More from the backblog . . .

The Strange Double Standards of Abortion  John Stackhouse muses on the murder of abortion doctor George Tiller, vigilantism, and hypocrisy.

This past week, a teenager in Vancouver was arrested by police because friends of his had noticed a “hit list” of over 100 people posted on his Facebook page. When the police seized the Grade 12 student, they found an arsenal of knives, guns and batons.  That young man attends my son’s high school.

Suppose he lived next door. Suppose I read the Facebook page one evening because my son brought it to my attention. Suppose the next morning I saw him loading weapons in the trunk of his car. What would I do to stop him from killing innocent people?


Reflections on My Termination Peter Augustine Lawler, former member of the President's Council on Bioethics, considers what is lost by President Obama's approach to the moral issues of the day.

For Obama, a valuable Council does nothing but offer advice to the administration. The Bush Council was actually given the additional mandate of public education, of developing a national dialogue on controversial bioethical issues. It's with that Socratic second mandate in mind that President Bush chose for his first chairman a man trained in medicine, natural science, and the wisdom about being human embodied in the Great Books from Plato through Shakespeare to Genesis--Leon Kass. For Obama, it would appear, there's no need for such moral and political discussion or such "humanistic" guidance because the experts know the nonideological and objective answer to the key questions that face us in our high-tech and increasingly biotech world. Personal opinion is trumped by what the "studies show," and public opinion should be guided toward a consensus based on those studies.

For many of the bioethical issues that face us, there's no obvious, objective solution—meaning one that emerges from experts without real moral and political deliberation. That doesn't mean that the contending parties involved should be narrowly ideological or blindly fundamentalist. It's their duty to be and in fact they often really are guided by what we can really know through science. But as Socrates himself constantly reminded us, for the most reasonable of men and women the key questions often remain more obvious than their answers. There's no substitute, in a democracy, for thinking together about who we are before deciding what to do, and it's not "anti-science" to sometimes conclude that science alone doesn't resolve every dilemma we face about human freedom and dignity.

The rule of experts might be fine if they were philosopher-kings who had united in themselves not only technological power but perfect wisdom. But of course, it's much more clear that the human power over nature and human nature is growing faster than is our wisdom to use it well for authentically human purposes. The experts, we have to remember, very often hide their own personal opinions and ideological agendas behind their impersonal claims to merely be following what the studies say. We can learn from them, but as long as they fall short of perfect objectivity based on perfect wisdom, we shouldn't trust them. These days, the people, above all, should distrust meddlesome, schoolmarmish judges and bureaucrats (and presidents who enable them) who want to deprive them of the capacity of thinking for themselves.


State Slaps Dr. Do-Good  Insurance laws have a purpose, as most well-intentioned laws do.  What laws rarely have is common sense, something judges sometimes, but increasingly rarely, provide.

The state is trying to shut down a New York City doctor's ambitious plan to treat uninsured patients for around $1,000 a year.  Dr. John Muney offers his patients everything from mammograms to mole removal at his AMG Medical Group clinics, which operate in all five boroughs.  "I'm trying to help uninsured people here," he said.  His patients agree to pay $79 a month for a year in return for unlimited office visits with a $10 co-pay.

But his plan landed him in the crosshairs of the state Insurance Department, which ordered him to drop his fixed-rate plan—which it claims is equivalent to an insurance policy.

He says he can afford to charge such a small amount because he doesn't have to process mountains of paperwork and spend hours on billing.  "If they leave me alone, I can serve thousands of patients," he said.

The state believes his plan runs afoul of the law because it promises to cover unplanned procedures—like treating a sudden ear infection—under a fixed rate. That's something only a licensed insurance company can do.

The doctor's plan is no substitute for health insurance, since it doesn't cover anything he can't do himself, eliminating the catastrophic, big-ticket items that are the raison d'être for insurance.  People who are generally healthy might find $1000 plus per year a bit steep for simple office visits, but what could be wrong with offering fixed-fee services, as long as he's not the only game in town?


Unplugging Grandma Isn't the Problem The problem is getting Grandma care in the first place.  The article also debunks the much-thrown-about life expectance statistics.

