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View Dr. Ezekiel Emanuel's academic profile at NIH Clinical Center Read Dr. Emanuel's book: The Ends of Human Life on Google Books, particularly chapter 3 Terminating Medical Care for Incompetent Patients |
Ezekiel Emanuel also referred to as the ‘Deadly Doctor,’ has been getting plenty of scrutiny these days. Opponents of health care reform have looked to the Deadly Doctor to back up their claims that the H.R. 3200 bill promotes euthanasia and advocates death panels, or boards that will determine who receives medical treatment based upon the common good of society. The section of H.R. 3200 that has drawn concern is section 1233. This section discusses end of life counseling sessions between patients and their physicians, as well as ensuring that Medicare would pay for these topics.
Sarah Palin caused great fear and controversy when she claimed that this section would open the door to widespread euthanasia and death panels. In defending her claim, after many stated that it wasn’t what the H.R. 3200 text read, she backed up her position by quoting Ezekiel Emanuel. Ezekiel Emanuel is the brother of Rahm Emanuel, President Obama’s chief of staff. Ezekiel or ‘Zeke’ Emanuel is also the health advisor to President Obama. Here is the quote from Sarah Palin’s Facebook page where she discusses her concerns with Ezekiel Emanuel’s past statements regarding euthanasia. (To read Sarah Palin’s original comment that makes the ‘death panel’ claim, click here
“Of course, it’s not just this one provision that presents a problem. My original comments concerned statements made by Dr. Ezekiel Emanuel, a health policy advisor to President Obama and the brother of the President’s chief of staff. Dr. Emanuel has written that some medical services should not be guaranteed to those “who are irreversibly prevented from being or becoming participating citizens....An obvious example is not guaranteeing health services to patients with dementia.” [10] Dr. Emanuel has also advocated basing medical decisions on a system which “produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.” [11]
Before Sarah Palin took to Facebook to address the concerns regarding Ezekiel Emanuel’s writings, former New York lieutenant governor, Betsy McCaughey published an op/ed piece in the New York Post on July 24, 2009. This is essentially where the ‘pulling the plug on Grandma’ came from. The piece, written by Besty McCaughey was titled ‘Deadly Doctors: Advisors want to ration care.’ You can read “Deadly Doctors” here
Needless to say, the person who is under the greatest scrutiny here, is Ezekiel Emanuel, and rightly so. As a key person influencing President Obama on issues of health, it is important to know his moral and ethical views on issues such as end of life care and rationing health care services to those who can contribute more to society as a whole. While speaking with Fact Check. Org, a project of the Annenberg Public Policy Center, Ezekiel Emanuel clarified his position and views. When asked if he agreed with the interpretation that Betsy McCaughey gave to his writings, implying not to spend too much money on seniors with Parkinson’s, or children with cerebral palsy, Ezekiel Emanuel stated, “This is certainly untrue and a distortion of my record.” He also stated that his academic work was being taken out of context. It might also be important to note that Ezekiel Emanuel has a sister with Cerebral Palsy.
The first report that Betsy McCaughey and Sarah Palin quote is the Hastings Report and Ezekiel Emanuel wrote it in 1996. Ezekiel Emanuel states that the article was written from a philosophical point of view, discussing the difference between basic and discretionary health care services. Here is the text of what he wrote.
Emanuel, Hastings Center Report, 1996: Communitarians endorse civic republicanism and a growing number of liberals endorse some version of deliberative democracy. … This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. … Substantively, it suggests services that promote the continuation of the polity – those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations – are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia. A less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason.
Though this is a philosophical point of view, it deals with an ethical issue that physicians face every day. If a patient is at death’s door, a doctor makes an ethical and scientific decision whether or not to approve or withhold treatment. For example, if a patient needs a liver transplant, but is dying of a different form of cancer, the physician will determine not to provide a liver transplant, at the choice that it would essentially be ‘wasteful.’
It is quite possible that the entire Hastings Report written by Ezekiel Emanuel dealt with these types of situations on a philosophical and larger scale basis.
However, it is also reasonable to see that Sarah Palin and Betsy McCaughey’s concerns were somewhat founded and logical. Should the government control a form of widespread health care, how would that philosophical argument evolve? Would physicians be pressured to meet quotas to ensure they aren’t spending too much money? If so, could services be delayed or prevented? The argument of whether a doctor should have/ or shouldn’t have performed, prescribed, or ordered certain medical procedures is already an issue, resulting in countless malpractice lawsuits each year.
Though it seems that ‘Deadly Doctors’ was based upon a philosophical paper, the issue is real, the man with cancer would not qualify for a liver transplant. More important than focusing on supposed ‘death panels’ is to determine who sets the groundwork for deciding what procedures are performed: patients, doctors or the government. And that is not a new concern that we can expect to look forward to, it is already in existence in the health care community.
Comments
I know it's a lot to ask of right wing idiots to understand what a "scholarly article" entails... but please, put down the crayons for a moment and focus. I'll try to make it simple for you.
Is he saying, as Palin and others have suggested, that those who aren’t “participating citizens” should have no guarantee to health care?
“No,” Emanuel says, “and I think I made it pretty clear I wasn... Read More’t endorsing that view, I was analyzing that perspective and what it might mean in practical terms. The rest of the text around that quote made it made it pretty clear I was trying to analyze it and understand it, not endorse it.”
