Part One: The Consultation

You have a life-threatening illness, right? You are over 65 years old, right? I am a doctor and am being paid by the Government to give you counseling about your end-of-life decisions. This consultation is entirely voluntary on your part, and is merely to provide you with information to help you decide now how you will want to be treated in advanced stages of your illness. The information concerns living wills, health care proxies, hospice, and pain medication.

Do I have your attention? Then let’s proceed.

1. ‘Living wills.’ You sign a document that declares which treatments you do or do not want applied to you if you have a terminal illness or lapse into a permanent vegetative state. Be assured that your living will would only be used when recovery is impossible. Who will decide that it’s impossible? A couple of (Government paid) doctors would have to certify that you are in this hopeless condition. Trust them.

2. ‘Health care proxy.’ This is for when you cannot speak for yourself – because you become demented, for instance – while your physical condition is not so dire that it would justify immediate action on your living will. You name a person who will make decisions for you about what care you should be given – within the parameters of what the Government would let you have, that is. You will of course name someone you really trust. Someone who loves you. Someone you know will only act as you would want him or her to act. Okay? Good. Just one thing to bear in mind – if the Government considers his or her decision to be not the right one, it can overrule him or her. So you see, you have a sort of upper guardian who will keep an eye out for misunderstandings or misjudgments. It’s a fail-safe arrangement, you might say. Your son or daughter decides as long as he or she chooses sensibly for you. If he or she doesn’t, no worry, the Government will make the right and final decision.

3. ‘Hospice.’ Hospices are comfy places to die. They are very nice death houses. No one will hurry you to shuffle off your mortal coil. (Only you won’t be let in if you’re likely to take an unreasonable stretch of time about what you’re in there for.) Medical staff will be very kind to you. You can sit on a cushion and sew a fine seam, and you may – if your digestion allows it – eat strawberries, sugar-substitute and cream. But remember, dear, you will be there to die.

4. ‘Pain medication.’ This is what you may have instead of an operation that could save your life. No, sorry, you cannot have the operation. It is expensive and the Government cannot pay for everyone with your illness to have this surgery. Just think: say we pay for it and then you go and die of complications soon afterwards. I mean, you’re old and your powers of recovery are not what they used to be. And even if you did recover, you wouldn’t be much use to Society, now would you? Be reasonable. Be selfless. Be patriotic. The Dear Leader made it perfectly clear that this would be Government policy. He said, ‘Take the pill instead of having the operation’. You remember now? Good. That’s clear then. And by the way, it’s true that there are some drugs that might help you to recover, but they’re also very expensive and as I said we have to think about who can best use their saved life for the good of Society – you who are old, or someone else who is young and vigorous. It stands to reason, doesn’t it, when you think about it? You are – if you don’t mind my putting it this way, just for clarity’s sake – a useless old bag, and somewhere there’s a young person with the same disease as you who can still be, let’s say, a brilliant community organizer if he gets the chance to live. So the drugs are for him, not you, dear. You understand? Fine. That’s settled then.

Oh, no dear! No one’s dictating to you what to do. It’s your choice, absolutely. You don’t have to make a living will, or appoint someone to act as your proxy, or go into a hospice, or take a pill to help your pain. No one’s forcing you. All we’re saying is that we’re not going to pay for you to have surgery or expensive drugs that might cure you. But all the rest is your choice, not ours, not anybody’s but yours. Doesn’t that make you feel that you’re in control dear?

You’re really having the best of all worlds, you know. You have all this choice as a free citizen of this free country. And at the same time you can feel safe, watched over, looked after to the last breath. What more could you ask?

Who are the people who will decide whether you’re too old for the surgery or the drugs? Well, there will be general guidelines, rules.

You say some individuals are stronger and more able to work at a late age than others, so will they have their cases examined individually? Yes. By whom, do you ask? By doctors – at least two doctors who will report to the authorities that you are an exception. Or not. And yes, the authorities will make the final decision.

Yes, the very young who have disabilities and have not yet had much money spent on them would also have to forego the expensive surgery and drugs, but their parents would have the same careful consideration given to their cases by the Government-paid experts as you will have.

You ask, would they not – these doctors, these authorities, these various experts and officials – constitute a panel deciding whether you may or may not have certain life-saving treatments? Yes, in effect. You could put it that way.

Sarah Palin did? Oh, you mustn’t believe Sarah Palin. She went much too far. She actually called it a ‘DEATH PANEL’. That’s entirely wrong. That’s just hysterical. Nutty. Way out. Totally inaccurate and misleading. A wicked distortion. A dangerous lie.

Calm down, please. I’m not prepared to carry on with this argument. It’s got out of hand. You’re crazy. She’s crazy. How can you think that Barack Obama, of all people, would want to set up a ‘death panel’? Perhaps you‘re suffering from incipient dementia, dear. Would you like to have a little chat with another Government-paid doctor about preparing for when it gets worse?

Part Two: A News Item

This week, reacting to the clamor from many angry and confused people, the Senate Finance Committee dropped the idea of including ‘advance care planning consultations’ in its health care bill.

Part Three: A Democrat Meditates

Why did so many react so unreasonably to a provision that was merely designed to allow Medicare to pay doctors who counsel patients about planning for end-of-life decisions? The consultations would have been entirely voluntary and would simply provide information about living wills, health care proxies, hospice, and pain medication. It’s mystifying how such a simple service could be so misinterpreted!

Part Four: The Denial

The Obama administration has been forced to react to a ridiculous rumor launched by Sarah Palin.

It has put this up on its website (excuse the clumsy wording but the clarification had to be posted in a hurry):

It’s a malicious myth that reform would encourage or even require euthanasia for seniors. For seniors who want to consult with their family and physicians about end-of life decisions, reform will help to cover these voluntary, private consultations for those who want help with these personal and difficult family decisions.

Part Five: The Climb-down?

Associated Press report August 16 2009:

Bowing to Republican pressure and an uneasy public, President Barack Obama’s administration signaled Sunday it is ready to abandon the idea of giving Americans the option of government-run insurance as part of a new health care system.

Part Six: Chorus of Old People and Children

Two words have saved us – ‘DEATH PANEL’.

We need no longer fear.

The Government will not insure our care.

It cannot say ‘care granted’ or ‘denied’.

Who’ll live or die it won’t decide.

Thank you, Sarah Palin!

Jillian Becker  August 2009