James Poulos has an interesting piece about so-called “death panels” at the American Scene. Poulos begins his examination with this observation about some of the conlficts between conservatism and liberalsm.
The archetypal or stereotypical conservative would say that even an old, isolated person has a reason to reject suicide that reaches to the foundations of what makes us human and what gives humans dignity. The archetypal or stereotypical progressive would say that conservatives need to abandon their romantic and/or religious fantasies that a dying person finds more dignity in enduring great suffering until their body fails than in choosing to die beforehand.
My immediate response was that this is a totally false dichotomy. Election of palliative treatment rather than a costly and quixotic attempt to prolong one’s life is simply not the same thing as suicide. By the same standard, any conscious decision not to pursue the most life-prolonging behavior is suicide. Fortunately, Poulos realizes this, bringing us back to the actual issue at stake.
By now it might be clear that I’ve been sliding back and forth between the assumption that enduring a terminal illness will be a natural or hands-off process versus one full of medication, treatment, and care. Possibly the final question about dignity that bears on our health care debate pertains less to choosing suicide than accepting death. But even this question is conditioned by the reality that choosing between acceptance and choice is made more human by doing so with one’s family. Unfortunately, ‘more human’ might not mean more painless or even more uplifting. Struggling with mortality can often be harder and messier with family than in isolation.
So perhaps the root moral issue behind the death panel debate actually just throws us back onto the question of whether we should choose to permit the government to influence this, one of our most difficult decisions, at one of our most vulnerable or susceptible moments. Because it appears the government at that moment would tend strongly to have greater confidence, and less at stake, than any of us.
It’s worth remembering that the specific provision would allow Medicare to reimburse doctors who provide counseling on end-of-life services and living wills to patients who request those services. The notion that the government is going to be nudging seniors towards specific end-of-life options is just a little bit paranoid.
On another level, this fear speaks to one of the key differences between how conservatives and liberals view the government. Certainly, there are some bureaucratic entities that will fight tooth and nail for their own survival — the clandestine services comes to mind — but with respect to social welfare programs, they are popular insofar as they meet the demands of society. Medicare does not serve the government. It serves society. If, for some reason — and I think it would be a horrible idea — Medicare actually did nudge doctors to “pull the plug on grandma,” this would be a societal decision. It would have to be a policy with a constituency, enacted by people whose jobs are subject to the votes of other people. If Americans don’t want Medicare to pull the plug, it won’t. There’s simply no constituency to euthanize the elderly.