Tuesday, August 11, 2009

Obamacare: Nudging Granny Toward End-of-Life Decisions

Maybe it's because I'm one of those adults in the population conveniently classified as seniors, but I've been nervous about Obamacare ever since I learned about the proposal to incorporate end-of-life counseling in the treatment of Medicare recipients.

Obama's smooth denials given at AARP town hall gatherings haven't reassured me in the least, nor have the irrational screechings of extremists on either the far left or far right.

Lee Siegel's post at the Daily Beast titled
Obama's Euthanasia Mistake has the effect that one typically experiences in at last confronting the reality of a situation. At least you know what you're dealing with and are thus better equipped to either support or protest what's happening.

Before turning to Siegel this morning, however, let me clarify something that has been bothering me since this discussion began. Obama and others have repeatedly referred to Social Security and Medicare as "entitlement" programs, making it sound as if seniors are getting handouts from the government in their retirement years. Wrong. We paid a Social Security tax throughout our working years, and we've also been taxed for Medicare. Post-retirment, the government deducts substantial monthly contributions to Medicare from our measley Social Security benefits. I just calculated it: my Medicare deduction equals about 11% of my monthly benefits.

On that note, let's go to Siegel. After introducing us to a couple of influential people in Obama's University of Chicago background, Siegel zeroes in on the issues at stake for seniors in Obamacare:

The section, on page 425 of the bill, offers to pay once every five years for a voluntary, not mandatory, consultation with a doctor, who will not blatantly tell the patient how to end his or her life sooner, but will explain to the patient the set of options available at the end of life, including living wills, palliative care and hospice, life sustaining treatment, and all aspects of advance care planning, including, presumably, the decision to end one’s life.

The shading in of human particulars is what makes this so unsettling. A doctor guided by a panel of experts who have decided that some treatments are futile will, in subtle ways, advance that point of view. Cass Sunstein calls this “nudging,” which he characterizes as using various types of reinforcement techniques to “nudge” people’s behavior in one direction or another. An elderly or sick person would be especially vulnerable to the sophisticated nudging of an authority figure like a doctor.

Bad enough for such people who are lucky enough to be supported by family and friends. But what about the dying person who is all alone in the world and who has only the “consultant” to turn to and rely on? The heartlessness of such a scene is chilling.

Yet many liberals seem drawn to such fantasies of power and control. We live in a highly quantified society, entertained on all sides by divertissements that reduce human life to cute little anecdotes illustrating the morality of statistical, utilitarian analysis, from Malcolm Gladwell to Freakonomics and beyond.

To read Siegel's post in its entirety - it's well worth it - go here.


  1. May I add that, another disturbing aspect of this proposal is that... as far as I can see... nowhere are mentioned the professionals that are actually prepared to deal with end of life issues.

    Why is the chaplaincy not included in the medical team that would "counsel" the aging patient every five years?

    The implication that physicians are up to this task is chilling, indeed. Cuz I don't know many who are.... after thirty years in the hospital trenches.

  2. Thanks for your input, SYD. And yes, it's interesting that the haloed Obama has neglected the importance of pastoral care and counseling in end of life situations.