[President Obama] has no plans, as he put it, to "pull the plug on Grandma."  The problem with government health systems is not that they pull the plug on Grandma. It's that Grandma has a hell of a time getting plugged in in the first place. The only way to "control costs" is to restrict access to treatment, and the easiest people to deny treatment to are the oldsters. Don't worry, it's all very scientific. In Britain, they use a "Quality-Adjusted Life Year" formula to decide that you don't really need that new knee because you're gonna die in a year or two, maybe a decade-and-a-half tops. So it's in the national interest for you to go around hobbling in pain rather than divert "finite resources" away from productive members of society to a useless old geezer like you. And you'd be surprised how quickly geezerdom kicks in: A couple of years back, some Quebec facilities were attributing death from hospital-contracted infection of anyone over 55 to "old age."

I had an elderly British visitor this month who's had a recurring problem with her left hand. At one point it swelled up alarmingly, and so we took her to Emergency. They did a CT scan, X-rays, blood samples, the works. In two hours at a small, rural, undistinguished, no-frills hospital in northern New Hampshire, this lady got more tests than she's had in the past decade in Britain—even though she goes to see her doctor once a month. He listens sympathetically, tells her old age often involves adjusting to the loss of mobility, and then advises her to take the British version of Tylenol and rest up. Anything else would use up those valuable "resources." So, in two hours in New Hampshire, she got tested and diagnosed (with gout) and prescribed something to deal with it. It's the difference between health "care" (i.e., going to the doctor's every month to no purpose) and health treatment—and on the latter America is the best in the world.


Daughter Saves Mother, 80, Left by Doctors to Starve  Speaking of unplugging Grandma . . .

Hazel Fenton, from East Sussex [England], is alive nine months after medics ruled she had only days to live, withdrew her antibiotics and denied her artificial feeding. The former school matron had been placed on a controversial care plan intended to ease the last days of dying patients.  Doctors say Fenton is an example of patients who have been condemned to death on the Liverpool care pathway plan. They argue that while it is suitable for patients who do have only days to live, it is being used more widely in the NHS, denying treatment to elderly patients who are not dying.

Fenton was admitted to hospital suffering from pneumonia. Although [her daughter, Christine Ball] acknowledged that her mother was very ill she was astonished when a junior doctor told her she was going to be placed on the plan to “make her more comfortable” in her last days.  Ball insisted that her mother was not dying but her objections were ignored. A nurse even approached her to say: “What do you want done with your mother’s body?”  On January 19, Fenton’s 80th birthday, Ball says her mother was feeling better and chatting to her family, but it took another four days to persuade doctors to give her artificial feeding.

Posted by sursumcorda on Tuesday, November 3, 2009 at 9:01 am | Edit
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I'm not sure why I finished Steyn's article when it already begins with name-calling, and I already suspected him of fudging terminology with examples to support his thesis. He grossly oversimplifies the new knee case. Yes, the quality adjusted life year enters into the decision - but it is not merely a matter of 2-15 years of pain or no pain. A knee implant, much as we have already gained experience with them, is a risky procedure, especially for patients that might have osteoporosis (which at the implied age is not at all unlikely). The older the patient, the more difficulty the body will have in coping with all the trauma associated with surgery, and looking at the benefits versus the risks is something an honest doctor ought to do.

Also, he doesn't show how the US system is superior, how it offers the impoverished great-grandma a knee replacement with a ribbon on top, which is the least I'm expecting after his laudatio. And giving individual examples does nothing but perhaps counterbalance the individual examples the folks on the other side of the argument are giving.

Regarding "death of old age" in Quebec, I think hospitals will try lots of things to obfuscate the prevalence of nosocomial infections and the danger they pose. They will try regardless of the health care system, because they live on trust and nosocomial infections do very little to bolster that trust.

Posted by Stephan on Tuesday, November 03, 2009 at 4:08 pm

Why? Perhaps you were feeling masochistic? If I can trust my traffic monitor (and I often can't), of all the articles, the only one you read in its entirety is the one you were pretty sure would upset you. :)

The problem of rationed care is with us no matter what health care system we espouse. It's the elephant in the room that I've worried about for at least 30 years (off and on, between more pressing life events).

We shouldn't need a boatload of tests, including a CAT scan, to diagnose gout, but neither should we brush off someone's problem with "you're getting older; live with it."

Posted by SursumCorda on Tuesday, November 03, 2009 at 7:49 pm

I apologize, also, for being provocative. Such was not, if you will believe it, my intent. I believe poor medical practices should be exposed no matter what the system, and I also worry about the confluence in modern culture of a diminished respect for the elderly and a diminished desire for children, creating a demographic with a top-heavy needy population and a weakened support base.

Posted by SursumCorda on Wednesday, November 04, 2009 at 7:06 am
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