Skip to comments.Wesley J. Smith: Medical Rationing as “Waste Avoidance”
Posted on 05/03/2012 4:20:44 PM PDT by wagglebee
The Medical Intelligentsia is bound and determined to devolve medicine into a technocracy. A professional practices medicine, providing optimal care to each patient as individuals. A technocrat is a service provider who provides consumers with medical care according to check lists and rules created by bureaucrats and expertsand does so in the context of perceived or imposed duties to general society.
The New England Journal of Medicine leads the technocratic pack. To illustrate from where the publication is coming, it has supported rationing, helped push the assisted suicide movement, respectfully published the Dutch infanticide checklist known as the Groningen Protocol, and pushed hard against medical conscience rights in the name of patient rights.
But patient rights dont extend to receiving treatment the would-be-bosses think should not be supplied based on quality of life judgmentalism or cost control concerns. And now, bioethicist/physician Howard Brody tries to shift the lexicon to hide the reality of the denials of treatment regime now on the Obamacare drawing board. From, From an Ethics of Rationing to an Ethic of Waste Avoidance:
Even though the concept of medical futility has had a vexed history, this new ethical question is a subcategory of the futility debate. We used to think that the issue of futility arose only when physicians, in keeping with their professional integrity, refused to offer useless treatment even when patients or families demanded it.
But you see, futile care isnt refused because it is uselessas if someone demanded an appendectomy to cure an earachebut because it does or may work.
When they impose qualitative futility impositions, futilitarians declare the patient futile, by refusing efficacious treatment precisely because it could extend life that they deem not worth living. Most perniciously, it holds that maintaining life when that is what the patient wants is useless or futile in some cases. in which parents were refused both life-sustaining treatment and minor surgery to permit them to take their baby home to die. Priests for Life arranged the proper care and the baby lived 7 more months. But Brody-type bioethicists would call that useless. Not. Their. Call.
People have been pushing back against futile care and invidious rationing plans politically. So Brody trots out a new lexicon by which to justify the planned service interruptions that the medical intelligentsia and bioethicists intend to impose on patients to supplant informed consent and refusal:
Since elimination of wasteful, nonbeneficial interventions is ethically mandated (as has recently been emphasized in the Choosing Wisely campaign led by the American Board of Internal Medicine Foundation), the question then shifts to implementation. Here, I believe, we must consider the limitations of evidence. Data from randomized clinical trials represent population averages that may apply poorly to any individual patient. An ethical system for eliminating waste will include a robust appeals process. Physicians, as loyal patient advocates, must invoke the process when (according to their best clinical judgment) a particular patient would benefit from an intervention even if the average patient wont. Few tests and treatments are futile across the board; most help a few patients and become wasteful when applied beyond that population. But the boundary between wise and wasteful application will often be fuzzy.
So heres the game that is afoot:
1. Centralize Insurance Coverage and Medical Decision Making;
2. Use evidence based medicine to determine whole categories of treatment or tests that should be refused as wasteful;
3. Then, require dissenting doctors and patients to appeal to bureaucratic bioethics boards staffed by technocratic true believers.
But the burden of proof, if there is to be one, should be the other way around. Besides, doctors have a tough time practicing medicine now with all the paper work. And Brody wants to add still more?
But make no mistake, it is just rationing by a more palatable name:
In the end, the ethics of rationing and of waste avoidance are complementary, not competing. Perhaps at present, waste avoidance could save enough money to permit both universal coverage and future cost control. As medical technology advances, especially with personalized genomic medicine, we will almost certainly arrive at the day when we cannot afford all potentially beneficial therapies for everyone. The ethical challenge of rationing care will have to be faced sooner or later, particularly when we confront inequitable distribution of health care resources globally.
Globally? Does that mean across the world spectrum? Ill bet it does. Social justice is about imposing equality of results, not opportunity, and that means no end to the technocratic enterprise, as experts devise ways of taking from those whose hard work and cultural virtues have led to a higher standard of life.
Whatever: We can call rationing and futile care impositions waste avoidance if we want. We can also call a dung beetle a butterfly and paste pretty wings on its bodybut it still eats dung.
And this is EXACTLY what Obama wants to impose.
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It really offends and angers me that these death mongers continue to approach these issues under the guise of ethical considerations.
They got their foot in the door peddling murder as “women’s health”.
It is a failed model that repeatedly occurs in these arenas, based on the assumption that medical (as all economic) resources are a static pool whose principal challenge is proper distribution, and whose growth is a secondary consideration if it is considered at all. It is central planning for bedpans, and it is doomed for the same reason that central planning in economics was.
There is a golden opportunity, here. Likely led by Catholic and other deeply religious physicians, to create an organization with a higher ethos and more restrictive oath.
The Physician’s Oath was codified in the Declaration of Geneva (1948) by the World Medical Association as a reaction to the medical abuses perpetrated by the Nazis. It is basically a rewrite of the Hippocratic oath.
However, since then, governments from Soviet to Obamanation have sought to undermine that oath for their own purposes.
So this organization would in effect, formally reject such abuses. Its members would refrain from performing abortion except to preserve life, as well as strong controls over sterilization and fertility; to adamantly reject euthanasia as murder; to shun medical practices that dehumanize or capitalize on human suffering; and a strict code under what circumstances human organs can be transplanted.
In character, it would deal directly with people, not via government or corporate health management, as these do not necessarily have the patient’s best interests in mind.
Such high ethical standards are not for everyone, but a patient with such a doctor would be guaranteed ethical medicine. Something not always available today.
Eugenics in real time.
What a SCAM:
1) Force everyone to buy health insurance knowing you are destroying free market health insurance and all will end up on the government plan.
2) Collect all that money while people are healthy and do not need care.
3) Refuse treatment when those same people actually do need care.
4) Pocket the money for other leftist causes.