral certainty that death has occurred before the transplantation of any unpaired vital organ. Unfortunately, in medicine today determination of death (brain death and non-heart-beating death) set standards which are much less stringent than the Holy Father’s guidelines. Examples of organs/tissues safe to donate after true death are corneas, heart valves (but not the entire heart), bones, skin, ligaments, and tendons.

How, and why, have medical ethics changed?

Several factors have contributed to changes over the years:

1) Bioethics : Hospitals and medical schools have appointed bioethicists as ethics experts. Bioethics, as currently practiced, focuses on quality of life. Bioethics expert Dianne Irving, Ph.D., explains that whereas “traditional medical ethics focuses on the physician’s duty to the individual patient, whose life and welfare are always sacrosanct,” the “focus of bioethics is fundamentally utilitarian, centered, like other utilitarian disciplines, around maximizing total human happiness.” Too often, bioethics shifts the emphasis from improving quality of life, to assessing quality of life — weighing the benefits and burdens of life itself.

2) An entrenched right-to-die belief system:… From Supreme Court cases, to state living will laws, to physician education, the mission was to popularize the concept of forgoing life-sustaining measures. Partnership [for Caring—a right-to-die group] disbanded, but many of its members are now in policy-setting positions in hospice and palliative care organizations at the national level. Visit www.lifetree.org/timeline for more information.

In the rush toward a new, federally controlled health care system, there is a distinct possibility that in their hysteria, its supporters will leave many of these questions either dangling in thin air or completely ignored. It is my considered opinion that health care “reform” advocates will answer very few such questions factually, with evidence to support their claims.

Finally, many ask whether or not health care “reform” could lead to rationing of health care. This is not a crazy question. To find answers, I did some research.

Did you know that Ezekiel Emanuel , M.D., the brother of White House chief of staff Rahm Emanuel, has written on the question of health care rationing? In fact, he has a long history of being deeply involved in end-of-life care discussions, and his statements do not provide comfort.

Wesley J. Smith, who studies bioethical questions, has examined Dr. Emanuel ’s views. He believes that in his January 31 Lancet article, Dr. Emanuel did not “explicitly” advocate rationing “now based on age.” However, Smith pointed out,

The same can’t be said of an article he wrote in the Hastings Center Report , in which he explicitly advocates rationing based on what appears to be a quality of life measurement. From the piece:

This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity-those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic.

Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.

A lot of people are frightened that someone who thinks like Emanuel is at the center of an administration seeking to remake the entire health care system. Having read these two articles, I think there is very real cause for concern.

Terri Schiavo’s brother, Bobby Schindler , who has been deeply involved in defending the vulnerable so that nothing like the horrors she died from will happen to others, likewise has words of warning about health care rationing:

Much has been written warning us about the dangers of Obamacare, but mostly in terms of what it would mean for the elderly and perhaps the chronically ill. Unfortunately, I have not seen any reports of what will happen to those like Terri—the cognitively disabled. However, from what I am reading and what is being proposed for health care reform, I think it is safe to say that those like Terri don’t stand a chance. Especially, if the proposed Independent Medicare Advisory Council (IMAC) is formed that will put bioethicists in charge of who can and cannot receive treatment.

We are in grave danger any time health care decisions are taken out of the hands of individual patients and their families and placed into the hands of government bureaucrats whose decisions are based on cutting costs rather than valuing the dignity and equal worth of every human life.

Finally, I defer to Zane F. Pollard, M.D., a pediatric ophthalmologist for Children’s Healthcare of Atlanta (a nonprofit organization), who wrote the following regarding “Obamacare ”:

I have taken care of Medicaid patients for 35 years while representing the only pediatric ophthalmology group left in Atlanta, Georgia that accepts Medicaid. For example, in the past 6 months I have cared for three young children on Medicaid who had corneal ulcers. This is a potentially blinding situation because if the cornea perforates from the infection, almost surely blindness will occur. In all three cases the antibiotic needed for the eradication of the infection was not on the approved Medicaid list.

Each time I was told to fax Medicaid for the approval forms, which I did. Within 48 hours the form came back to me which was sent in immediately via fax, and I was told that I would have my answer in 10 days. Of course by then each child would have been blind in the eye.

Each time the request came back denied. All three times I personally provided the antibiotic for each patient which was not on the Medicaid approved list. Get the point — rationing of care.

Over the past 35 years I have cared for over 1000 children born with congenital cataracts. In older children and in adults the vision is rehabilitated with an intraocular lens. In newborns we use contact lenses which are very expensive. It takes Medicaid over one year to approve a contact lens post cataract surgery. By that time a successful anatomical operation is wasted as the child will be close to blind from a lack of focusing for so long a period of time.

Again, extreme rationing. Solution: I have a foundation here in Atlanta supported 100% by private funds which supplies all of these contact lenses for my Medicaid and illegal immigrants children for free. Again, waiting for the government would be disastrous…

The bottom line is that I urge all of you to contact your congresswomen and congressmen and senators to defeat this bill. I promise you that you will not like rationing of your own health.

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  • mamamull

    WE adopted a baby girl – she was almost allowed to die – but for the Grace of God that a geneticist walked past when some other docs said they she had trisomy 18 a fatal disorder. Dr Bofinger walked by and turns out she could debunk that easily – and Claire was given a chance.

