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Zeke Emanuel on Sarah Palin’s Accusation of 'Death Panels': 'It’s An Absolute Outrage'
August 13, 2009 3:53 PM
Dr. Ezekiel Emanuel, the health-policy adviser at the White House’s Office of Management and Budget -- who has been caricatured by conservatives as a “Dr. Death” seeking to pull the I.V.s out of your grandparents’ arms in the name of cost containment -- is not happy.
Asked by ABC News in an interview about the thoroughly discredited claim by former Alaska Gov. Sarah Palin to paint his philosophical writings as evidence -- along with a provision providing optional end of life counseling in the House Democrats’ health care reform bill -- that President Obama wants to set up “death panels” to deny medical treatments to seniors and the disabled, including her son Trig, Emanuel, brother of White House chief of staff Rahm Emanuel, does not hold back.
“It’s an absolute outrage that you would take first of all a provision written in the bill,” Emanuel says, a provision allowing for “doctors to talk to patients about end of life care, and turn it into the suggestion that we’re going to have euthanasia boards -- that’s a complete misreading of what’s there. It’s just trying to scare people.”
Emanuel says as an oncologist he’s had hundreds of discussions with patients about what to do when treatment doesn’t work.
“It’s wrenching,” he says.
The provision in the House Democrats’ bill is “an acknowledgment doctors should be compensated for making that conversation available,” he says. “It’s not forced -- it’s voluntary.”
As for Palin’s vision of “Obama ‘death panels,’” Emanuel argues “there’s no basis for that claim either in any of my writings or the legislation. It has no grounds in reality. It’s surreal and Orwellian, the idea that this legislation or my writings suggest that her son Trig shouldn’t get health care.”
He notes that his sister has Cerebral Palsy, so he is not without personal sympathy for those with disabilities.
An opponent of euthanasia, Emanuel says he “abhor”s people “cavalierly distorting those writings and the work that I’ve done over 25 years to help improve medical care in America for vulnerable people who often have no voice.”
In fact, as an academic he looked into the notion of euthanasia when the “Right to Die” movement started gaining attention and he says he’s been “very solidly consistently against it.” The misperception was prevalent, he says, that those seeking assisted suicide did so because they were “writhing in pain,” when in fact the main motivation for those seeking voluntary euthanasia was depression.
One of the passages written by Emanuel and used as evidence by Palin and others that he would favor withholding medical care from those who aren’t productive members of society include a 1996 contribution to the Hastings Center Report, in which he said that under the “civic republican or deliberative democratic” construct, “services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia. A less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason."
Is he saying, as Palin and others have suggested, that those who aren’t “participating citizens” should have no guarantee to health care?
“No,” Emanuel says, “and I think I made it pretty clear I wasn’t endorsing that view, I was analyzing that perspective and what it might mean in practical terms. The rest of the text around that quote made it made it pretty clear I was trying to analyze it and understand it, not endorse it.”
Emanuel acknowledges that philosophical treatises can be difficult to consume and might lend themselves to this kind of misinterpretation. People in the world of academia “tend to know your whole body of work, and when they make a response it tends to be to one line of argument in context.” But that said, “a lot of philosophy can sometimes seem extremely abstract to people and hard to follow -- even well-educated people.” He says sometimes he has trouble following a philosophical article. “They’re not necessarily the easiest thing to read.”
(See also our blog “When Academic Words Become Political Ammunition,” July 28.)
In another article used as grist for his critics, in Lancet in January 2009, Emanuel and two co-authors discussed rationing care. But Emanuel cautions the goal of the article was not to apply his views of rationing onto providing health care in general.
“We were examining a very particular situation,” he said.
The situation: “we don’t have enough organs for everybody who needs a transplant. You have one liver, you have three people who need the liver - who gets it? The solution isn’t ‘We get more livers.’ You can’t. It’s a tragic choice.” It’s a decision made in the story in the context of “absolute scarcity.”
“it doesn’t apply generally to health care services more broadly,” Emanuel underlines. “Only by ignoring what we say there could anyone come to a different conclusion. Only by taking two sentences out of their complete context.”
