Secretary Not-A-Death-Panel
Secretary of Health and Human Services Kathleen Sebelius is refusing to intervene so that ten-year-old Sarah Murnaghan can jump ahead in line to get the urgent lung transplant that will save her life. Naturally, Sebelius is being attacked as heartless, and conservatives are having a field day equating her decision with Sarah Palin’s infamous “death panels” characterization of Obamacare.
The manner in which organs are allocated for transplants is justly controversial, obviously flawed, and arguably unethical. Any real person whom the system will fail, however, instantly becomes sympathetic beyond the mere faceless numbers she is being compared to. Sebelius is quite correct: if the girl is moved ahead in line, someone else won’t get lungs, for this is musical chairs and a zero sum game. If she was to make an exception to the policy for this case, it would be impossible for her to deny the next case, and soon Kathleen Sebelius would indeed become a one-woman death panel.
That’s not what she is doing now. What she is doing is adhering to an existing policy in which there are winners and losers, and the losers die, until the policy is reviewed and perhaps changed for the better. Her decision isn’t cold-hearted, cruel or unkind. It is responsible, fair and courageous. The alternative is to have no policy at all.
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Source: NBC News
Ethics Alarms 
Completely agree, and given that Drudge has been playing this one hard the only surprise in this post was that it wasn’t entitled “Ethics Dunce: Matt Drudge.”
For those who might disagree, imagine a world in which cabinet secretaries could arbitrarily step in and order rules changes on a whim. We’re too close to that already.
Also Rush Limbaugh, Chris Plante, Sean Hannity…the Radio Right is aligned on this one.
Good post. Tough situation.
I agree, much as I might not like to, this is a no-win situation for the Secretary.
And I think CNN deserves a little discrediting for running this story over and over and over again. Shameless pandering.
Agreed. But it’s made for ratings and the “Think of the children!” crowd.
I wonder how Obama reconciles this with his “it it can same one child’s life” nonsense in the gun debate…
I’m not surprised that the left cares nothing for this little girl. They would probably argue that she should have been aborted in the womb in the first place so she would be spared this pain.
We need to get the govenment out of the health care business. Period. They’re the reason we’re in the mess we’re in to begin with.
Um what? I am a liberal and I care deeply for this little girl. That doesn’t mean I want to give a government official the power to decide that another person should die to save her life. As for the reason we’re in this mess — can you explain? The government didn’t cause this little girl to need a lung transplant!
Why do you hate Carolyn Gannett, the 37-year old mother of three that is supposed to receive these lungs if the Secretary doesn’t intervene? Or maybe it’s Julio Vargas, a high school science teacher and soccer coach? Or Fred Smith, a gas station cashier who’s half-way through night school to get his degree? Or…well, I’m making all this up. We don’t know the identity of the person who will die if this little girl gets the transplant. But why should that make him or her less worthy?
As for getting-the-government out of healthcare, do you think involving politically-appointed bureaucrats in individual healthcare decisions makes the government less involved or more involved?
Brava Kathleen Sebelius!
Great post, Jack.
If there aren’t enough lungs, why don’t these outraged people make sure they sign their organ donor cards if their health allows? The number of people waiting a long time is far fewer than die from accidents every week.
Anyone who demands she intervene and claims the mantle of small government conservative is a hypocrite in the extreme.
unos.org is the responsible party, not hhs. They are contracted to fill this role independently by HHS, incorporated in Virginia, led by a board of directors who are medical professionals. For a conservative to demand any decision from Sebelius is to assert a presidential appointee should hold life and death authority. At that point, organs will be for sale to the highest donor. If it is true, as the committee member (Republican) asserted, that she has the power to override, those of us who are true libertarian conservatives should demand that change.
These decisions must be made on medical efficacy, never swayed by PR or who donated to which campaign.
Well put.
That all said, this isn’t surprising. Remember Terry Schiavo?
Full Disclosure: My 8 year old daughter has Cystic Fibrosis. I’ve stood by that bed. I’ll stand by it again in the future – one day, facing this exact dilemma. I hope to God that she’s older than 12 when I do.
