death panels

Morning Ethics Warm-Up: 8/2/17

/ Jack Marshall / 156 Comments

Gooooood morning!

(I don’t know about you, but it’s always a good morning for me when the Boston Red Sox win the most exciting game of the baseball season so far with a three-run homer in the bottom of the ninth after what should have been the last out reached first because  a swinging strike three went through the catcher for a passed ball….)

1. Yesterday, the gang at HLN were laughing and guffawing over the fact that someone sent e-mails purporting to be from Anthony Scaramucci to various White House officials and fooled the recipients into responding. Such publicity is what hoaxers dream about. This is why we have despicable fake news sites like “The News Nerd” and others. This is why Facebook feels it needs a special task force to search out and destroy false representations. CNN and other news media also treated the e-mails as significant news—more newsworthy, for example, than the Pakistani crooks the Democratic party had handling sensitive e-mails and other data. Why is this news, other than the fact that the “bad guys” were fooled, in the warped perspective of “resistance” journalists? More to the point, why is it funny? Why is the news media encouraging hoaxes by rewarding them with the notoriety they crave, so they can puff up their little pigeon chests and say, “See? I matter!”

The reports attempted to bootstrap the story by explaining that fake e-mails are how cyber-predators can get access to e-mail accounts. Those phishing episodes, however, involve the credulous recipients clicking on links in the message, which did not occur here. That’s what Hillary Clinton and John Podesta did. I don’t recall HLN chortling about that, however.

2. I’m still waiting for the news media’s apology to Sarah Palin. The news from UK socialized medicine today:

“Obese people will be routinely refused operations across the NHS, health service bosses have warned, after one authority said it would limit procedures on an unprecedented scale.Hospital leaders in North Yorkshire said that patients with a body mass index (BMI) of 30 or above – as well as smokers – will be barred from most surgery for up to a year amid increasingly desperate measures to plug a funding black hole. The restrictions will apply to standard hip and knee operations. The decision, described by the Royal College of Surgeons as the “most severe the modern NHS has ever seen”, led to warnings that other trusts will soon be forced to follow suit and rationing will become the norm if the current funding crisis continues.”

Continue reading →

Observations On Britain’s Charlie Gard Ethics Fiasco

/ Jack Marshall / 40 Comments

A recipient of Great Britain’s national health care, infant Charlie Gard was born with  a rare genetic condition resulting in what is probably irreversable brain damage.  He cannot move his arms or legs, eat or even breathe without a ventilator.

After 10 months of being kept alive, Charlie’s caretakers, the Great Ormond Street Hospital for Children in London, announced that it was time for Charlie to die. Chris Gard and Connie Yates, Charlie’s parents, wanted to take him to the United States to try an experimental treatment available here. The doctors at the hospital refused to allow them to take the child, and vetoed their decision, even though the parents had received sufficient funds from donations to pay for the effort.  In  the resulting lawsuit, British courts sided with the hospital. The parents then brought the case  to the European Court of Human Rights, which declined to hear the case last week. The previous court rulings that it was in Charlie’s best interest to withdraw life support and that the state, not the parents, got to make this life and death decision stood.

The  parents, Chris Gard and Connie Yates, appeared on a video this week,, sobbing and saying their son would be removed from life support at the hospital. “He’d fight to the very end, but we’re not allowed to fight for him anymore,” Gard said in the video statement. “We can’t even take our own son home to die.”

Initially, the hospital would not delay the fatal  disconnection of the child from life support so family members could gather and say goodbye. It has since relented.

Observations: Continue reading →

Comment Of The Day: “Comment Of The Day: ‘Comment Of The Day: No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not Discrimination.’”

/ Jack Marshall / 17 Comments

I agree, this is getting ridiculous: our colloquy on the ethical and policy complexities of health care policy has created the first Ethics Alarms Comment of the Day on a Comment of the Day on a Comment of the Day. Nonetheless, John Billingsley’s COTD is deserving, as well as interesting and informative. Here it is, his comment on Comment Of The Day: “Comment Of The Day: ‘No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not Discrimination’”—which in this case you really should read Charlie Green’s post that prompted it.

