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Death Panels, Palliative Care, and the Dangers of Modern McCarthyism

McCarthy and CohnIt’s time to fight back. The “death panel” nonsense is not a harmless and amusing political canard – it is modern McCarthyism: the shameless, heinous use of lies and distortions to scare and confuse people. The tide will only turn if all of us begin speaking up for the truth.

Read NY Times piece on palliative care, and you get a sense of the power and beauty of the modern movement to provide patients and families with information and support at the end of life. The piece chronicles the decline and ultimate death of Deborah Migliore, a former topless dancer from the Bronx, from metastatic carcinoid, and the efforts of palliative care specialist Sean O’Mahony to support the patient and her husband through her painful final weeks. The article describes palliative care providers this way:

They are tour guides on the road to death, the equivalent of the ferryman in the Greek myth who accompanied people across the river Styx to the underworld. They argue that a frank acknowledgement of the inevitability of death allows patients to concentrate on improving the quality of their lives, rather than lengthening them, to put their affairs in order and to say goodbye before it is too late.

This has been precisely my experience working with our extraordinary palliative care team at UCSF. So I was pleased to see some support for palliative care embedded into the early versions of health reform legislation.

Then came Sarah Palin and the other hypocritical asses who have managed to take a serious, even profound, issue and turn it into a mockery. Read Joe Klein’s article in this week’s Time magazine to get your blood boiling. Klein begins with a poignant discussion of the end-of-life issues he’s grapping with for his elderly parents, but then – after the obligatory “there are still a few reasonable Republicans out there… somewhere” riff – gets to the point:

… But they have been overwhelmed by nihilists and hypocrites more interested in destroying the opposition and gaining power than in the public weal. The philosophically supple party that existed as recently as George H.W. Bush’s presidency has been obliterated. The party’s putative intellectuals — people like the Weekly Standard’s William Kristol — are prosaic tacticians who make precious few substantive arguments but oppose health-care reform mostly because passage would help Barack Obama’s political prospects. In 1993, when the Clintons tried health-care reform, the Republican John Chafee offered a creative (in fact, superior) alternative — which Kristol quashed with his famous “Don’t Help Clinton” fax to the troops. There is no Republican health-care alternative in 2009. The same people who rail against a government takeover of health care tried to enforce a government takeover of Terri Schiavo’s end-of-life decisions. And when Palin floated the “death panel” canard, the number of prominent Republicans who rose up to call her out could be counted on one hand.

Is this modern McCarthyism? Klein argues that it may be worse, because in those times:

… the crazies were a faction — often a powerful faction — of the Republican Party, but they didn’t run it. The neofascist Father Coughlin had a huge radio audience in the 1930s, but he didn’t have the power to control and silence the elected leaders of the party that Limbaugh — who, if not the party’s leader, is certainly the most powerful Republican extant — does now. Until recently, the Republican Party contained a strong moderate wing. It was a Republican, the lawyer Joseph Welch, who delivered the coup de grâce to Senator McCarthy when he said, “Have you no sense of decency, sir, at long last?” Where is the Republican who would dare say that to Rush Limbaugh, who has compared the President of the United States to Adolf Hitler?

Good on you, Barney Frank, for silencing the loony woman at his town hall meeting after she made such a comparison. As for our President, it is time for him to channel a little Barney Frank – and Machiavelli – and get tough. There can, and should, be reasonable disagreements about health reform, but the Fox News/Town Hall crowd is not interested in negotiation, or progress, or bettering the lives of our citizens – they are ideologues hell bent on destruction, gamesmanship, and Neilsen ratings. It is time to use all the tools at the Administration’s disposal to out the truth and fix what’s wrong with American healthcare.

It can be done, but it’ll take a fight. So let’s have one.

Robert Wachter is widely regarded as a leading figure in the modern patient safety movement. Together with Dr. Lee Goldman, he coined the term “hospitalist” in an influential 1996 essay in The New England Journal of Medicine. His most recent book, Understanding Patient Safety, (McGraw-Hill, 2008) examines the factors that have contributed to what is often described as “an epidemic” facing American hospitals. His posts appear semi-regularly on THCB and on his own blog “Wachter’s World,” where this post first appeared.

