A great clatter of protest has been raised about a part of the proposed Obama government medical business takeover bill, which allegedly rations care for our elderly citizens at the end of their lives. Since most of us have grandparents whom we love, this has become a major motivation for the growing opposition to the bill.

Propagandists on both sides of the debate have issued excited utterances that have clouded the analysis. Talk radio has been apoplectic about the peril that this bill poses to the symbolic "granny," while state-aligned media shills have said such an interpretation is absurd. Herewith is a lawyer's-eye view about what the actual language of the bill says, and what history and experience predict about its practical outcome.

Do they really want to croak granny?  The answer is: yes, sometimes.

The focus of current public outrage is on Section 1233 of the Obama House bill, which technically adds one definition to the existing 63 pages of fine-print definitions in the Medicare portion of the Social Security Act. (42 U.S.C. 1395x) That added definition regards an "advance care planning consultation," which may be held between doctor and patient every five years, or more often in cases of chronic or life-threatening illnesses, to be paid for by Medicare.

So why all the howling about a definition? It sounds innocuous, and on the surface it is. However, in these advance-care planning consultations, we will be subjected to the incessant drumbeat of our duty to go quietly when it is our "time." The law actually says that the consultation consists of discussions about living wills, healthcare proxies, an explanation of "end-of-life services," and similar topics. The doctor must urge the victim to prepare documents that direct relatives and medical personnel how to handle serious illnesses when the patient cannot make decisions on his or her own: i.e. to "pull the plug," to attempt resuscitation, or what to do in other dire contingencies. 

The big question is whether these consulations are mandated, and they are not. No one is required to participate. However, state-allied television will certainly encourage them relentlessly, as will the doctors who make the money doing them, since these consultations can become an easy new profit center with little effort expended on the part of the doctor.

The statist supporters of government healthcare have leapt into the controversy, excoriating the talk-show hosts, commentators, and others who have remarked with alarm on the alleged "kill granny" section of the bill. However, they betray a — if you will — fatal ignorance of statutory interpretation and history, in two respects. First, while this section does not contain language that directly mandates termination of the elderly, the idea is certainly to acclimate as many persons as possible to doing their duty and just dying quietly without using up our money. Once such a notion becomes part of the ethical fabric of our culture, the government will start saving billions each year on care of the old. Second, it ignores the other portions of the law that are designed to limit and ration care, and which will have the practical effect of killing granny anyway.

On the first matter, the bill is clear. It is now the stated policy of the government to force people to consider planning for the end of their lives in advance, and to endorse agreements that allow relatives and doctors to end life support when incapacitation occurs. In essence, we are asking granny herself to sign her death warrant in advance, should she become a "useless" drain on resources. 

Humanist ethicists, from Thomas Malthus in the early 19th century to Paul Ehrlich and Peter Singer in the late 20th, have always favored a very small population, with a very big government to enforce their ideal. I note that none of these ethicists have ever volunteered to go first before suggesting that we or our grannies do so. Undoubtedly, they regard their services as indispensable to a much-diminished humankind after we do our duty.

While the imposition of this new ethos of death is justly alarming, the more present problem of medical rationing is likely to impact granny much more gravely and much sooner. The rationing of medical treatment for the elderly is marbled throughout the Obama bill in so many places that we will have to address this issue in more detail in a future installment. For example, cancer treatment, much of which is skewed toward an older demographic, will be limited ("adjusted" in Obama-speak, "rationed" in actual English), if it becomes too costly in a particular hospital. (Section 1145) Another example: services to be provided under many plans are quite limited, i.e. rationing.  A more attenuated but relevant problem is that hospitals are actually prohibited from expanding, and are limited to their size as of the date of the enactment of the bill, unless a medical politburo, answerable to no one, gives the OK to expand. Thus, treatment options become further limited.

Dr. Ezekiel J. Emanuel, a key medical ethics adviser to the president, and brother of Obama's chief-of-staff Rahm Emanuel, has set forth in writing a deadly formula for allocating care. In a January 31, 2009 article in a prestigious British medical journal, The Lancet, he and two co-authors offer a theory they call, "the complete lives system," as a means to decide who gets care and who dies.

In a complex web of interlocking principles for allocating medical treatment, in an environment where rationing is assumed, Dr. Emanuel opines that teenagers should have priority over infants, because they have received more resources from society. Older people, however, are "objectively less valuable," so, yes, granny does have to die. Under this system, using utilitarian and amoral criteria like "distributive justice," young healthy people from ages 15-40 get priority, and the rest, including grandma, may not.

One can infer that this premise will undergird the implementation of the Obama healthcare regime, including the assumption of rationing of care. While the self-anointed messiah Obama brazenly proclaims throughout the land that his deadly healthcare bill will be good for society, the Hebrew prophet Isaiah rightly saw that such thinking reflects that "the dust of death" has settled over a culture.

The Obama bill reflects the ethos of amoral "utility" throughout. For example, in Section 1177, many plans will not be allowed to enroll "special needs" people. No explanation is given as to the rationale behind this cruel mandate.  

