LET’S BE HONEST ABOUT CHARLES KRAUTHAMMER
Charles Krauthammer, MD (Psychiatrist) is one of the best political commentators on the contemporary scene. About the only program I watch on Fox Cable News is Special Report, which comes on at 5:00 PM every day. And the only reason I watch it is to catch the few minutes of commentary by Charles Krauthammer at the end of the program.
Charles Krauthammer is good, but he is not perfect. Like some conservative commentators he seeks to preserve his reputation for high quality commentary by distancing himself from other conservatives who have become the subject of scorn and ridicule by the MSM and liberal commentators, and especially by liberal bloggers, conservatives such as Glen Beck, Rush Limbaugh and especially, Sarah Palin. I consider it a character flaw in men like Krauthammer, Richard Lowry and some of the writers of National Review, that they always distance themselves from Sara Palin before they say or write something that is basically in agreement with something she has already said.
The most recent example of this was the comment Sarah put on her Facebook site about Section 1233 of H.R. 3200, calling it a provision to create death panels. On Facebook one cannot engage in a lengthy explanation of one’s point and so she captured the essence of what she felt was wrong with the bill by using the words “death panels”. Krauthammer, Mark Steyn, Jonah Goldberg, et al wishing to avoid being labelled ‘crazies’ in the way the media has labeled Sarah crazy, start off their commentary by saying in effect, “look, I am not crazy like Sarah Palin” but then they go on to say or write something which is in substantial agreement with her point, if not her choice of words.
There is a term that describes their actions: cowardice. The virus of cowardice is found too often in conservatives. A Nancy Pelosi, Harry Reid, Barney Frank, Charles Schumer or Unmentionable Waxman, would never hesitate to call a spade a spade. But not conservatives and Republicans (note that I make a distinction between them). They always use polite language, which is fine, but sometimes they give aid and comfort to the enemy as in their case of putting down Sarah Palin, by saying in effect, “I am not like her!”
The reality is that anything that Congress passes in the way of Health Care legislation that provides for end of life counseling will have to be administered with the 50 states and will be further subject to state laws and regulations about the end of life. Here in Texas, for example, we already have death panels, only they are called ethics committees. Orwellian semantics are already a big part of the ordinary discourse of Barack Hussein Obama and the Obamacrats in Congress. It is not helpful when someone like Krauthammer chooses to avoid calling a spade a spade, and instead by circumlocution waters down the horror of what is being proposed in Obamacare.
Here are two articles. The first by Krauthammer is the immediate cause of my comments above. The second, by Robert W. Painter, a Houston, Texas attorney, tells the truth about the death panels (ethics committees) that are already at work in Texas putting people to death. Texas has the dubious honor of leading the nation in executions in its prisons, soon it will have the dubious honor of leading the nation in indirect involuntary euthanasia in our hospitals. The only difference under Obamacare (and what a terrible difference it is) is that doctors will now be paid to give the end-of-life counseling they presently give free of charge.
Let’s Be Honest About Death Counseling
by Charles Krauthammer
THE WASHINGTON POST
Friday, August 21, 2009
Let’s see if we can have a reasoned discussion about end-of-life counseling. We might start by asking Sarah Palin to leave the room. I’ve got nothing against her. She’s a remarkable political talent. But there are no “death panels” in the Democratic health care bills, and to say that there are is to debase the debate.
We also have to tell the defenders of the notorious Section 1233 of H.R. 3200 that it is not quite as benign as they pretend. To offer government reimbursement to any doctor who gives end-of-life counseling — whether or not the patient asked for it — is to create an incentive for such a chat.
What do you think such a chat would be like? Do you think the doctor will go on and on about the fantastic new million-dollar high-tech gizmo that can prolong the patient’s otherwise hopeless condition for another six months? Or do you think he’s going to talk about — as the bill specifically spells out — hospice care and palliative care and other ways of letting go of life?
No, say the defenders. It’s just that we want the doctors to talk to you about putting in place a living will and other such instruments. Really? Then consider the actual efficacy of a living will. When you are old, infirm and lying in the ICU with pseudomonas pneumonia and deciding whether to (a) go through the long antibiotic treatment or (b) allow what used to be called “the old man’s friend” to take you away, the doctor will ask you at that time what you want for yourself — no matter what piece of paper you signed five years ago.
You are told constantly how very important it is to write your living will years in advance. But the relevant question is what you desire at the end — when facing death — not what you felt sometime in the past when you were hale and hearty and sitting in your lawyer’s office barely able to contemplate a life of pain and diminishment.
Well, as pain and diminishment enter your life as you age, your calculations change and your tolerance for suffering increases. In the ICU, you might have a new way of looking at things.
My own living will, which I have always considered more a literary than legal document, basically says: “I’ve had some good innings, thank you. If I have anything so much as a hangnail, pull the plug.” I’ve never taken it terribly seriously because unless I’m comatose or demented, they’re going to ask me at the time whether or not I want to be resuscitated if I go into cardiac arrest. The paper I signed years ago will mean nothing.
And if I’m totally out of it, my family will decide, with little or no reference to my living will. Why? I’ll give you an example. When my father was dying, my mother and brother and I had to decide how much treatment to pursue. What was a better way to ascertain my father’s wishes: What he checked off on a form one fine summer’s day years before being stricken; or what we, who had known him intimately for decades, thought he would want? The answer is obvious.
