Fear over end-of-life counseling and refusal of care for persons with physical or mental disabilities have become major issues in the current health-care debate. These fears arise from misrepresentation of a paragraph in the most frequently mentioned bill and of two papers dealing with the limits of health-care possibilities.
The reform bill passage would require the government to pay for voluntary consultation with a “practitioner of advance care planning.” As described in the bill, the role of such a person actually could be helpful, especially to some elderly people.
Today, when you register for hospital care, you usually are asked whether you have a living will, a document that says whether you want to be kept alive by “extraordinary means” if something goes wrong during surgery. That is, if during surgery, something life-threatening happens and you are not in a decision-making condition, how far do you want the doctors to go in saving your life? Do you want to be connected to a machine that might keep you breathing for years though you were in a coma? And whom do you want to make that decision?
The ordinary person may not be aware of all the factors in a use of extraordinary means. Under one proposed bill, the government would provide payment for someone to clarify for you the options and implications in the case of your incapacity. This would enable you to make your own decision with regard to any unforeseen emergency and, if you wish, to secure a living will. That is end-of-life counseling.
Some opponents of the legislation have distorted its contents and have connected it with a misrepresentation of a couple of papers written a few years ago by Ezekiel Emmanuel, one of President Obama’s health-care advisors. The papers dealt with problems already existing because of the impossibility of providing the highest attainable medical care to every person needing it. For example, in the current shortage of swine flu, who will receive the vaccine first? Who decides eligibility and on what basis?
In one paper, Emmanuel and two colleagues described and rejected several possible approaches to the problem – holding a lottery, giving priority to the sickest or to the youngest, giving partial aid to everyone in order to save the most lives possible, and giving priority to those who seem the most socially useful or to those who have been most useful in the past.
Now, most decisions are made on the basis of money, political influence or both. The paper was an attempt to bring morality into play, and it proposed a solution that would be a combination of several options. It insisted, however, that should Congress ever propose legislation, the proposal should be subject to public hearings and that no legislation should be passed without such hearings.
The second paper, of which Emmanuel was the sole author, was published by the Hastings Center, a highly reputable, conservative center for ethics in health-care issues. Decisions about allocation of available health-care resources, the paper points out, always rest upon an assumption as to the “good” way to use those allocations when there are not enough for all who need them.
There is a growing consensus among persons across the political spectrum, according to Emmanuel, that thinks that priority should be given to those who will ensure future healthy generations. This would involve, says Emmanuel, whether services should be guaranteed to those with dementia and whether neuropsychological services should be provided to help learning disabled children learn to read. Because he says he is reporting this consensus, neither overstating nor defending it, it is unclear to what extent Emmanuel agrees or disagrees with the consensus.
It is understandable why some people distrust the government in this matter. Since at least the years of the Vietnam War, all administrations, no matter which party was in power, have assumed that lying to the public goes with the job.
It also is easy to understand Sarah Palin’s assertion that she would not have wanted a government official telling her that she could not give birth to her child with Down syndrome, and – in light of the Holocaust – why many see the bill as a slippery slope that could lead to euthanasia.
But the bill does not provide for euthanasia or for forced abortion, and it is unfortunate that some represent it as doing so. Yes, we should debate the slippery slope issue, but we should not pretend that the proposed bill would place us at the bottom of the slope.
Emmanuel and others are correct in their presentation of the problem. The proposals they describe, however, risk defining a person’s worth only in terms of his or her “contribution to society, an expression that usually rests on a definition rooted in consumerism. From a biblical perspective, a good society protects the weak and the poor from the machinations of the strong and the productive and does not simply cast them aside. Of course, in a world of scarcity, that simply complicates the matter.
From a specifically Christian perspective, those who teach giving up one’s life for the well-being of both friend and foe should consider what this implies for health care in a world of scarcity. It probably means putting oneself at the end of the line.
Gene Davenport is professor emeritus of religion at Lambuth University in Jackson, Tenn., and theologian in residence at St. Luke’s Episcopal Church in Jackson. It is reprinted here courtesy of the Jackson Sun.
Gene Davenport (1936-2018) was Professor Emeritus of Religion at Lambuth University and a columnist for The Jackson Sun.