I know rightwingers love to play "pretend." But this is is a ridiculous and unnecesary smearing of a good man who has done NOTHING but work on improving health care for ALL Americans.
I love how people like that below attempt to tell others what someone they do not even know MEANT to say which is different than what they DID commit to paper.
I always tend to believe what people have published BEFORE it really mattered is more sincere than what they may say after it matters.
Yes, and (before it mattered) Palin advocated end-of-life services which she now uses as proof of a death panel. I love how she originally misread and therefore misinterpreted the quote about children with neuropsychological disorders (article says they would be guaranteed services)and said this bill would let Trig die bc of it.
No one really knows what Emmanuel thinks, we know what he (academically) wrote and says. I have taken pretty indefensable positions in papers, that I sincerely hope I am not held to as my beliefs someday down the road.
And I agree with DBD: Why would someone who works for healthcare for everyone (This is a good thing isn't it?) then want to allow/mandate certain people to die? It just does not connect. If he wanted that to happen he could have worked for a pharma company and left health care the way it is!
Yes, and (before it mattered) Palin advocated end-of-life services which she now uses as proof of a death panel. I love how she originally misread and therefore misinterpreted the quote about children with neuropsychological disorders (article says they would be guaranteed services)and said this bill would let Trig die bc of it.
No one really knows what Emmanuel thinks, we know what he (academically) wrote and says. I have taken pretty indefensable positions in papers, that I sincerely hope I am not held to as my beliefs someday down the road.
And I agree with DBD: Why would someone who works for healthcare for everyone (This is a good thing isn't it?) then want to allow/mandate certain people to die? It just does not connect. If he wanted that to happen he could have worked for a pharma company and left health care the way it is!
I have read the paper discussed. It is a philosophical discussion of methods for the distribution of care. The authors discuss already used methods,reject them and "propose" a new method they call "The complete lives system". Below are some quotes from the article with a link.
"Because none of the currently used systems satisfy all
ethical requirements for just allocation, we propose an
alternative: the complete lives system. This system
incorporates fi ve principles (table 2): youngest-fi rst,
prognosis, save the most lives, lottery, and instrumental
value.5 As such, it prioritises younger people who have not
yet lived a complete life and will be unlikely to do so
without aid"
"Consideration of the importance of complete lives also
supports modifying the youngest-fi rst principle by
prioritising adolescents and young adults over infants
(fi gure)."
www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60137-9/fulltext
It appears to me from this paper that Ezeiel Emanuel is in favor of limiting healthcare to individuals based on their ability to be productive citizens. I don't think that he necessarily has any sympathy for other people based on the fact that he has a sister with cerebral palsy. His family is wealth and can afford to provide the care for her. The real issue is when the state or insurance has to pay for it.
At the very least this should be cause for concern when the Health Care advisor to the President has these beliefs. And furthermore we need to ask ourselves if this is the kind of man the resident hired what does that say about the Presidents thought system as well?
I have read the paper discussed. It is a philosophical discussion of methods for the distribution of care. The authors discuss already used methods,reject them and "propose" a new method they call "The complete lives system". Below are some quotes from the article with a link.
"Because none of the currently used systems satisfy all
ethical requirements for just allocation, we propose an
alternative: the complete lives system. This system
incorporates fi ve principles (table 2): youngest-fi rst,
prognosis, save the most lives, lottery, and instrumental
value.5 As such, it prioritises younger people who have not
yet lived a complete life and will be unlikely to do so
without aid"
"Consideration of the importance of complete lives also
supports modifying the youngest-fi rst principle by
prioritising adolescents and young adults over infants
(fi gure)."
www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60137-9/fulltext
I think those who support and try to explain away the Doc's point of view work on the "what is is" theory of words. Folks, words have specific meanings, they cannot be assigned meanings you like.
Gregory W. Rutecki, M.D. (2003)
jbem/volume8
num3/rutecki_an_evangelical_critique_of_advance_directives
In 1988: Emanuel followed nursing home patients for two years after the completion of an advance directive. After medical record review and physician interview, the authors concluded that in many cases the patient's choices were overridden because their physician disagreed with the wisdom of their choice. On occasion, the override represented the withholding of treatment because the physician decided it would not benefit the patient. End-of-life choices through vaguely worded advance directives may be primarily relegated to physicians who lack a consensus about what it means to be human". "With increasing governmental and third party intrusion into the contemporary contract model of medical care, will advance directives become a coercive tool that rations end-of-life care by offering euthanasia as a cheaper alternative to life?"
29. op. cit., Emanuel, E.J., et al., 19
Great article...well researched with excellent conclusions..Well done
Great article...well researched with excellent conclusions..Well done
doctors are already facing these things and already engaging in end of life care decisions that lead to people dying before their time. just google, death by morphine, or deadly doctors. Surprisingly, however, doctors, nurse practitioners and physician assistants need little convincing to end the lives of those who "don't deserve" care.
doctors are already facing these things and already engaging in end of life care decisions that lead to people dying before their time. just google, death by morphine, or deadly doctors. Surprisingly, however, doctors, nurse practitioners and physician assistants need little convincing to end the lives of those who "don't deserve" care.
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