More on THCB by this author:

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EHS studentmamiejannaCicelyVictor MisrockMelodie Miller Recent comment authors
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EHS student
Guest
EHS student

Please take my health care survey for my AP Government class. Here is the link.
http://www.surveymonkey.com/s.aspx?sm=C0cJjk_2fBoRkfZUp1UrGRSQ_3d_3d
Thank You

mamiejanna
Guest
mamiejanna

I used to have a girlfriend who was a palliative care nurse. She was very emotionally involved in her work. She cared very much for the patients who were in her ward. She took it very personally when they died. I think that when a patient is admitted into the palliative care unit, they are in the best care that they can possibly receive. The people who work in these units understand that this is the end for the people who come into their care and they treat them like they’re royalty because they need it. They have enough crap,… Read more »

Cicely
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Cicely

As a hospice nurse for 6 years, I can attest to the need for end -of -life counseling. And it needs to occur long before it’s needed. Those unfamiliar with end-of -life issues and decisions need to become educated on the facts for themselves. These issues have nothing to do with “death panels”. Advance directives are based on each person’s individual choice in the kind of care desired at the end of life. I have met so many patients and families that have not made plans for end-of-life care. There are many decisions to be made and much information is… Read more »

Victor Misrock
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Victor Misrock

Death Panels are REAL. Please check out this interview:
http://www.youtube.com/watch?v=LQE0vNEcb8k

Victor Misrock
Guest
Victor Misrock

Death Panels are REAL. Please check out this interview:
<“>http://www.youtube.com/watch?v=LQE0vNEcb8k&gt;

Melodie Miller
Guest

NO NEED TO FEAR END OF LIFE COUNSELING My father died 2 years ago last month. Collectively, as a family, we chose to care for him at home for the last 2 months of his life. We enlisted Hospice for end of life counseling which was a God sent. Hospice walked us thru ever step of death, what we should expect and how to care for our father during this time. Hospice was available at all hours of the day and night to answer questions and squelch our fears. This is end of life counseling. At a time when all… Read more »

J.D. Kleinke
Guest

Amen, Bob. The health care reform debate has been turned into a fetid dumping ground not just for right-wing fanatics and the disgruntled fools who follow them, but for the sprawling, unconscious anxieties of people who know nothing about medicine or how health care financing and delivery really works. Death panels? Puh-leeze! Aside from those transparently on the anti-Obama warpath, what is really driving the hysteria about the belated modernization of reimbursement for end-of-life care is nothing more complicated than fear: an unalloyed fear of death, a primordial revulsion at the gruesome reality that awaits all of us sooner or… Read more »

Just Sayin
Guest

What is wrong with death panels anyway?
http://justsayin06.blogspot.com/

frank patton
Guest

http://www.youtube.com/watch?v=l_WKSJWc79w
… a simple video message: everybody in, nobody out

Nate
Guest
Nate

It’s the Liberal Math, no wonder I don’t understand your support for Medicare. It’s like the new Math the left tried to teach in schools for awhile. Everyone should be forced to pay into an insolvant plan even though everyone knows it is insolvant. In Private Insurance when a plan is deemed insolvant they immediatly have to stop adding business, otherwise you exasperates the insolvancy, and the plan is quickly disbanded. Healthy risk is moved to other functioning plans, along with some of the bad risk as a requirement to take the good. Any toxic business is wound down and… Read more »

Peter
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Peter

“Why is my grandmother opting out of Medicare?”
No she wouldn’t, or any other grandma, but if you and thousands of others opt out where will the money come from to pay grandma? The fund is already underfunded.
“I rather die because I can’t afford to buy care then die becuase the government outlaws me buying it.”
Does this make sense to anyone?

Nate
Guest
Nate

d’cm, I have no idea how the GOP plan would do anything they claim nor do I care for the GOP plan, it’s almost as worthless and the Democrat’s plan. My point was disproving the blatant lies from the left that the GOP doesn’t have any plans. That is why I copied and pasted the quote and put ” and ” around it. I never commented nor supported it. Joe Klien is full of BS as is almost all of the reporting comming from the media. I have seen multiple “journalist” make this same claim.

d'cm
Guest
d'cm

In response to Nate: I just read the GOP’s outline for healthcare reform aaaannd how is this all that different than the Dem’s? One thing that struck me was paragraph 6 under the Cost Savings section: ” Provides Medicare and Medicaid with additional authority and resources to stop waste, fraud, and abuse that costs taxpayers billions of dollars every year”. Nate, how is the GOP going to do that AND stay true to the promise to “4.Ensure that medical decisions are made by patients and their doctors, not government bureaucrats.”? Nate, who do you think generates the most waste, fraud… Read more »

d'cm
Guest
d'cm

I was looking at a patient in my hospital today, she is in unresponsive even to painful stimuli from a massive stroke, she is kept alive by a ventilator and hemodialysis. The family insists we “do everything possible”. And I thought, “death panels sound like a good idea.” I mean why should the taxpayer shoulder the financial burden of this futile technology. It isn’t healthcare, it’s death prolonging pathology and it would be great to hand the decision to some faceless panel to decide to pull the plug – or hand the bill to the family.

Nate
Guest
Nate

just so you don’t put any more words in my mouth let me make it clear for you;
I rather die because I can’t afford to buy care then die becuase the government outlaws me buying it. Or outlaws a provider from selling it to me, or any of the other numerous ways politicians can find to ration care.