Not so long ago, death was considered an enemy that doctors fought. They felt defeated if they “lost” a patient.
Donald Seldin, M.D., founder of the medicine program at Texas Southwestern, said that the purpose of medicine was to “relieve pain, prevent disability, and postpone death.”
Under the new order, death can be a “right” or a tool, and hastening death may be a means to the end of population health.
Not all human life is a problem—just that which is unwanted, excessive, low-quality, not productive, imperfect, or not permitted (in China now, perhaps here in the future).
The Oath of Hippocrates was unambiguous: the ethical physician did not kill patients, either before or after birth. “A Modern Hippocratic Oath” by Louis Lasagna of Columbia, which was proudly and piously read at the 40th reunion of the class of 1974, states: “If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.” [For a comparison of various oaths, see aapsonline.org/ethics/oaths.htm.]
Death and the Progressive Regime
Reserving the right to change his mind later, 57-year-old Ezekiel Emanuel explains “Why I Hope to Die at 75” (The Atlantic, October 2014).
People that old don’t contribute much to society; are more likely to be disabled, or “faltering and declining”; and “they set expectations, render judgments, impose their opinions, interfere, and are generally a looming presence for even adult children.”
Decent people would call this “the mission statement of a death cult,” writes John Nolte.
Longevity is a terrible problem for Medicare, and putting an expiration date at age 75 won’t solve it. In 1965, life expectancy was 67, so covering people at 65 was not a bad gamble.
The Veterans Administration is also stressed by high costs. To review VA hospitals after the recent scandal, new VA secretary Robert McDonald chose the Joint Commission, the same auditor that accredited hospitals where patients died from scheduling delays—and named some of them “top performers.”
A committee appointed by the Institute of Medicine presented a 507-page report, “Dying in America,” calling for a sweeping overhaul of end-of-life care. Going beyond advance directives, it recommended a shift away from fee-for-service payment, and dramatic changes in certifying boards, accrediting boards, and regulatory entities, to “ensure consistency and quality of palliative care.” Discussions might start at the time of getting a first driver’s license (NYT 9/17/14).
The report was financed by an anonymous donor, and the panel was co-chaired by David Walker, former U.S. Comptroller General.
The AMA has created CPT codes for end-of-life discussions and submitted them to Medicare. Some states, including Oregon and Colorado, have begun covering the sessions for Medicaid patients. “Private” insurers, operating in an environment of government-directed incentives and restricted revenue, have begun funding “advance planning.” The government can claim that the Affordable Care Act (ACA) should “conform” to what medical professional organizations are recommending.
“We’re acknowledging that this is an important thing. That’s a huge message,” stated AMA past president Michael Fleming.
“Drawing the line” is an inherent part of any socialized medical system, writes Paul Hsieh, M.D.
In 2013, there were 4,829 cases of euthanasia in the Netherlands. In Belgium, euthanasia can be performed for psychiatric reasons—and followed by organ harvest, writes Wesley Smith. Critics fear loss of livelihood.
Excess Life
ACA contraception mandates implement the government’s supposed “compelling interest” in population control—as does government funding of the nation’s largest and highly profitable abortion chain, Planned Parenthood. Taxpayer funding continues to increase, topping half a billion dollars in 2011-2012, when PPFA’s profits were $87 million.
Newly appointed Ebola czar Ron Klain has stated that growing population is the “top leadership issue challenging our world today.” He is also concerned about human-caused climate change from CO2 emissions.
Not only do human beings have a carbon footprint; those who procreate leave a “carbon legacy,” writes Cristina Richie in the Journal of Medical Ethics (doi:10.1136/medethics-2013-101716).
Access to contraception improves health, write Patz et al. And the difference between low-end and high-end UN projections of world population (7.4 billion vs. 10.6 billion) is a 32% difference in global CO2 emissions by 2050 (JAMA 10/15/14). The accompanying editorial states: “Climate change poses the same threat to health as the lack of sanitation, clean water, and pollution did in the early 20th century.”
Preventing life, ending life, and restricting access to energy and the fundamental building block of life (CO2) are in the unified agenda packaged as population health. This will require draconian central control by the political elite.
A Change in Culture
On Ash Wednesday, Chris Adrian, M.D., M.Div., member of the Pastoral Care Dept. at Columbia Univ. College of Physicians and Surgeons, declined to impose ashes, out of conviction. He is an atheist—not a unbeliever, but a believer in the absence of God. Atheism organizes his life, he writes. He felt “pouty and jealous” of colleagues, who got to do something as a chaplain, and fantasized a change in the ceremony.
“From dust thou were made, to dust thou shalt return, I could mutter, and then draw, not a cross, but a smiley face on someone’s forehead, and then we could trade European-style air kisses, and shrug” (JAMA 10/15/14).
