Socialized medicine's inevitable death panels

[Seth]

Canada Has Death Panels

And that’s a good thing.
By Adam Goldenberg
A woman holds the hand of her mother who is dying from cancer during her final hours at a palliative care hospital in Winnipeg July 24, 2010. A woman holds the hand of her mother, who is dying from cancer, during her final hours at a palliative care hospital in Winnipeg on July 24, 2010. In the neighboring province of Ontario, a tribunal, rather than a patient's family or doctors, can make final health care decisions.

Photo by Shaun Best/Reuters

See Slate's complete coverage of Obamacare. David Auerbach explains what's gone wrong with healthcare.gov, and David Weigel explains why Republicans are calling for Kathleen Sebelius to be fired.

Last week Canada’s Supreme Court ruled that doctors could not unilaterally ignore a Toronto family’s decision to keep their near-dead husband and father on life support. In the same breath, however, the court also confirmed that, under the laws of Ontario, Canada’s most populous province, a group of government-appointed adjudicators could yet overrule the family’s choice. That tribunal, not the family or the doctors, has the ultimate power to pull the plug.

In other words: Canada has death panels.

I use that term advisedly. Former Republican vice presidential candidate Sarah Palin made it famous in the summer of 2009, when Congress was fighting over whether to pass Obamacare. As Republicans and Democrats continue to spar over health care, we should pause to wonder why millions of Canadians have come to accept the functional equivalent of an idea that almost sank health care reform even though, in this country, it was imaginary.

Ontario’s Health Care Consent Act has been on the books for nearly two decades. Like similar laws in many Canadian provinces—and American states—it sets out the process for making treatment decisions when a patient cannot provide or withhold her consent—when she is in a coma and on life support, for example. In such cases, power automatically shifts to a “substitute decision maker,” usually a close relative. When these family members disagree with a patient’s doctors, and when the doctors are nonetheless determined to act, the dispute generally goes to court, where it can take months or even years to resolve. That is how it works in other Canadian and American jurisdictions, anyway. In Ontario, by contrast, the provincial legislature decided in 1996 to create a quasijudicial tribunal, the Consent and Capacity Board, to make these life-and-death decisions more quickly. If a patient’s substitute decision maker withholds consent, then doctors may apply to the board—comprised of lawyers, mental health professionals, and community members—for a determination that the proposed treatment is in the patient’s best interest. If so, the board has the power to consent on the patient’s behalf.

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[subversive science]

As opposed to corporate death panels?

[MrJonno]

Well if I become incapacitated I want doctors making their best decision not my wife (and I've told her that). Not that I don't love my wife but she isn't a doctor and simply isn't qualified to make such decisions.

As for death panels, my mother has cancer she is also old with lots of other conditions She is perfectly competent and in discussion with the doctors she isn't being treated for the cancer as any drugs would interfere with anti-pain drugs she takes. Lunatics can call that death panels if they want I call it decent healthcare

[Azathoth]

So availability of care will be based on the considered opinions of experts rather than by ability to pay?

[mistermack]

Well if I become incapacitated I want doctors making their best decision not my wife (and I've told her that). Not that I don't love my wife but she isn't a doctor and simply isn't qualified to make such decisions.

As for death panels, my mother has cancer she is also old with lots of other conditions She is perfectly competent and in discussion with the doctors she isn't being treated for the cancer as any drugs would interfere with anti-pain drugs she takes. Lunatics can call that death panels if they want I call it decent healthcare

Sorry to hear that. I hope she doesn't suffer much pain. But I agree. And the last thing you want in those circumstances is for her health insurance status to play a part in her treatment.
ie, some doctor saying ''we can do this for her'' knowing that she's covered, or not offering it, knowing that she's not.

[MrJonno]

The cancer is one that apparently progresses very slowly , common in the elderly and actually rarely kills (people die of other things). The point is doctors are involved in palliative/terminal care and they are involved quite simply when you will die (hopefully you get a say as well)

[Brian Peacock]

An unscrupulous healthcare provider might decide that their financial interest in keep a terminal patient on the most expensive intervention possible outweighs any claims for a dignified and peaceful death. And it#s end of life care we're talking about here. The Cancer is killing the patient, not the panel.

[mistermack]

In many cases, the doctors and nursing staff are the best ones to decide treatment. Sometimes they do go over the top, but in the UK, at least it's not for financial reasons.
Nobody can get everything right, every time. But as long as they do their best, and for the right reasons, you can't ask much more.
As far as the OP goes, I see nothing wrong with having a panel as a last resort. It's better than having things decided in courts, with all the delays that that involves.
The relatives are not always the best people to decide treatment. A panel of responsible qualified people with the best interests of the patient their main concern is probably as good as it gets, and I'd be quite happy to abide by that sort of ruling for myself, as well as for family.

Calling it a death panel is moronic, well worthy of Sarah Palin. It's a ''best interests'' panel.

