Jahi’s Plight: Why Death Panels Are Inevitable And Necessary If We Are Going To Pay For Each Other’s Health Care

death panels

Even while the Affordable Care Act debacle is mired in other problems, the “death panel” controversy lingers on, as conservatives exploit the public’s visceral reaction against an inevitable result of modern health care cost-sharing, and progressives dishonestly deny and ridicule the reality of that result, because it makes health care reform less attractive.

The case of Jahi McMath is instructive, if anyone bothers to consider its practical and ethical implications. Jahi, 13, underwent a tonsillectomy Dec. 9, and emerged from her post-op recovery legally dead, due to massive swelling in her brain. She was placed on a ventilator, and according to its policy, Children’s Hospital Oakland was preparing to take her off life support when the family strenuously objected. It petitioned a court to keep her technically alive so she could spend Christmas with them. An Alameda County judge Monday ordered hospital officials to keep Jahi on a ventilator until Dec. 30 while an independent neurologist reviews her case. Meanwhile, her mother told CNN and other local media that although she appreciates  the second opinion and court order, she will fight to keep her daughter on life-support as long as possible, saying,

“I’m her mother. I’m going to support her. It’s my job to do it. Any mother would do it. I just want her to have more time. There are so many stories of people waking up in her situation.”

This is, undeniably, a tragic, heart-breaking situation. If the family wanted to keep Jahi on life support indefinitely and could pay all costs while also ensuring that her continuing care would not cause a shortage of space, facilities, equipment or personnel needed by other patients, then the handling of her maintenance would be the business of nobody else, certainly not the government. That is not the case, however, and virtually never is in such tragedies. Jahi’s care is expensive, and will soon create costs in the tens of thousands, and eventually hundreds of thousands. However the costs are divided among the hospital, insurers and the government, in the end, you and I will pay, either in taxes, insurance premiums, or higher prices for medical services. An ethical argument can be mounted for this when the health and life of a child is involved, but not when society is paying for futile hopes, denial, and the sentimental wishes of a family to pretend their dead daughter is spending Christmas with them. I don’t want to pay for it, and should not have to.

In a shared system, there must be a mechanism to prevent people from wasting everyone else’s limited resources. That means death panels, either operated by private insurers, or the government. Unfortunately, most Americans, like Jahi’s family, will continue to behave as if they are paying for such extraordinary care and nobody but them has a stake in the treatment of their daughter, even when that is far from the case. There must be death panels, or we all have to pay for our own health care and insurance.

Anyone who supports shared health care costs and denies the necessity for death panels is a liar, or a fool.

__________________________________

Sources: USA Today, LA Times, CBS

Graphic: AEI

30 Comments

Filed under Bioethics, Business & Commercial, Family, Government & Politics, Health and Medicine, U.S. Society

30 responses to “Jahi’s Plight: Why Death Panels Are Inevitable And Necessary If We Are Going To Pay For Each Other’s Health Care

  1. That is,unfortunately,the truth. My husband faced this when his teen daughter was severely injured in a car accident. There was virtually no hope of recovery from the injury to her brain. She lasted 3 days,then died while on life support so the family didn’t have to make the decision,fortunately.

  2. Why do you want to kill children, Jack?

  3. Fred

    Hello, Jack,

    ???

    I understand your point, but that example does not fit it with your usual precision of thought.

    A Sarah Palin death panel would be judging among people who were still alive, and judging their value to society rather than their medical prognosis. That’s what people are talking about and fearing.

    A better example, one which actually went into effect, were the medical committees deciding who would get dialysis.

    Nor is it intrinsically inevitable. We didn’t have this problem a hundred years ago, when all doctors could do was set bones, go “Hmm”, and cheaply watch people die. We’ve developed ways to spend unlimited amounts of money to manage decline rather than curing people. Physical laws don’t require that — it’s conceivable to reform medical research in favor of prevention and cure, and if that succeeded there would be many fewer people needing near-infinite resources, maybe few enough that they’d be affordable when their costs were spread over the whole population.

    • Nor is it intrinsically inevitable.

      Yes, it is. You can not increase demand while leaving supply constant (or, in fact, decreasing it) without instituting rationing, unless you allow costs to increase as needed.

      This is one of the most basic principles of economics.

      • FinlayOshea

        This is one of the most basic principles of economics.
        **************
        Stop insulting the Utopian Dream of Obamacare with actual facts.
        Nobody wants to hear that, you hater!

