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Guest commentary: Return of the death panels

Guest commentary: Return of the death panels

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On July 16, 2009, Betsy McCaughey coined the term "death panel." It was quickly picked up by Michele Bachmann and parroted by Sarah Palin. These women with ties to the Tea Party movement were opposed to the Obama health care plan. Of the three, only McCaughey noted that a provision promoting counseling for the elderly around issues at the end of life was a good thing. The idea, of course, was to have patients and families think about what they would want done if they became severely ill.

McCaughey's objection mainly was that the provision seemed to suggest that the elderly, once they had become gravely ill, would be bound to that earlier decision.

As too often happens in today's political circuses, what had been a thoughtful question — should patients really be bound by an earlier life-or-death decision? — mutated into that political monster known as a sound bite. Thus was birthed the "death panel."

In a recent Republican presidential debate, U.S. Rep. Ron Paul, R-Texas, was put on the spot about his position on health care financing. Moderator Wolf Blitzer of CNN asked him if a 30-year-old man who had decided not to purchase medical insurance and who had come down with a severe illness requiring six months in the intensive care unit should be allowed to die because he lacked health insurance. Paul stated that his advice to the young man would have been to purchase a medical plan, but that the great thing about freedom is that it was the young man's choice.

Blitzer pressed him, asking if the young man should be allowed to die. Before Paul could answer, some people in the crowd full of Tea Partiers shouted "Yes!" just as Paul, a physician, said, "No." Paul went on to make a nuanced point about having practiced in a different climate prior to Medicaid. His point was that under a different schema of health care financing, people find ways to take care of other people.

How is it that the Tea Party now is in favor of "death panels," where a panel of doctors and administrators decide whether health care should be stopped, this time based on a wallet biopsy rather than the age?

Raymond DeVries, a sociologist, has suggested that we have spent too much time focusing on the financing of health care as if the problem were an economic one. The real problem, DeVries suggests, is one of culture. His point is that if you scratch the surface of the economic debate on health care, you find that there are larger cultural forces at work.

I generally agree with DeVries; but as a philosopher, I would tweak his point a bit. If you scratch the surface of the health care finance debate, you find not merely cultural, but also metaphysical and moral systems beneath them.

The U.S. political system was built on the fundamental commitment that religious belief can be separated from public matters. Put into non-religious terms, the U.S. political system is built on the fundamental commitment that deeply held beliefs about morality and what it means to be human are private matters, goods of the home rather than goods of the polis. In other words, we all share life in common, but the meaning and value of that life is a private matter.

Yet, one of the fundamental truths about human life is that we are social animals, dependent on one another biologically and economically for life. So, we fight over financing, but this economic war is just a proxy for the wars over deeply held beliefs about life, death, freedom and necessity.

The use of money is intimately tied to the moral values we hold, especially around questions at the margins of human life — birth and death. Both economic and biological well-being are intimately tied to our material well-being.

The liberals who said that the idea of death panels purely was fabricated have to realize that if there is going to be public funding of health care, there inevitably will be some sort of balancing of public values with private values around life and death.

Conservatives and Tea Party members who cried that "death panels devalue human life" will have to realize that when they shouted "Yes!" in response to Blitzer's question, they were in part acting as a death panel might act.

In other words, "death panels" are inevitable because one cannot with great ease unpick the dependency of human life on its material foundations, both biological and economic. I do not mean a secret panel of people making life-and-death decisions. Here I mean a group of people gathered around a patient weighing all of the material factors that support life with the values that make it meaningful.

It also will mean that we cannot preclude the private morals and private understandings of human life from the political process. Until we recognize this, we never will be able to solve the economic problem.

Dr. Jeffrey P. Bishop holds the Tenet Endowed Chair in Health Care Ethics at St. Louis University and wrote "The Anticipatory Corpse: Medicine, Power, and the Care of the Dying," (University of Notre Dame Press, 2011).

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