I have a few comments on specific points.

“New diseases like RLS”

RLS was first described in 1685 and the first detailed clinical description was in 1944 and it was shown in test recordings in 1962. Not really a new disease but a newly publicized disease. Once a medication was developed that was effective at relieving the symptoms, it became profitable for a pharmaceutical company to target it and raise awareness. The company was not being altruistic, but is it wrong to make money by informing someone that there is a way to relieve the distress they are experiencing? If you have ever talked to someone who really has this disorder, you know how much it disrupts their lives. Is it over diagnosed? Possibly, but polysomnography to make a firm diagnosis is expensive and it is a condition where the clinical symptoms are pretty reliable. Probably cheaper to just treat it.

“Because who’s still going to argue with your doc? Especially when he or she gets side benefits from giving in to the latest DTC ads on network news programs?”

I hate DTC ads. I would be good with a spot that just said, do you experience these symptoms (of RLS perhaps)? If you do, tell your doctor. I actually spent quite a bit of time telling patients why they did not need the newest, expensive drug they heard about on TV or in a magazine either because they didn’t meet the criteria for it or because I felt that the cheaper alternatives were just as effective and needed to be tried first. It was a hard sell, particularly when the patient would say, “but my insurance will cover it.” I, and I think most doctors, take being a good steward of the healthcare dollar seriously. In the past there were sometimes substantial “side benefits” from drug companies especially if you used really expensive things like artificial joints or pacemakers. The most I ever received was dinner in a restaurant and things like cheap pens and sticky note pads. These days there are no more cheap ballpoint pens and meals typically are take out from Newks or equivalent in the office during a presentation. Not something I am likely to sell my soul for although I understand the implications. Continue reading →

Comment Of The Day: “Comment Of The Day: ‘No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not Discrimination.’”

/ Jack Marshall / 33 Comments

The health care/ACA/AHCA commentary from readers continues to be uniformly excellent. (It was originally spurred by the post, No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not “Discrimination.”)  Spartan’s Comment of the Day on the topic has itself sparked its own Comment Of The Day, this one authored by Charles Green.

By fortune’s smiles, I was able to finally meet Charlie last week face to face, as he kindly alerted me that he would be passing through my neighborhood. Finally having personal contact with an Ethics Alarms reader is always a revealing and enjoyable experience, and this time especially so. I think you would all enjoy Charlie; I certainly did. Maybe I need to hold an Ethics Alarms convention.

Here is his Comment of the Day on the post, Comment Of The Day: “No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not ‘Discrimination’.”

…The claim that “a free market system” and “freedom of choice” is the solution to all that ails us is a mindless mantra that is only occasionally true, but not always.

It’s important to be clear about when free market solutions are good, and when they are not. It’s not all that hard to sort out. Basically:

Free market solutions ought to be the presumptive default. Unless there is good reason to the contrary, they ought to be the rule.

1. Exception Number 1: Natural monopolies. It makes no sense to have competition for municipal water supplies; airports; multiple-gauge railroads; fishing grounds; groundwater; or police departments. The basic reason is the putative economic benefit is either simply not there, or is absurdly overwhelmed by the social confusion engendered by multiple suppliers.
In these cases, a form of regulated monopoly is desirable. (By the way, the airline industry at a national level is precisely this kind of market; we do not have too little competition there, but too little regulation).

2. Exception Number 2a: Wallet-driven market power monopolies. It’s strategy 101 in business schools that the way to be successful is to be #1 or #2, and the best way to do that is to get more market share than your competition, so you can drive them out of business. The one guaranteed way to do that is to cut prices so low that no one else can compete. Think Walmart. Think Amazon. Think Japanese in the 60s and 70s in any industry.
The reason we have anti-monopoly laws is to reset the playing field when a competitor dominates the market too strongly.