Do the proponents of pragmatic elder-cide have grandparents? What do they want for themselves or their families when they are old and frail? Their cavalier attitude about your grandmother is borne of a certitude that their own grandmothers will not be hunted down and told to make way for the more productive, as they will all exempt themselves and their dear ones from this debacle that is to be imposed on everyone else. If members of Congress and their courtiers were made subject to this deadly debacle, cries for its implementation would cease almost immediately.

This is the second installment in our "ObamaCare Shocker" series examining provisions of the proposed Obama healthcare bill that deprive citizens of rights, or are of particular concern due to their likely intrusion on personal privacy or family autonomy. Gregory A. Hession, the author of the series, is an attorney in Massachusetts who specializes in family and constitutional law. Check back frequently for further parts of this series, where we will isolate and analyze the scaries parts of the 1,107-page Obama healthcare bill.

Related article:

"ObamaCare Shocker: Send in the Social Workers"

TrackBack URI for this entry

Comments (7)

Subscribe to this comment's feed

Flu-Bird said:

	Obama death care So is it looking like the movie LOGANS RUN where your not allowed to live over 30? when soon will the sandmen come to liquidate us?
	report abuse vote down vote up

August 13, 2009
Votes: +2

Seriously?, Lowly rated comment [Show]

Arvizu said:

	... In essence, our caring government feels that they can make better decisions than relatives in this scenario. So it's best to let them handle our end of life issues. What! If our government Empty Suits can't even operate the boodgoggle program, Cash For Clunkers, how on God's good earth can he run healthcare for 200+ million Americans? Then there's Medicare, FEMA, DMV...etc. 1984 here we come!
	report abuse vote down vote up

August 13, 2009
Votes: +3

Daniel said:

Palin all the way I would just like to say that the last few days has just proven that Palin knows what she is talking about regarding Health Care for the American people. She has forced Obama to argue 1 on 1 with her, forcing him to raise her to presidential level. Not only is she proving her leadership ability she is also demonstrating that she has the courage to stand in a ring with Obama and duke it out. She has everyone in the White House and Obama administration talking about her, she has gotten in their heads. Its obvious that she has read the bill (which is probably way she was so quite over the last few weeks) and understands it, unlike Obama who doesn’t even know what is inside the bill. She didn’t just pull her thoughts out of thin air…she has read the different variants of the bill and she knows what is in it. American people this is the person you need to vote for in 2012, someone who will actually stand up for you. (I’m Australian and gay, and a huge supporter of Palin, if I was an American I would def vote for her. I personally don’t think she is out of power like most insider Washington folks, she is fighting in what she believes in and fighting for the everyday American….and this scars the pants off Washington

report abuse vote down vote up

August 13, 2009
Votes: +6

Nurse said:

	Disgusting Everything about Obama disgusts me. I've never known a president who so often stood up and said "I'm the PRESIENT" the way this jerk does. He sounds exactly like Fidel Castro.
	report abuse vote down vote up

August 14, 2009
Votes: +1

Adam said:

... There are two issues at play, here: the monopoly, closed-shop system of medical associations (unions) and medical-financial companies actuarial interests. The system of professions is a bad carryover from the guilds of old. It's the worst of both world. There is no public, or government oversight of doctors, yet they have a legal monopoly. Medical licensing should either be taken over by the government (under the oversight of elected officials), or medical associations disbanded, in favour of an 'open-shop' system. The 'doctor shortage' up here in Canada was solely the result of medical associations restricting admission to med. school, in order to create a sellers' market. Doctors make their own rules, including deciding who lives or dies. Conversly, utterly useless and costly 'treatments', like chemotherapy (or tonsilectomies, routine circumcisions, 'preventative' mastectomies, &c.) are foisted on patients, to generate income for doctors and medical contractors like pharmaceutical companies. Doctors need to be slapped down a notch. The other problem is Obama's donors, the HMOs. A dead patient needs no further, costly medical treatment. Kill the patient, kill the costs. People have to take control of their health from medical associations and insurers/HMOs.

report abuse vote down vote up

August 15, 2009
Votes: +0

CC said:

So true This article comes at an interesting time for me. I'm currently living in New Zealand with my American husband and American children. We have a nationalized health care system here. My 89 year old grandmother is currently in hospital because of injuries she sustained in a fall. Two nights ago she became unconscious for unknown reasons. She had tests run the following morning but no physiological cause could be found. That very afternoon, the doctors started discussing with my parents the possibility of taking her off the oxygen she was on (via mask, not intubation)that night and letting her die if she couldn't fight for life on her own. Thankfully she ended up with antibiotics and her condition is beginning to improve and is breathing with no help. I found it absolutely disgusting the speed at which they considered letting her die. My plea is this: DON'T DO IT AMERICA! You have no idea how good you currently have it when compared to a government run system.

report abuse vote down vote up

August 27, 2009
Votes: +1