Thursday, August 20, 2009

Tonight's Daily Show: The Deconstruction of Death Panels

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The Wise Bard
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Registered: 08-20-2009

The Wise Bard

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Advance Directives for Health Care

I write as a retired professor of law and bioethics. I served as senior staff of a Presidential Commission on Bioethics from 1980-83 and as Executive Director of the New Jersey (State) Bioethics Commission from 1987-90, where we developed proposals for state statutes on declaring death and advance directives for health care. I personally also produced a model advance directives form, which emphasizes the right of the individual to request, as well as to decline, all medically appropriate procedures to sustain life. I should note that advance directives also include, and sometimes prefer, naming a proxy or representative to speak for the patient when the patient is no longer capable of speaking for her- or himself, as well as "instruction directives" or so-called "living wills."

I have, for the past three decades, strongly advocated the use of advance directives and the availability of hospice care --and for the desirability of patient-family-physician consultation well in advance of medical crisis, and for necessary updating as medical circumstances--and possibly opinions--change over time.I have, for better or worse, opposed legalization of physician-assisted suicide or medical killing, feeling that these are, particularly in the absence of universal health insurance including superior pain management and the availability of hospice options, too likely to invite abuse. I have worked in every way possible to improve care and support of dying patients.

Perhaps somewhat surprisingly to some, while I have worked for widespread access to advance directive forms and appropriate consultation and counselling regarding end-of-life decisionmaking, I have been reluctant to support attaching this process to government financing of health care. While I strongly believe that physicians should be compensated for time spent counselling patients, I have been concerned that linking governmental financing programs (such as Medicare) to end-of-life planning might be misunderstood as pressure on patients to make certain choices in order to reduce the cost of their care. Given the delicacy of these issues, and the motives of political opponents to misconstrue such provisions to terrify fearful patients and family members, I thought the risks not worth the benefits of making this connection. I do support other measures encouraging health care providers and hospitals to raise these issues and to assist patients and families in working their way through these sensitive and challenging matters.

While I probably would have discouraged including these provisions in the various pending health reform measures, the mischaracterization of what these provisions say, and the invocation of language like "death panels" in recent months to evoke fear and distract from the moral necessity of improving access to quality health care, has been a disgrace and a terribledisservice to the American people and the integrity of public discussion and debate. Ms. McCaughey's participation in this process should be a source of everlasting shame--as was her disgraceful performance in 1993-4 opposing the last round of attempts to reform the dysfunctional and morally indefensible non-system of American health care.

Jon Stewart's participation in this evening's just-concluded interview was, in a word, magnificent. Jon was at the top of his form, exceptionally well-informed on the issues (I doubt that many professional bioethicists who have worked on these issues for years could do as well), razor sharp in his focus on critical details, and cutting through the obfuscation and blatant misrepresentations propounded, ever so brazenly, by Ms McCaughey. Ms McCaughey is not Orly Taitz; she is more dangerous because she appears to know what she is talking about and does not make a self-parody of herself. It takes an exceptionally skilled interviewer to pin her down and show the emptiness of her preposterous claims. Jon fully met that challenge tonight.

The Daily Show is, of course, a comedy, and Jon a comedian. Every once in a while, however, he allows his considerable intellect and insight to emerge in the service of an important public objective. He did so, memorably, in his critique of phony debate shows such as the late and unlamented Crossfire. This was another such occasion.

I am proud to be a fan, rarely more than tonight. Thank you, Jon.

(Prof.) Alan Jay Weisbard (blogging as The Wise Bard), Madison, WI.