        • Michael Ejercito

          http://tinyurl.com/mt2eb9t

          “Vaccinating children against deadly diseases in Third World countries costs very little per child costs very little per child and saves many lives, including decades of life per child. Meanwhile, a heart transplant for an eighty-year-old man is enormously expensive and can yield only a limited amount of additional life, even if it is completely successful, since the life expectancy of an octogenarian is not great in any case.”

          • dragin_dragon

            Nifty thinking, especially if you are NOT the old man. Since I am one, I object strenuously. How is it that my life is less valuable?

            • Steve

              I’m also in your age bracket, but I speak only for myself. I’ve had as full a life as I could ask for. While my life may be no less important than a 13yr child, why should I expect to have my needs as a 60yr old be fully met at the expense of a child? How could I possibly justify such selfishness? It facinates me how “Christians” continue to profess “preserving life at all costs”, but are very seldom willing to finacially support social programs that provide a better quality of life to those less fortunate than themselves. Any wonder why a growing number of us have given-up on the “Christian establishment” and have abandoned all forms of organized religion? I can simply no longer tolerate the hypocrisy.
              Steve

      • It is that “while leaving supply constant” that those few rational people favouring this are banking on not getting. They are of the sincere if mistaken belief that the right reforms can raise supply faster than demand, indefinitely and sustainably. That’s not an inherent, logical impossibility; rather, it’s the double mistake of supposing that such reforms exist at all in the continuum of possibilities (which is far from established), and that these are such reforms (which actual analysis has shown not in fact to be the case). It’s a bad case of counting their chickens before they are hatched, is all.

    • Dwayne N. Zechman

      A Sarah Palin death panel would be judging among people who were still alive, and judging their value to society rather than their medical prognosis. That’s what people are talking about and fearing.

      This a distinction without a difference. ANY decision-making body–and ESPECIALLY one that is a part of the government–who exercises authority to withhold health care of any sort is, by extension, in a position to make arbitrary decisions on who lives and who dies.

      It is the very existence of such an authority, and the exercise of it (without possibility of appeal) that is “what people are talking about and fearing.” NO ONE SHOULD HOLD THAT POWER OVER OTHERS.

      The criteria for the decisions is irrelevant.

      –Dwayne

      • deery

        It is the very existence of such an authority, and the exercise of it (without possibility of appeal) that is “what people are talking about and fearing.” NO ONE SHOULD HOLD THAT POWER OVER OTHERS.

        The criteria for the decisions is irrelevant.

        So the problem is that we would have a government entity making the decision rather than the for-profit corporation making the decision now? In either case, the decision making body isn’t physically removing the tubes from the brain-dead person, but just declining to provide the funds for it. The family, or hospital could choose to step in and pay as well if they firmly believe that the person is still there, but it is telling that they won’t.

        With all that said, my grandmother a few years back had a massive stroke. They said she was brain dead, showed us the brain waves, and recommended that we take her off of life support. The family gathered in her room to tearfully say goodbye to her. As we leaned over her and told her we loved her, she muttered “I love you” back. You could have knocked us over with a feather. The doctors told us we were hallucinating until they saw it for themselves. Within a week she was off life support, sitting up, laughing and talking. Three weeks later, she died of a pulmonary embolism, but the time that we had with her in between was priceless. Doctors aren’t gods. Ever since then, I’ve always had a large amount of skepticism towards the pronouncements of medical professionals.

        • So the problem is that we would have a government entity making the decision rather than the for-profit corporation making the decision now?

          Well, which one do you think can be sued?

          • Dwayne N. Zechman

            The for-profit corporation has me as a voluntary customer, and I can choose to take my business elsewhere (and my money, which they want me to keep sending to them so that they can continue to turn a profit.

            The government entity has me as a mandatory taxpayer, and is quickly establishing itself as a monopoly.

            To put it simply, I can choose a different insurance provider if I want to. That means that I retain the aforementioned power over myself.

            But not so with the government.

            –Dwayne

          • Liberal Dan

            Depends on what tort reform measures are passed in the state you are living on. When sheilded from fiscal loss for doing wrong, companies will be more likely to make the profitable decision even if it is the wrong one morally/ethically.

    • A distinction without a difference. The issue is resources wasted on the dead, near dead, inevitably dead or unavoidably soon to be dead. You’re quibbling. No, I don’t want to pay for the hundreds of thousands of dollars it will take to keep Granny in painful, half-life for another three months, either.

      • “A distinction without a difference. The issue is resources wasted on the dead, near dead, inevitably dead or unavoidably soon to be dead. You’re quibbling. No, I don’t want to pay for the hundreds of thousands of dollars it will take to keep Granny in painful, half-life for another three months, either.”