Except for the demented orphan, the living will is quite beside the point. The one time it really is essential is if you think your fractious family will be only too happy to hasten your demise to get your money. That’s what the law is good at — protecting you from murder and theft. But that is a far cry from assuring a peaceful and willed death, which is what most people imagine living wills are about.
So why get Medicare to pay the doctor to do the counseling? Because we know that if this white-coated authority whose chosen vocation is curing and healing is the one opening your mind to hospice and palliative care, we’ve nudged you ever so slightly toward letting go.
It’s not an outrage. It’s surely not a death panel. But it is subtle pressure applied by society through your doctor. And when you include it in a health care reform whose major objective is to bend the cost curve downward, you have to be a fool or a knave to deny that it’s intended to gently point you in a certain direction, toward the corner of the sick room where stands a ghostly figure, scythe in hand, offering release.
‘Death panels’ exist already
Obamacare would hasten a process under way at state level
By Robert W. Painter
Wednesday, August 19, 2009
THE WASHINGTON TIMES
Former Alaska Gov. Sarah Palin, who says President Obama’s heath care reform would result in “death panels,” needs to look no further than Texas to see a slippery slope like the one she envisions.
In Texas, a legislative provision that many thought was an innocuous proposal to help people has been twisted to snatch end-of-life decisions out of the hands of families.
The provision to which Mrs. Palin refers, Section 1233 of America’s Affordable Health Choices Act of 2009, would allow Medicare to pay doctors to counsel or steer end-of-life decisions for a patient every five years or more often “if there is a significant change in the health condition of the individual” or an admission to a nursing home or long-term care facility. Both the White House and some members of Congress dispute Mrs. Palin’s contention about how this language would play out, but based on what has happened in Texas, Americans should heed her warning.
One of the drawbacks of trying to overhaul an industry as large and sweeping as health care on the short schedule demanded by the president is that there is not time to study how the legislation would work in the context of existing state law.
The truth is, for many states, Mrs. Palin’s assessment likely is dead-on, except the “death panels” would be hospital-run, not government-run. Consider Texas. The Texas Advance Directives Act of 1999 became law with support from a broad ideological spectrum, but one of its unintended consequences has been astounding. When a patient or family wants health care to continue but the attending physician does not, the Texas law allows a hospital committee to have the final say under the amorphous concept of “medical futility.”
Texas law only requires the hospital to provide the patient and family with 48 hours’ notice before a hospital “ethics” committee meets and makes a decision on terminating life support. There are few due-process safeguards in the law to protect patients during this committee proceeding.
Once the hospital ethics committee decides that further care is medically futile, the family is given just 10 days to find a facility that will accept the patient, or the hospital and doctors can end curative care with impunity. Virginia law is similar but gives the family 14 days.
Furthermore, if the statute is followed, the hospital and others involved are cloaked with complete criminal, civil and licensing immunity. In other words, even if the hospital’s decision to pull life support was incorrect, it is immune from lawsuit or prosecution. All this sounds quite like a “death panel” to me. Under Texas law, the hospitals are not just allowed to try to persuade a family to “pull the plug” but are allowed to take the action themselves and end all curative care if the family disagrees.
When patients and their families are battling a serious illness, they are in a vulnerable frame of mind. Some physicians and hospitals will try to step in during this emotional time and impose their will even when it goes against the patient’s and family’s decision and belief system. I have seen numerous Texas cases in which health care providers have tried to split families in an attempt to find someone to support the hospital’s desire to end care. In the end, though, under Texas law, the hospital can go against the family’s wishes if the family will not agree to end the life of their loved one.
The Texas experience should not be ignored in the face of proposed legislation that would nationalize a policy that further goes against individual rights. The proposal is to pay doctors to counsel patients on end-of-life decisions. In practice, those consultations likely would take place frequently, considering that it is left to the doctor to determine what a “significant change in the health condition” is. Further, imagine how worn out senior citizens might feel by the repetitive discussion each time they move between a nursing home, long-term care facility or hospital.
The end-of-life provisions of the Obama health care plan would upset the balance of power in health care decision-making in favor of doctors and hospitals and against individuals and families. The federal legislation provides an economic incentive for doctors and hospital administrators to use Medicare funds to start hastening certain patient deaths a bit sooner under existing state laws. In Texas, that balance already is tipped in favor of the health care providers, and the proposed federal legislation would only make matters worse by placing more Medicare dollars on that side of the scale.
Sen. Charles E. Grassley, Iowa Republican, is rightly concerned that the end-of-life provisions in the proposed federal law could be “misinterpreted and implemented incorrectly.” Federal lawmakers interested in protecting individual and patient rights need to study carefully the end-of-life provisions with the understanding that the law will be implemented in health care settings governed under 50 different sets of state law.
Admittedly, the warning of “death panels” is a shocking claim. But when I inform people of the effect of the Texas law and how it has trampled on individual rights, they are understandably shocked. If the Texas Advance Directives Act has shown us anything, it is that governments should leave end-of-life decisions to patients and their families.
Robert W. Painter, an attorney at Painter Law Firm PLLC, handles medical malpractice and other litigation matters and has testified on the Advance Directives Act in the Texas Legislature.