At Columbia and many other places, the doctor on call might not believe in prolonging your life, and the chaplain on call might mock the idea of an immortal soul.
Ideas Have Consequences
- It Follows That: “‘After-birth abortion’ (killing a newborn) should be permissible in all the cases where abortion is, including cases where the newborn is not disabled” (Giubilini A, Minerva F. J Med Ethics doi:10.1136/medethics-2011-100411).
- Definition of Death: Pronounced brain dead after a surgical complication on Dec 9, 2013, Jahi McMath was denied a feeding tube because it would be unethical to operate on a corpse. She was transferred from Children’s Hospital Oakland at her mother’s insistence. She has since had menarche, and moves a hand and foot on request.
- Population Death: By 2050, the population of Germany is expected to shrink by 10 million people, despite 4 million immigrants. German fertility, now at 1.4, has been below replacement (2.1) for 45 years.
Flashback: Nazism’s First Victims
Recently, Germany unveiled an 80-foot glass panel memorializing the 70,000 sick and disabled people who were killed by the Third Reich in Aktion T4. Propaganda posters told Germans that caring for someone with hereditary defects cost 60,000 Reichsmarks, which came from ordinary Germans’ pockets (Christian Healthcare Newsletter, October 2014). The campaign was led by Hitler’s personal physician Karl Brandt (see Hieb L. J Am Phys Surg, spring 2011).
As Edwin Black pointed out in War Against the Weak, the ideas leading to Aktion T4 were made with pride in U.S.A., in the eugenics movement led by professors, industrialists, and government. Hundreds of thousands of Americans were prevented from reproducing, on the basis of “polysyllabic academic arrogance.”
Claud A. Boyd, Jr., M.D.: R.I.P.
AAPS past president Claud A. Boyd, Jr., M.D., died at age 77 on Sep 20. He was actively practicing dermatology in Georgia and Texas. He attained the rank of captain in the U.S. Army. He served several terms on the board of directors of AAPS and also Doctors for Disaster Preparedness.
♦ ♦ ♦
“All they that hate me love death.” (Proverbs 8:36)
Public vs. Population Health Priorities
City and state public health departments are an “engine of innovation,” write Gostin et al., citing the New York City ban on large soda servings as an “historic” example of a way to transform social norms and combat the “unequal burden of obesity-related disease.” The court ruling to strike it down will be “chilling.”
“With the epidemiologic transition from infectious to noncommunicable diseases, today’s salient threats include poor diet, physical inactivity, and smoking.” Ethnic minorities are disproportionately targeted by ads for sugary drinks (JAMA 10/15/14).
“The first responsibility of any health care organization is to address disparities” in provision and outcome (JAMA 2/26/14).
The chief architect of the “Big Gulp” policy is Thomas Frieden, now CDC director. Only months after 9/11, during the anthrax scares, Frieden was interviewed for the job of NYC health commissioner. His chief priority was not bioterrorism, but attacking tobacco companies.
More Anti-MOC Resolutions Pass
The Iowa Medical Society Policy Forum, the Medical Association of Georgia, and the Washington State Medical Society have adopted resolutions opposing Maintenance of Certification. Grassroots support was overwhelming, but getting the resolution to the floor of the WSMA was a struggle. AAPS member Ken Ping-Chang Lee, M.D., describes how he overcame the roadblocks.
“To mount a resolution to stop MOC at your state society is a long, bitter and lonely fight…. [T]here is a chance that freedom minded physicians) can do what I have done. If we lose our freedom, nothing else holds much meaning,” he writes.
Kick the Can Past Mid-term Election
- Premiums: CMS announced it will not publish Exchange premiums until Nov 15.
- Risk Subsidy: By executive order, Obama created an unlimited ObamaCare reinsurance program estimated to cost $1.3 trillion.
- Open Enrollment Delayed: Obama delayed the potentially disastrous open-enrollment period from Oct 15 to Nov 15, and shortened it from 6 to 3 months. Premiums will likely be up 20%, subsidies should be harder to get, and young people are less likely to sign up.
AAPS Calendar
Jan 9, 2015. Thrive, Not Just Survive XXI and
Jan 10, 2015. Board of directors meeting, New Orleans, LA.
Oct 1-3, 2015. 72nd annual meeting, St. Louis, MO.
Medical “Ethics” and “Professionalism”
Medical boards may sentence physicians to enroll in an approved “ethics” course like the 22-hour, $1,795 course offered by the Univ. of California Irvine. As in a Communist self-criticism session, attendees must describe their ethics violation in person, and develop a personal “violation prevention” plan. Attendees must explore their “resistance to face [their] violation potential.”