3. Exception Number 2b: Product-driven market power monopolies. Where the product is so obscure, expensive, infinitely variable, and difficult to understand that the producers are de facto in control, because it is too confusing and too dangerous to challenge them.
Drug prescriptions are an interesting example. The ‘free market solution’ to high drug prices was (partly) to let drug companies advertise, and to loosen up the definition of what constituted a ‘new’ drug. What did we get? New diseases like RLS, new definitions of ‘new’ (moving ‘off label’ to ‘on label’) and even higher drug company profits. Because who’s still going to argue with your doc? Especially when he or she gets side benefits from giving in to the latest DTC ads on network news programs?

Continue reading →

Wasting A Heart

/ Jack Marshall / 30 Comments

Heart transplant patient

I don’t have a solution to an ethics fiasco like this or know how it could be avoided, but there have to be some lessons buried here somewhere.

In 2013, 15-year-old Anthony Stokes was denied a place on the waiting list for a life-saving heart transplant  at Children’s Healthcare of Atlanta at Egleston because, the hospital explained, he had “a history of noncompliance, which is one of our center’s contraindications to listing for heart transplant.”

This means that doctors doubted that Anthony would take his medicine or go to follow-up appointments. In other words, he was too unreliable and irresponsible to be entrusted with a heart that could save the life of someone else more likely to make good use of it. When a doctor told the family that Anthony’s low grades and time spent in juvenile detention factored into the assessment, however, that gave the family an opening to save the boy’s life. They played the race card. Anthony was being sentenced to death because he was poor and black, and a white patient would naturally be a better risk. The media ran with the narrative, and there was national outrage. Fearing a public relations disaster, the hospital reversed its decision, and Stokes got his heart.

From the Washington Post today:

Tuesday afternoon, [Anthony] Stokes died after a vehicle he was driving jumped a curb, hit a pedestrian and collided with a pole in a car chase with police, according to WSBTV. The pedestrian was hospitalized for her injuries, but Stokes’s car was nearly split in half by the sign, according to the Atlanta Journal-Constitution.

Police said he had to be cut out of the Honda by first responders and rushed to a hospital where he later died…Stokes was driving a car that matched the description of one used by a person suspected of breaking into an elderly woman’s home. The chase began after officers responding to her 911 call attempted to pull Stokes over, according to WXIA.

Pensive and Rueful Observations: Continue reading →

Autonomy: The Ethics Alarm That Obamacare Should Be Setting Off, But Isn’t

/ Jack Marshall / 53 Comments

fire_alarm

Autonomy. This is the ethical value, a sub-set of the “respect” section of the Josephson Institute’s Six Pillars of Character, that is suddenly absent from the value set of the New American Left. This is cause for concern to say the least, because autonomy is the very value that was the impetus for the nation’s founding, and that is at the core of the Bill of Rights as well as the “inalienable rights” that introduce Mr. Jefferson’s mission statement for our strange experiment in self-governance. Beginning back in Bill Clinton’s administration, advocates of a nationalized health care system, including President Clinton himself, began floating the historical and logical nonsense that Jefferson and the Founders would have enthusiastically supported national health care. This is, of course, a cynical lie if one is educated (as it was in Clinton’s case) or proof positive of complete unfamiliarity with, oh, everything about the Founders, their political philosophy, and political philosophy generally. Whatever the value of a national health care program, the idea that the government would presume to dictate how one managed something so personal and intimate as one’s own health would have horrified  every signer of the Declaration, from its author to Button Gwinett.