In that article Emanuel analyzed eight different views that have been advocated and, with his co-author, argued none are adequate. They combined five views to create the “Complete Life” theory. One of the arguments it that the younger patient should get the liver before the older patient -- though Complete Life theory makes exceptions to that rule.
Emanuel points out that there is some support for the positions he takes in that article from public polling, and that none of these discussions are removed from the world -- as with the prioritization by the Centers for Disease Control and Prevention for those who are health care workers, or pregnant women, to get the H1N1 vaccine.
“Throughout my career I’ve taken on those kinds of questions,” he says, “ones that people don’t like confronting.” They’re difficult issues, he says, but society already makes decisions, one way or another, about who gets the liver, and how to care for dying patients. “I understand it can make people queasy but there’s no way of escaping it. I hope at the end of the day I can make things better for people, especially vulnerable people.”
The oncologist suggests that his words are being twisted because opponents “don’t have a solution” to the health care reform debate. “Maybe the only tactic is to sow fear and use whatever means you have to attack whether that’s grounded in reality or not... If you don’t have good arguments you use whatever you got, I guess, to say things that are distortive and untrue.”
He says “there have been previous attempts to come after me and after some of my colleagues, but this is certainly on a completely different scale and magnitude. I’ve never been mentioned on Sunday shows in this light and certainly never on the floor of Congress. The distortions are much larger than I’ve ever seen or would have believed could happen.”
Much of the last quarter century he’s spent as an oncologist, he says, has been devoted to improving end of life care in America. He was told when he began exploring some of these issues in the 1980s not to do it.
About 15 years ago he did think rationing was necessary because of cost issues but he has come to change his mind. “The more I’ve looked into it the less I think it’s true,” he says. “We spend a lot of money and resources -- hundreds of billions of dollars -- for unnecessary care, care that doesn’t help patients,” and in some case might make them sicker by exposing them to hospital-acquired infections.
“We don’t have to raise the issue of denying care, or choosing which people gets services,” he says.
-- jpt
August 13, 2009 | Permalink | Share | User Comments (436)
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Why, Dr. E... you are sooo smart and we are sooo stupid! Of course, when you stated people who are not socially productive should not necessarily receive medical treatment... you really didn't MEAN it... yeah, right!
The Obama administration is full of LIARS!
Posted by: RKA | Aug 29, 2009 9:22:49 PM
I'm with Edie if any politician thinks this is such a wonderful plan why are they not giving up their posh insurance WE AMERICAN CITIZENS PAY FOR and sign at the top of the list?
Answer: It's good enough for the AMERICAN CITIZENS but not good enough for them!!!!
Posted by: Tina | Aug 17, 2009 3:07:38 PM
If Palin is so inocuous, why is the left so rabid when she speaks ? Me thinks they doth protest too much, not for Palin's words, but for the weakness
of their own arguments.
Posted by: verda | Aug 17, 2009 7:46:53 AM
Elderly right now today are being denied life saving care because the ethich panels in hosp. are saying they are not worth the money for the outcome. Disabled people are being neglected because some Dr. thinks they aren't having a quality of life. One Dr. once told me that Quality of Life meant " you could wipe your ***". Tell that to a Quad comming home from Iraq! These people have to literally fight to get care that they deserve, right up to their last breath, which should be determined by God, not some Dr. or Insurance co. People are told love ones are brain dead every day. They trust the Dr. without knowing there should be 2 Dr. and 3 tests to certify No brain waves and the person is truley brain dead. The truth is they want organs donated, and yes They Do make money, Big Money. I have seen it with my own eyes more than once.
Posted by: toldyaso | Aug 16, 2009 11:02:50 PM
One just has to google the radical Dr.Death to know where he's coming from....he makes Nazi Germany look like Sesame Street!He would deprive handicapped infants, children and adults of care because of their inability to contribute to society!
All this to save the socialist system a couple of trillion!This is a medical advisor to the president in America???Or maybe I should say,"Amerika"
Posted by: keefir1 | Aug 16, 2009 7:06:16 PM
Maybe he should put on his new uniform first. Then it would look more impressive and official.