Those “who fail to actively participate or who exhibit behaviors demonstrating persistent lack of insight, projection of blame, or inappropriate behavior or comments will be failed and reported to the referring agency.”
Is This Separation of Church and State?
- Send in Your Sermons. Houston mayor Annise Parker subpoenaed all communications, including sermons, from five pastors, to be scrutinized for possible expressions of opposition to an ordinance that requires allowing transgendered persons to use whatever restroom they prefer.
- Perform Same-Sex Weddings or Go to Jail. Christian pastors Donald and Evelyn Knapp were told they could face fines and 6 months in jail for declining to perform a same-sex wedding under a Coeur d’Alene city ordinance barring discrimination in places of “public accommodation.”
Mass. Ban on Pro-Life Speech Overturned
In a unanimous decision in McCullen v. Coakley, the U.S. Supreme Court held that “caring, consensual” conversations with pro-life sidewalk counselors could not be banned within a “buffer zone” of 35 feet of abortion facilities.
Justices Scalia, Thomas, and Kennedy filed a concurring opinion, objecting to the holding that the ban was “viewpoint- and content-neutral.”
“Today’s opinion carries forward this Court’s practice of giving abortion-rights advocates a pass when it comes to suppressing the free-speech rights of their opponents” and “continues the onward march of abortion-speech-only jurisprudence,” Scalia wrote.
The National Organization for Women responded: “There can be no other way to describe…what anti-abortion protesters have engaged in for four decades and that is terrorism.”
This Supreme Court term, religious freedom has come into “sharp conflict with the government’s interest in providing affordable access to health care,” write I. Glenn Cohen et al. (N Engl J Med 8/14/14). McCullen “deals another blow to abortion rights,” but leaves open the possibility of laws such as a floating “bubble zone” around women approaching clinics for abortion, used in Mass. 2000–2007 and upheld in a Colorado case in 2000.
Tip of the Month: Responding to the U.S. Census Bureau Health Insurance Cost Study is voluntary. After badgering a medical office, the Bureau finally sent a request in writing. Buried in the letter that asks for a response within 15 days, and says that reasonable estimates are accepted, is the statement that “your response to this voluntary study is extremely important to ensure that accurate information is available for policymakers to make important decisions about our Nation’s healthcare system.”
Beware of Interstate Medical Licensure Compact
The Interstate Medical Licensure Compact crafted by the Federation of State Medical Boards (FSMB) is touted as a way to ease the physician shortage, speed the growth of telemedicine, and facilitate specialist consultations (JAMA 8/20/14). FSMB president Humayun Chaudry, D.O., states that the compact would ease the daunting administrative burden that physicians face when they try to practice medicine in multiple states.
On reading the Compact, AAPS notes that to meet the definition of “physician” one must hold a specialty certification or a time-unlimited specialty certificate recognized by the American Board of Medical Specialties or the American Osteopathic Association’s Bureau of Osteopathic Specialists; never have held a license subjected to discipline by the licensing authority in any jurisdiction; and not be under active investigation by a licensing agency or law enforcement authority in any jurisdiction.
Any public complaint against a physician in any jurisdiction in which he is licensed under the compact must be reported to the interstate commission, and any disciplinary action anywhere is deemed to be unprofessional conduct subject to discipline by other member boards, in addition to any violation of the medical practice act in that state. Physicians would be subject to all the rules and regulations in the state in which the patient resides.
AAPS has proposed a resolution to the American Legislative Exchange Council (ALEC) opposing participation in the Compact, noting that it will supersede a state’s autonomy and control over the practice of medicine, and impose significant costs.
Supreme Court Precedent: End Justifies Means
A Buffalo prosecution that convicted Mark Kirsch, former local president and business manager of the International Union of Operating Engineers (IUOE) Local 17, tested a U.S. Supreme Court precedent that the end justifies the means, writes AAPS past president Lawrence Huntoon, M.D., Ph.D.
Several labor leaders were accused of “using death threats, assaults and vandalism to force construction companies into hiring union workers…[and engaging in] a decade of extortion and racketeering as part [of] an ongoing criminal enterprise.”
Attorneys representing unions said that violence, threats, intimidation, and property damage are legal under federal law as long as such conduct is in the “pursuit of legitimate union objectives.” The case that they cited is U.S. vs. Enmons (1973).
“This is the same situation we have in sham peer review,” Huntoon writes. “Hospitals say they can do anything they want to physicians as long as they call it ‘peer review’ and claim that it is all done in the pursuit of quality care.” Witness the fact that there were no prosecutions in the Fitzgibbons case, where a Mafia thug hired by a hospital executive tried to kill Dr. Fitzgibbons or his family, set him up to be arrested on false charges, and planted drugs in his car while it was in the police impound lot.