That Mr. Jefferson’s supposed followers—he is the Original Democrat, by most lights, would reach the point of maintaining that the public’s beliefs, opinions and attitudes must be bent to their will is a development that threatens the existence of United States society and culture as we know it. The recent flare in this emergency arrived via the mugging of Brandon Eich, ex-CEO of Mozilla, who was deemed by the liberal elite as unworthy of keeping his job (though Mozilla is an internet company and he is an innovator in the field) because he was not convinced of the rightness of same-sex marriage by the elite’s newly determined, and well past,  deadline—a deadline that such progressive icons as Barack Obama and Hillary Clinton also missed, but never mind. Conformity to Progressive Truth has become the order of the day, and woe be to any good citizen who dares to oppose it. Does this sound like freedom to you? “Choice,” to use a popular rallying cry in the protest against the “War against Women?” It doesn’t sound like freedom to me. Continue reading →

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

/ Jack Marshall / 30 Comments

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.” Continue reading →

Donald Trump, Birther

/ Jack Marshall / 23 Comments

Classy as ever, Donald!

Donald Trump, whose pseudo-entry into the Republican presidential sweepstakes has had the effect of making all the other candidates and near-candidates look classy by comparison, now is playing the despicable “birther” card. It figures. Everything about Trump’s career, personal life and properties, even his hairstyle, has been an exercise in bad taste.

This tactic plays to the lowest lights in the Republican party, about 70% of whose members harbor serious doubts about President Obama’s place of birth. This is not surprising: it is pure confirmation bias. Most Republicans don’t like Obama, and so don’t trust him. The confusion about his birth certificate feeds that distrust, and confirms it. It seems plausible to them that such an untrustworthy sort is hiding his true place of birth. To someone who trusts the President, this is not plausible. The slow-motion furor over his citizenship confirms their already formed beliefs too: that the Republicans are fools and racists. Continue reading →

“Lie of the Year”? Hardly.

/ Jack Marshall / 2 Comments

PolitiFact, the political fact-checking website, has once again announced its “Lie of the Year”:

“PolitiFact editors and reporters have chosen “government takeover of health care” as the 2010 Lie of the Year. Uttered by dozens of politicians and pundits, it played an important role in shaping public opinion about the health care plan and was a significant factor in the Democrats’ shellacking in the November elections. Readers of PolitiFact, the St. Petersburg Times’ independent fact-checking website, also chose it as the year’s most significant falsehood by an overwhelming margin. (Their second-place choice was Rep. Michele Bachmann’s claim that Obama was going to spend $200 million a day on a trip to India, a falsity that still sprouts.)”

This tells us a lot about PolitiFact. Continue reading →

The Damage of Health Care Reform “By Any Means Necessary”

/ Jack Marshall / 5 Comments

I have no idea whether the health care reform bill, assuming it finally gets passed in one form or another, will make things better or worse, and if you are honest about it, neither do you…and neither, I am certain, do most of the elected representatives who will have voted for it or against it (or for it and against it) by the time the dust clears. To only cite the most obvious proof, the bill’s current form was just posted yesterday, giving Congress 72 hours to read and understand over 2,000 pages of technical jargon and badly-written prose. I don’t believe I have ever read 700 pages a day for three days at any point in my life, and if I have, I know it had to be something more diverting than a health care bill.

Relying on second-hand analysis—also by individuals who haven’t read the current bill—simply puts us (and the members of Congress) at the mercy of the biases of those rendering the opinions. For example, one of my favorite commentators, Robert Samuelson, has persuasive arguments against the bill here and here, while one of my least favorite, Paul Krugman, weighs in on the bill’s virtues here and here. Now, I think Krugman has squandered his credibility by blatant untruths in the past (One howler, his infamous statement about the national health care systems of Canada and Great Britain that “We’ve all heard scare stories about how that works in practice; these stories are false” is derisively quoted almost daily by Wall Street Journal blogger James Taranto as he relays tales of national health care horrors from the London press), but the man has won a Nobel prize: maybe he’s right and Samuelson is wrong. I really don’t know.

I do know this, however: whether the bill proves to be disaster or panacea, the manner in which President Obama and the Democrats have gone about passing it has done real and lasting harm.  Continue reading →