[Tero]

An unscrupulous healthcare provider might decide that their financial interest in keep a terminal patient on the most expensive intervention possible outweighs any claims for a dignified and peaceful death. And it#s end of life care we're talking about here. The Cancer is killing the patient, not the panel.

Also, they make it a guilt trip for the survivors. If you are not involved in payments...or the inheritance of money not paid to hospitals..you can make guilt free decisions. Pull the plug!

[Brian Peacock]

Calling it a death panel is moronic, well worthy of Sarah Palin. It's a ''best interests'' panel.

Exactly. What is this kind or rhetoric for, and which position does it serve - the patient and relatives or the health insurers and providers? To call it a death panel not only suggests that the panel and not the medical condition are actively causing the death, but it also hints that prolonging life, or a cure, is possible in the panel's absence. The fallacy here is the idea that patients and relatives are the best people to decide on health outcomes, and therefore they have a right to demand that outcome - if they can afford it. This means they don't really have much of a choice at all. One would hope that an ethical medical system would be focussing on giving people the most efficacious treatments for the best outcome possible in the circumstances, and not misinforming them that they can always have what they want while only giving them what they can afford.

[Seth]

As opposed to corporate death panels?

Well, if you don't like the decision your "corporate" insurance provider makes you can always find someone else or pay for the care yourself. But when the government says it's time to pull your plug because socialized medicine is the only game in town, you're going to die.

[Seth]

Well if I become incapacitated I want doctors making their best decision not my wife (and I've told her that). Not that I don't love my wife but she isn't a doctor and simply isn't qualified to make such decisions.

Well, that's a decision you get to make for yourself.

As for death panels, my mother has cancer she is also old with lots of other conditions She is perfectly competent and in discussion with the doctors she isn't being treated for the cancer as any drugs would interfere with anti-pain drugs she takes. Lunatics can call that death panels if they want I call it decent healthcare

Strawman. We're not talking about voluntary decisions about treatment, we're talking about government bureaucrats deciding when you're mother's become too expensive to treat and since she's a PITA for them they will pull the plug on her no matter what she, you or anyone else wants. That's a death panel in no uncertain terms.

[Seth]

So availability of care will be based on the considered opinions of experts rather than by ability to pay?

The only "experts" that are going to end up opining are the bean-counting bureaucrats two thousand miles away who have never met you and don't give a flying fuck whether you live or die, they just want to make the balance sheet come out right, and if that means cutting you off, so be it.

[subversive science]

As opposed to corporate death panels?

Well, if you don't like the decision your "corporate" insurance provider makes you can always find someone else or pay for the care yourself. But when the government says it's time to pull your plug because socialized medicine is the only game in town, you're going to die.

That's only because the ACA disallows rejection based on pre-existing conditions and such. Without Obamacare, once the corporate death panel hammer drops, you either die or go broke trying to survive.

[Seth]

Calling it a death panel is moronic, well worthy of Sarah Palin. It's a ''best interests'' panel.

Exactly. What is this kind or rhetoric for, and which position does it serve - the patient and relatives or the health insurers and providers? To call it a death panel not only suggests that the panel and not the medical condition are actively causing the death, but it also hints that prolonging life, or a cure, is possible in the panel's absence. The fallacy here is the idea that patients and relatives are the best people to decide on health outcomes, and therefore they have a right to demand that outcome - if they can afford it. This means they don't really have much of a choice at all. One would hope that an ethical medical system would be focussing on giving people the most efficacious treatments for the best outcome possible in the circumstances, and not misinforming them that they can always have what they want while only giving them what they can afford.

Yes, but the problem is that socialized medical systems are not "ethical medical systems" by definition, and they always end up using cost of treatment and some sort of assigned value of the patient to decide who gets and who does not get medical care. Such systems HAVE to do this because it is simply impossible for any nation anywhere to provide unlimited care of the highest quality to each and every person no matter how dire their circumstances or how small the hope of recovery. Choices must be made in any publicly paid for health care system about where the limited amount of public money available for providing "free" medical care will best be used. It's an obvious necessity. Supply and demand. Not enough medical care available, somebody has to get stiffed, so the government must perforce convene a "death panel" to decide who does and who does not get to draw from the limited pool of care. They may or may not stand Grandma up before the board for an individual review of her case, but how it usually works is that the death panel looks at the cost of care for particular afflictions and says, "We can afford to pay for this, but not that," thereby condemning people to death who have the disfavored affliction.

That's as much a death panel as a bunch of bureaucrats sitting at a table reviewing Grandma's life record to decide if she's been a good proletarian slave and if she has a few years of labor according to her ability they can extract from her before putting her in line for the bolt gun and Soylent Green factory.

Any time any group of people other than the patient him or herself, or persons designated by the patient to make medical decisions in case of the patient's incapacity makes a decision to stop or deny treatment of a life-threatening illness or injury, no matter what the reason for doing so, it's a "death panel." It's a bunch of people deciding what's best for one or more of the interested parties, which may or may not include the patient.

That's just simple fact.