Though some limits may have been established in Buffalo, four defendants were acquitted, and attempts to repeal the 40-year-old Enmons exemption to the Hobbs anti-racketeering law have failed. ACA may establish and the courts accept similar utilitarian exemptions for “health care.”
Correspondence
Zeke Emanuel’s Complete Life. This summer, Emanuel tells us he climbed Mt. Kilomanjaro. He did not take the opportunity to set an example for all: if dying at age 75 is “good” for society, would not going out in one’s prime be even better?
Emanuel has lots of free time for contemplation. His job, apparently, is to engage his high intellect and impart socialist wisdom to the rest of society.
Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY
Pay for Terminal Diagnosis. A lawsuit filed against Optum (United Healthcare) Hospice Services (formerly Evercare) alleges that pay-for-performance measures create incentives to admit and retain ineligible patients. It’s beginning to sound like the same stat rats at the VA, who were so stuck on numbers they could not make a left turn to save a life. Chronically ill patients with dementia and pulmonary conditions could be certified as “terminal” upon admission, allowing the hospice to keep them longer and bill more. Salaried physicians are coerced; they can be fired for no reason. To me, a hospice company owned by an insurance company just does not mix.
Barbara Duck, http://ducknetweb.blogspot.com/
Population Health. Most medical schools now have a Dept of Population Health. The Institute for Healthcare Improvement (IHI), Don Berwick’s old outfit, recently held a $4,950-per-person conference on “Population Management.” ObamaCare presents many funding opportunities, and vast resources are being devoted to something with no agreed definition. The Kindig/Stoddard definition would place virtually every human activity under the management of “population health” experts—food, education, the arts, architecture, even “individual behavior.” To them, the needs of any individual are unimportant. Things are measured by averages. The average result will improve if we eliminate the outliers—say those with serious diseases—who bring down the average. This is sometimes known as thinning the herd. The current adoration of Zeke Emmanuel and Peter Singer suggests that this is exactly what lies ahead as long as we keep empowering the elite rather than the people.
Greg Scandlen, Consumers for Health Care Choices
Emanuel’s Time to Die. While I disagree with Dr. Emanuel, his article is his opinion. But if the government adopts this approach through the Independent Payment Advisory Board (IPAB), we have a problem. Emanuel was a chief architect of ObamaCare.
Donald J. Palmisano, M.D., New Orleans, LA – intrepidresources.com
Why Marines Are Called Leathernecks. At the height of the 18th century, Muslim pirates terrorized the Mediterranean and North Atlantic, carrying out their Prophet’s mandate to make war on and enslave unbelievers. Thomas Jefferson decided to stop paying tribute, raised a naval force, and fought a 4-year war with Tripoli. Leather collars of their uniforms kept Marines from being beheaded with scimitars as they boarded Muslim ships.
Joseph Scherzer, M.D., Scottsdale, AZ
The Plan to Transform America. Creating havoc is Obama’s game plan, which precisely follows Saul Alinsky. Fear will lead to a government takeover of the medical system. The public fears an Ebola epidemic, and the Administration gives illogical reasons for refusing to restrict travel from affected areas. Airport screening protocols are illogical, and training protocols have been unsuccessful. Havoc will intensify if there is an influenza epidemic. Who will pay for the isolation and contact tracing?
Stanley Feld, M.D., Dallas, TX
The High Cost of Dying. In the U.S., we don’t give money to patients and their families; we give money to the medical-industrial complex. In health care, every dollar of wasteful spending is a dollar of income to someone. Tremendous forces are arrayed against those who want to die at home. Permission may be required from a state-contracted managed-care agency with a vested interest in keeping the patient institutionalized. It can be “like being in prison.”
John Goodman, Ph.D., Dallas, TX
Death Panels. Vancouver, British Columbia, where I used to live, denied 6,000 life-saving surgeries to close a $200 million budget gap. In Ontario, a man comatose after a heart attack was to be denied sustenance unless he was awake enough to ask for it.
Jim Vanne, Aurora, IL
Emanuel’s “Choice.” Though disguised as a “personal opinion,” Emanuel’s article is really the foundation of ObamaCare. He frequently uses the terms “greater good” and “productive lives”—which are of great historical importance in socialism and eugenics.
Michael Riesberg, M.D., Pensacola, FL
Medicare and ACA. Federally Facilitated Marketplaces are not currently set up to prevent Medicare eligibles from enrolling in a Qualified Health Plan. But after age 65, the Exchanges will cut off all premium subsidies and cost-sharing to encourage people to rely solely on Medicare—a trap with a $43 trillion liability.
Twila Brase, R.N., St. Paul, MN