I don’t blame the parents one bit – I believe the rule as it stands is capricious and unfair. They should do everything in their power to save their daughter, and I’m glad that they are doing so. The judge ruling that the rule should be waved is a far better source for that decision than HHS, since this is essentially a dispute between a non-profit organization and a family.
However, Sibelius’ reasoning is faulty. She cannot say ‘I cannot put one life above another’ when she is doing exactly that. In particular, she’s putting a hypothetical life above the life of this very real girl. True, she deserves kudos for sticking to the letter of the law, but just as DAs have discretion in which cases to pursue, so too do doctors.
Sibelius and her compatriots want to have the authority to make calls like this. Right now, there is a non-profit organization imposing rules between the doctors and the patient – very well, they are the ones that do the work procuring the organs, they get to establish rules. And the family should be able to contest those rules – that’s good and proper work for a government. The organization does kind of have the market cornered when it comes to this little girl’s life. The government is also in the middle of establishing a case that they, too should be allowed to impose their own rules between doctors and patients. I believe their response to how rules that are imposed on this relationship from without are implemented IS a valid point of criticism – not to the point of demonizing Sibelius, but as a grander point in the Obamacare argument. Not that there’s not plenty of points to demonize Sibelius on already.
I believe the policy should be reviewed, and I’m glad that the Federal judge stepped in to give the girl a chance while it is being reviewed. That’s a better solution than HHS making the call, anyway. If it were a federal law, then it would be on HHS’ plate.
No one can blame the parents. But the parents aren’t supposed to be fair and objective either: they are supposed to advocate for their child. That’s their jobs. (The predictable—stupid—comments online that say, “Sibelius wouldn’t be taking this position if it were HER daughter..”: well, of course not, and that proves nothing at all. In that case, she’d be biased, In that case, she’s have a conflict of interest. People really think that’s some kind of zinger! It is a confession of ethics ignorance.
But you can’t say “she’s putting a hypothetical life above the life of this very real girl.” The fact that someone else will not get the lungs the girl get is unavoidable; that life isn’t hypothetical at all, it’s certain and real, just unidentifiable. If you save your friend from a soon to explode hand grenade by throwing it out the window into the middle of a crowded sidewalk, you can’t say that you saved a real person in exchange for a hypothetical life…you just killed someone. You don’t know who, but that doesn’t make him/her less dead, or you less responsible.
I was asked to sign a petition on Sarah’s behalf. It said nothing about Sarah jumping the line but that she was being denied because of some minimum age requirement.
She was denied be cause of a strange rule that set her in line because of her age. It doesn’t matter why her place in line is what it is…now her parents (apparently successfully, thus killing someone else)have made enough noise that they have achieved their goal. Good for them and their daughter, bad for everyone else.
I fully agree that it was not HHS’s role to override the normal policy, and I am not sure whether or not I agree with the judge’s decision to have her put on the adult list. But I do object to language like “thus killing someone else.” First, anyone who dies of their disease while waiting for a transplant was killed by the disease, not by anyone else. In this situation, there are those who have the power of deciding which person to save; that everyone cannot be saved is tragic, but advocating for one person is not the same as killing another. If two people are about to be swept away by a flood and I choose to rescue my daughter instead of the stranger – or beg the first responder on the scene to make that choice while I am powerless to help personally – I have not killed the stranger.
Second, there is no certainty that anyone dies as a result of this. According to accepted criteria, she needs the transplant more than anyone she displaces. Making up numbers here, but let’s say there are 100 people in the region who would be compatible with the same lungs as Sarah, and she is now second on the list. So she gets the second available transplant. This doesn’t necessarily mean person number 3 doesn’t get one; he/she just has to wait longer. And by definition, they are believed to have more time to wait.
It’s agonizing, and yes, it’s possible that person 3 dies before they get a transplant. Or maybe they get one, but person 4 doesn’t. But it’s also possible that five lungs become available, Sarah and four other people get their transplant, and the other 95 people on the list have enough breathing room (an unfortunate and unintended pun) that none of them die as a direct result of waiting a bit longer for a transplant. Previously, Sarah was at the very bottom of the list despite having a greater need than many of the others, leaving her almost certain to die.
