Wednesday, June 08, 2011

The real Ezekiel Emanuel, revisited

Thanks to Ezra Klein for bringing into the current debate about euthanasia and assisted suicide Ezekiel Emanuel's humane argument against legalizing those practices, expressed in a 1997 Atlantic article.  Emanuel's chief concern was that once assisted suicide and euthanasia become common and accepted, subtle (or not-so-subtle) pressure would be exerted on some very sick patients to end their lives to ease the burden on their caregivers and loved ones:
Broad legalization of physician-assisted suicide and euthanasia would have the paradoxical effect of making patients seem to be responsible for their own suffering. Rather than being seen primarily as the victims of pain and suffering caused by disease, patients would be seen as having the power to end their suffering by agreeing to an injection or taking some pills; refusing would mean that living through the pain was the patient's decision, the patient's responsibility. Placing the blame on the patient would reduce the motivation of caregivers to provide the extra care that might be required, and would ease guilt if the care fell short. Such an easy, thoughtless shift of responsibility is probably what makes most hospice workers so deeply opposed to physician-assisted suicide and euthanasia.
That pressure, Emanuel warned, could also be financial, particularly in the United States:

In the Netherlands physician-assisted suicide and euthanasia are provided in the context of universal and comprehensive health care. The United States has yet to provide such coverage, and leaves tens of millions effectively without health care. Paul van der Maas, the professor of public health who conducted the two Netherlands studies, has said that in the absence of health-care coverage he would be loath to permit euthanasia in the Netherlands, fearing that pressure might be brought to bear on patients and doctors to save money rather than to help patients.
Reading this article in the wake of the bitter and ongoing fight over the Affordable Care Act brought home to me the bitter irony that the voluminous writings of Emanuel, a health care advisor to Obama's OMB, was the vehicle by which the tag team of shameless smear artists McCaughey--Bachmann--Palin entrenched the death panel meme. In the long hot summer of 2009, McCaughey pasted up a few dismembered snippets from assorted Emanuel writings to dub him a "deadly doctor" who held that health care should be "reserved for the nondisabled"; Bachmann parroted the smear job on the House floor; and Palin, citing Bachmann, transmogrified the lie that Emanuel wanted to send the young, the old and the infirm "to the back of the line" for healthcare into a fantasy "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."

Whatever your feelings about euthanasia and assisted suicide, you can not read Emanuel's argument, based on a careful reading of  the Dutch experience of agreeing not to prosecute doctors who aid in these acts and his own intense experience working with the dying and those who love and care for them, without being struck by the Orwellian operation that branded him the death panel doctor.

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