Posted by: jack27 | Aug 16, 2009 4:13:13 PM
Socialism uses the basis of capitalist infrastructure. It requires the leadership by an organized and conscious by , of and for the working class, which is organized as a ruling class. Nationalization affects a minority in favor of the vast majority. Small businesses and small farmers are not nationalized. The work week is reduced, with annual paid vacations, free medical care, free schoosl including university and equality for women. Students will choose their own careers and receive the education and training for it. Upon graduation, they will be guaranteed a job in their area of study. Unemployment is done away with, workers cannot be fired, the State pays pensions and disability compensation, homelessness is done away with, rent is less than 5% of income, all debts are canceled. The goals of a socialist society are: a life free of exploitation, insecurity, poverty, and end to unemployment, hunger and homelessness, and end to racism, national oppression. Renewal and extension of democracy; an end to private ownership of the wealth of our Nation. Affirmative action will be expanded immediately. Political power will be in the hands of the working people. Corporations and banks, the energy industry and all natural resources come under the ownership of the working class. Under socialism, productions increases, science and technology are advanced, and the environment is protected. Poverty will be ended with the recovery of the vast resources now wasted in war production, corporate profits and the extravagant lifestyles of the super rich. We have a highly developed industrial society with a trained work force. Free from foreign intervention, socialism will not have to divert human resources to defend itself.There will be no rationale for wars of intervention and world wars. The military is turned into a people's militia under the control of the working class. War propaganda will be outlawed. This is the reality today in Socialist countries. What people call Orwellian is not socialism- there were certain conditions in which the Soviets were attacked by the Nazis which put socialism on a war footing. With spies everywhere, the Soviets had to be cautious. Those days are over and have nothing to do with socialism in real life today.
Posted by: ANTONIO | Aug 16, 2009 4:06:02 PM
Gingrich/Palin in 2012 !! Thank God for the controversy because it clearly exposes liberal Democrats for what they are statists bent on a Marxist State . If you want Obamacare where big brother controls every aspect of your life your going to get it . Ronald Reagan before he was a politician warned us about Socialized Medicine as the back door used to enforce Socialism in a 1961 speech . Tyranny is when government has control of every aspect of your life . Choose where you want to go with Obamacare . Liberty or Tyranny . Abraham Lincoln 1864 " We all declare for liberty ; but in using the same word we do not all mean the same thing . With some the word liberty may mean for each man to do as he pleases with himself , and the product of his labor ; while with others , the same word may mean for some men to do as they please with other men , and the product of other mens labor . Here are two , not only different , but incompatible things , called by the same name -- liberty . And it follows that each of the things is , by the respective parties , called by two different and incompatible names ---liberty and tyranny . Irresponsible elected Republicans in your voting records take note : Conservative Republicans will hold your feet on this one . Thank God for Sarah Palin . There needs to be adjustments in health care but not to this degree . We can take care of the unemployed and those with out insurance a small percentage . 45 million is not true break it down .
Posted by: Edie | Aug 16, 2009 12:10:34 PM
All I want is for all these big talkers like Obama, Emanuel, all in Congress and Unions to sign up for this gov't program. Why should ANYONE be excluded. When you exclude you are discriminating.
Step up boys be the first in this wonderful new system you propose.
Posted by: JN | Aug 16, 2009 11:03:19 AM
Now that's interesting...Dr Death or the Death Pannel telling Sarah there is no Death Pannel. That makes sense.
Posted by: flying john | Aug 16, 2009 8:27:23 AM
Idahogirl888,thank you for posting the information on Dr. Emanuel's views, clarifying he was referring to making choices when there is a scarcity, such as organs for transplant or flu vaccines. Once again, those on the far right have taken words and twisted them to suit their views that those in our government are without morals. I kind of figured their views were skewed way off the truth since they've done it so many times before.
When you follow where many of their 'experts' come from, they are often from organizations that are funded by the corporations making big profits from the way things are and wanting this to continue at the expense of our health and our wallets.
Posted by: Lydia | Aug 16, 2009 3:12:57 AM
Dr. EZ eh, changes his mind(?) when under fire. Afraid I don't believe his new found denial ... “We don’t have to raise the issue of denying care, or choosing which people gets services,” he says.
By the way, has he ever earned his living as a practicing physician? build up his practice slowly year over the years you know?
Posted by: Ed | Aug 16, 2009 2:30:02 AM
Take a long walk on a short pier after taking an aspirin. Then call me in the morning! LOL!