        This is why a living will is so helpful. I have one which makes my decision to “die” solely my own. If there is no hope and I am brain dead or otherwise unable to sustain my own life functions let me go.

      • Fred

        Here’s what people think is happening:
        Quote from someone who was on a major party presidential ticket:
        “The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care.”

        The difference between that and whether to have a corpse on a ventilator is not “quibbling”. One affects the living, the other doesn’t. One is based on subjectivity and arbitrary power, the other is based on non-discriminatory cost-effectiveness studies.

        Looking at the broader picture, what if there were a competitive health insurance market where anyone who wanted to pony up the money could buy a rider that would cover the extra hundreds of thousands of dollars to make their final months a living hell? Then it would be a matter of individual choice.

        • what if there were a competitive health insurance market where anyone who wanted to pony up the money could buy a rider that would cover the extra hundreds of thousands of dollars to make their final months a living hell? Then it would be a matter of individual choice.

          Yeah, a shame that that exact plan – they were called “catastrophic coverage” – are no longer legal under the ACA.

        • We’ve discussed this. Palin’s dumb characterization of “death panels” in her original statement was expanded to the more realistic definition long ago, in 2009, and even Palin joined the band. Obamacare defenders (or, at this point, deniers) like to default back to her typically irresponsible hyperbole whenever they are called on their false refusal to admit there are “death panels” inherent in Obamacare. Ampersand and I went around on that. It’s a dodge. Palin’s statement was important because it tried to raise the necessary debate over rationed health care, and in the stampede to pass the ACA without thinking or being transparent to the public, Democrats wouldn’t allow any truth to peak through the hype.

          • Fred

            “inherent in Obamacare”:

            You said it better in the original post. It’s not about Obamacare — it’s about any system with shared costs, be it for-profit insurance, the NHS, or a co-op.

            Even without shared costs, we have rationing by price.

            All people who insinuate that this is new in Obamacare are being deceptive whether they mean to or not.

    • Joe Fowler

      Let’s see: “it’s conceivable”…”if that succeeded”..”fewer people…maybe few enough”. Well, that’s good enough for me! Let the government loose on this, I don’t care what it costs!

  4. Bruce

    The problem is unavoidable even if every mechanism for healthcare rsk pooling were to be prohibited by statute law. In that extreme case a ‘death panel’ consisting of the whole electorate would have decided that the poor and the unfortunate few with high medical costs would die preferentially.

    If you allow risk-pooling of healthcare costs, the only reasonable course of action for any individual or group of any size whatever is to seek a system of utilitarian balance where the harms mitigated by each possible risk pooling scheme are optimised against the harms done by the adverse unethical decisions of the respective form of death panel for each system of pooling. There would need to be some flexibility to cover exceptional cases, for example if some higher duty or superior right were involved.

    That’s not sufficient and not ethical as a solution. But that’s all there is as far as I can see.

    In the UK/NHS where risk is not only pooled by government but care delivered by government we mostly effectively draw lots to choose the slain We distribute funding and care delivery by an obscure and somewhat arbitrary method whereby no one person or panel makes the decision, which I think is basically as close to blind luck as you can get (though a very expensive and ethically difficult form of blind luck). Then we deny loudly that we have made a decision at all.

    But in essence a decision must always be made. The decision may be by panel, by lot, by playing chess with each other, or some other inventive fashion – no matter. The choice is inevitable even if you decide not to choose at all.

  5. I can only speak for myself, but I don’t want my life to be just survival under medical extreme measures. Most of the people I’ve spoken with about it feel the same way. In a truly free society the person themselves would be the one to decide, not some “panel” somewhere. That person, and those who choose to support them, would also be the ones to pay for it. If they weren’t being forced to pay for someone else’s care they would be able to make the best personal decision using their own resources.

  6. Just to point something out, even if we didn’t have the ACA/Obamacare we would still have shared healthcare costs AND we would still have people making life or death coverage decisions. Eliminating the ACA would return us to annual and lifetime coverage limits. It would also have employees of that insurance company making coverage decisions.

    So it is not that death panels are inevitable, it is that they have always existed and the hypocrisy of complaining when government does it but not when a corporation does it shows that people are not willing to have an honest debate on the issue.

    Plus there were times during the debate over the ACA where people were calling things “death panels” that clearly were not. The Liberty Counsil called a section of the HR 3200 bill that limited cost sharing “death panels”. That section had nothing to do with any sort of end of life decision. It just said companies were limited in cost sharing they could implment.

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