    With Obama care – she probably would not even made it to the hospital where the docs thought she had trisomy 18 – so sad – she lived for 7 years and was a wonderful kid. We called her Miss Congeniality for being so friendly and outgoing.

  • Mary Kochan

    The administration’s media puppets are going all out. Check out what PBS NOW is about this week: http://www.pbs.org/now/shows/512/index.html and while you are there you might want to vote in their poll on that page about whether protesters at the town hall meetings are unpatriotic.

  • jamespereira

    Every time I read such discussions I’m saddened. I’ve worked with Big Pharma companies for 23 years until I decided I couldn’t take the lies and deceit that we spin any longer. I’ve now founded my own company to battle Big Pharma’s lies.

    We are at the crossroads of health (not just in the US but all over the world) because we have over a 200-year period handed our health care responsibilities to the medical-pharmaceutical complex.

    Until 200 years ago medical doctors practiced preventive medicine. That is, they advised patients how to remain well rather than focus the bulk of their attention on treating diseases. When the pharmaceutical companies were formed, medicine was hijacked and doctors no longer know how to prevent anything. Look at the medical syllabus in med school. They learn how to diagnose and use medicines supplied by the pharma companies. Big Pharma drives the language of medicine today. They don’t learn preventive medicine anymore.

    The first thing you should realize is that more than 90% of drugs do not cure the diseases they treat. Which cardiovascular drug cures your disease? Which gastrointestinal drug cures your malady? They only control your condition…for a while before you have to increase the dose or try the next revolutionary drug that comes along.

    Secondly, the reason health care is so expensive is because the drugs used have to be evaluated over many years and the cost of bringing the new drug to market is easily $350 million per drug. And after approval by the FDA, the patent lasts about 10 years on average. How does Big Pharma recoup their costs? By making sure that they recover their initial investment in 24 months after launch – i.e. via huge promotional budgets and huge selling prices. Remember, no pharma company has your face on their charts, it’s only the sales performance parameters they care about.

    The key to genuine health care freedom is to crush the shackles of the medico-pharma industry. Make no mistake, it’s an industry. You have to get back to accepting that your health is your responsibility. The only rights I see in health care, is your right to decide whether you want to use drugs to treat your illness or whether you choose to take measures to prevent or slash risks of contracting diseases.

    My message is, “Get Back to Nature”. You can remain well and even alleviate many diseases without the use a single, wallet depleting drug.

    My company offers health boosting tips free. Just register your name and you will receive 365 Daily Health Booster Tips (one every day). Use these tips to gain your freedom from Pharma and Obama (they tend to rhyme too).

    Get your tips here – http://www.BreakthroughHealthSolutions.com

  • dennisofraleigh

    We pro-life activists in Raleigh are very grateful for the hard work of Dr. Wickham and her LifeTree associates. To that end we are very excited about the benefit 15th Annual 5-k Run for Life that will take place on August 29, 2009 in Cary, NC (near Raleigh). LifeTree is this year’s designated recipient of the monies we raise by holding this wonderful annual event. In previous years the Run has supported crisis pregnancy centers and post-abortion ministries. For more information about the Run (registration fees, maps, etc.), or how to become a sponsor (and get your business’ logo on the back of the T-Shirt!) please visit http://raleighrunforlife.org/.

  • http://tapsearch.com/pope-benedict-economic-encyclical tapsearcher

    This is an excellent article and I will link to it at my philosopy and relgion site at http://www.therationale.com The big question behind all this is who is going to rule on these matters that affect life directly. It is clear that goverment does not have the ability to make the proper distinction between life and death. This goes back to the aptitude of the mind for truth. Too many no longer believe the object of the mind is truth and have put it in a test tube as an ongoing search that never really ends. In abortion, government has ruled on life based on it not knowing when life begins. If they do not know this then they certainly will (and do question) what the dignity of life is at the end. See also our review of Pope Benedict’s -Charity is truth – encyclical at http://tapsearch.com/pope-benedict-economic-encyclical where we discuss this too.

  • goral

    No free latte tomorrow morning for the originator of todays question on PBS.
    75% of the votes are against calling the “disruptive” participants at town hall meetings unpatriotic. This is PBS where patriotism is synonymous with Obama.

    Dr. Howard “yahoo” Dean also mouths-off in favor of making the rest of the country go the way of Vermont – extinct!

  • juanita

    The Church supports the poor all over the world, as a correct expression of faith, which is why it is unconscionable that Catholics should work against health care reform. All this talk of assisted death and other lies are just shock tactics which distract from discussion of what reformers really want: access to affordable, quality health care for everyone. If your child or elderly parent is ill, I believe that you have the God-given right to get help without having to consider whether you have the money in your pocket today. Priests in poor parishes have a particular responsibility to guide their flocks towards help. Nothing in any health care bill forces anyone to do anything–other than to be insured. Making the pool of insured so large is part of what brings the costs down for everyone. This is a reform movement to help the poor, the sick, and the needy, and to allow yourself to believe untruths is not the way toward’s God’s love.

  • http://www.vatican.va Michael

    Democrats have done a terrible job selling…is it health insurance reform, health care reform, or just a power play.

    It looks like number 3.

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