Posted by: VAMtns41 | Aug 15, 2009 7:36:48 PM
Maybe one of you can help me? There seems to be a lot of opinions here. What do you do when you're paying $700 per month for insurance coverage but you cannot get annual physicals, lab work, or the necessary treatment for preventive care. The deductible is $5000 in order to keep the premium at $700 per month. What do we do? We are small business owners, so we don't have coverage through an employer. Help.
Posted by: clarrity | Aug 15, 2009 5:35:43 PM
Doth the doctor protest too much. He shouldn't have written the article if he didn't want the heat. Under ideal conditions this would never happen. However, after Obama spends us into the poor house there will have to be rationing and this is a fact. Even if this Obamacare bill doesn't become a reality we are still faced with all of Obamas expensive, unpopular programs. I see another bank has failed so tighten your belts cause we could be right back to square one all over again if something isn't done. It's time for someone to be held accountable and soon.
Posted by: meholliday63 | Aug 15, 2009 5:31:04 PM
Valerie Tarantolo | Aug 15, 2009 2:49:47 PM posted "Emanuel is a liar".
Valerie, have you actually read Dr. Ezekial Emanuel's article in the medical journal, Lancet? I have. The article covers the ethics of allocating medical care when resources are scarce, such as transplant organs or during a pandemic. Our nation is ALREADY using this kind of decision-making process for the new H1N1 Flu Vaccine.
Dr. Emanuel (along with two other authors) compares the advantages and disadvantages of treating the sickest first - or using a lottery to allocate organ transplants - or maximizing the number of life years.
This article discusses medical ethics, required to answer questions such as, "if there is only one liver, should that transplant go to a 65 year old who was first in line - or someone who has more money - or a patient with a better health plan - or a 25 year-old who has a better prognosis?"
Do you honestly believe TODAY insurance companies or government medical programs like Medicare pay for every possible medical procedure? The answer is NO. That's why financial advisors encourage seniors to purchase Long Term Care insurance. And, that's why families pay from their own pocket after medical coverage reaches a limit.
Dr. Emanuel's article concludes it has presented a combination of morally relevant principles: "youngest-first, prognosis, save the most lives, lottery, and instrumental value" - a process to justly allocation of SCARCE life-saving interventions.
His article was NOT designed for heath care as a whole, or to create classes of humans whose lives and well being are not worth spending money on.
Today, do you honestly think Insurance Companies use "morally relevant principles" to determine who is compensated for medical treatment? Again, the answer is NO. They purposefully cull the sick or handicapped from coverage to increase profits.
Posted by: Idahogirl888 | Aug 15, 2009 4:51:04 PM
Emanuel is a liar, what about the papers he has written about end of life and limiting care because older Americans are not so valuable. Did we not contribute to this country for years. Emanuel is a typical left winger who lies when he is confronted with the truth, he is as, if not more dangerous than his terrible brother Rahm. um I wonder what their parents are like?
Posted by: Valerie Tarantolo | Aug 15, 2009 2:49:47 PM
TANSTAAFL wrote: “… why did the Senate remove the death panel provisions for the current bill?”
They didn’t. They removed the end-of-life care consultation provision. Death Panels exist only during Sarah Palin’s mind.
“Who 'thoroughly discredited' Gov. Palin, btw?”
Well first off, please copy and paste the passage(s) from HR 3200, section 1233 in which Ex-Governor Palin’s death panels are hiding. Then ask that question again.
Posted by: WWW | Aug 15, 2009 2:20:43 PM
The difference between rationing and determining "waste" and "unnecessary services" is a semantic line that doesn't eliminate the concept. Determining where "savings can be made" and cutting benefits are one in the same. The "advisory" councils that would give "suggestions" on effective treatment, and the council that would set reimbursement rates for government programs are functions of rationing.
The administration says that insurance companies already ration, and they don't want this to happen. They say that they don't want government to do it either, but in reality the only way that they can impose these "savings" are in govenment plans.
Posted by: Lindad | Aug 15, 2009 1:45:49 PM
Who " thoroughly discredited" Gov. Palin, btw?
Posted by: TANSTAAFL | Aug 15, 2009 1:20:51 PM
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