I know it’s a tradeoff, and I know that the chances of everyone on the list surviving aren’t good – after all, that’s why they’re waiting for a transplant in the first place. And I’m glad I don’t have to make those decisions, and beyond thankful that I’m not in a position to be subject to them for myself or my family. I don’t know what the right answer is here, and that wasn’t my purpose in commenting – I just don’t think the “killing someone else” rhetoric is accurate.
Exactly. Now, if the person at the top of the list had an equally urgent need for the lungs – that is, if the list were organized according to who needed the next set of lungs immediately – and Sarah asked to jump in line, then it would be a matter of putting Sarah’s life above that person’s. But if that person can live for 10 weeks, and Sarah only 5, then it’s not a matter of ‘letting someone else die’ it’s a matter of triage. Sarah will die if she’s kept at the bottom of the list because of an arcane rule. The person at the top of the list may die in three weeks instead of five – in which case, they would have the more urgent claim. Certainly I hope that rules like this which determine the ordero of eligibility are reviewed often enough to keep up with rapidly changing medical reality. The surgery that was impossible five years ago may be commonplace today. But that only helps if the laws and rules that bind doctors keep pace with that reality – one of the most frightening things about Obamacare’s arguments, to my mind.
It is unfortunate in this case that Obamacare opponents who have, for years, demanded government power stay out of medical decisions became the people demanding Sebelius seize power from the doctors, railroading a budget hearing in the process.
Republican Rep Meehan is Chief Hypocrite on this one streaming vindictive death panel assertions until he got a taste of the power to make the death panel decision himself.
I rarely have much good to say about members of the current Presidential administration, but Secretary Sebelius was spot on correct with how she handled this and her explanation why.
I believe the court was right to use an injunction, but targeting Secretary Sebelius was incorrect. They should have issued the order directly to the independent board of medical professionals who have the authority to set the standard.
Sec. Sebelius can respond by declaring she has no standing to act and the case dies or at least guess dragged down a rat hole that out lives this child.
The Right’s grandstanding on this matter is pretty revolting.
I could not agree more, and if it is not apparent from what I have written else where, it is highly unlikely anyone who knows me would place my beliefs to the left. Unfortunately The Right and the right are greatly divergent political frameworks, as are The Left and the left.
There is one political philosophy shared by our politically powerful officials – self aggrandizement at any ethical cost.
It’s been decades since I was in nursing school, but I have a clear recollection of a nursing ethics course in which your argument was raised and found invalid on medical grounds. As it went then, the prognosis limit is set at a matter of months. The line placement occurs when the person’s need hits that outer limit and the “count-down” begins there, leaving virtually no wiggle room. The ability to make a prognosis within that time-frame is considered pretty much the same as the word implies — prognostication and foretelling, crystal balls and tarot cards. Much as we would like to think it, and as it once was thought, doctors are not magicians. A similar line (granted, without the urgency) is drawn for people to enter hospice care.
Of course, I could be wrong, and there is now a way to divine the urgency within weeks, days or hours, but I doubt it. The balance between death and desire (or design, if one is religiously inclined), is quite amazingly unforseeable.
If she was next in line and denied because of an age requirement then I say some rules are made to be broken. If she’s next in line that’s all that should matter. Denying her because she’s a child and they favor adults is bad policy.
It is denied because the chance of killing her with the operation is higher due to her age (this is somewhat false, the risk is possibly higher for the typical 12 year old but there is not really enough data to be sure) . The standard is set based on medical efficacy and need. Her doctors are not the ones who made the rule, and they challenge the age exclusion as arbitrary, but the age rule is based on risk factors that are believed to be real by a team of medical professionals who oversee the transplant program nationally.
” Her doctors are not the ones who made the rule, and they challenge the age exclusion as arbitrary, but the age rule is based on risk factors that are believed to be real by a team of medical professionals who oversee the transplant program nationally.”
Thanks Matt. That I can understand.