Death Panels: Can We Handle The Truth?

In December, I defended the term death panel.  Specifically, I demonstrated that we already have, and for over 50 years have had, quite a number of tribunals that act as death panels.

For example, at least daily, UNOS denies potentially life-saving organ transplant requests. While the term “death panel” has a pejorative connotation, the essential concept and function is necessary. Particularly in situations of strict scarcity, life and death decisions must be made. They are made. And they will continue to be made.

So, the relevant question is not whether to “have” death panels. Instead, the relevant question is whether we want to openly “acknowledge” our death panels. I am reminded of a famous scene from the 1992 film, A Few Good Men. You will recall that the story revolves around the court martial of two Marines charged with the murder of a fellow Marine. The defendants had administered a “Code Red,” an unofficial punishment, against a fellow member of their unit who was not sufficiently squared away to meet the Corps’ standards.

In the film’s most famous scene, Lt. Kaffee (Tom Cruise) cross examines Col. Jessup (Jack Nicholson) about the Code Red. Lt. Kaffee says, “I want the truth!” Jessup responds:

You can’t handle the truth! Son, we live in a world that has walls, and those walls have to be guarded by men with guns. . . . I have a greater responsibility than you can possibly fathom.

You weep for Santiago and you curse the Marines. You have that luxury. You have the luxury of not knowing what I know, that Santiago’s death, while tragic, probably saved lives. And my existence, while grotesque and incomprehensible to you, saves lives!

You don’t want the truth, because deep down in places you don’t talk about at parties, you want me on that wall.

Col. Jessup’s point is that Code Reds are an invaluable part of close infantry training. But since they are “grotesque,” they are officially discouraged (even prohibited).

Is this the path that we should take with death panels? Since we find them grotesque, should we deny both their necessity and their existence? The argument has been compellingly made. In their 1978 book, Tragic Choices, Guido Calabresi and Phillip Bobbitt argued that the difficult but necessary life-and-death choices entailed in rationing can only be made by hiding them from public scrutiny.

In contrast, others call for open acknowledgement of death panels. For example, in a recent interview with Rolling Stones, Bill Gates rightly observed that we must deny even effective and life-saving medical technology to some people. “The idea that there aren’t trade-offs is an outrageous thing. Most countries know that there are trade-offs, but here, we manage to have the notion that there aren’t any. So that’s unfortunate, to not have people think, ‘Hey, there are finite resources here.’”

Gates is right. Calabresi and Bobbitt are wrong. The disadvantages of a “hide and deny” approach are substantial. First, it makes it more difficult to have our death panels operate in an open and transparent manner. This increases the risk of bias and corruption. Second, it means that they may not operate according to sufficiently deliberated principles. Third, a hide and deny approach means that death panels may not operate in a consistent and uniform manner from region to region. In short, hiding and denying death panels forecloses and delays much needed public discourse over how we want out death panels to operate.

Death panels, while tragic, save lives. And their existence, while grotesque and incomprehensible to many, saves lives. We don’t want the truth, because deep down in places we don’t talk about at parties, we want death panels.

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Categories: Economics, OP-ED, THCB

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6 replies »

  1. The term “Death Panel” when stated outright does scare a lot of people. However, as pointed out, we’ve had these panels for years. When you are denied coverage or the best medical treatment and given something lesser, you are effectively being judged by some type of panel. And if there’s a chance of death in your situation, you’ve been judged by a death panel that denies treatment based on several factors (money being a primary driver). In some cases, they are good in the hospice scenario. In others, when my father had cancer and was denied the newest technology, he was judged by a death panel. Luckily, he paid out of pocket and survived. But how many people have the ability to do that? It will be a very interesting next 10 years to see how the ACA plays out.

  2. When we focus with opprobrium upon death panels it’s like saying we don’t like decisions. We have always had them and will always have them because folks need help in leaving this vale….whether it’s only to stop pushing food to grandma or whether no one can afford an extra-corporeal membrane oxygenator for someone who is 93 years old with COPD.

    Every time we talk to a hospice worker about our loved one, it’s a death panel. Death panels are good, normal, happy, and beneficent. Like them.

  3. This is a great post, and as the other two commentators have correctly noted, we cannot handle the truth. Even more to the point, we are ignorant of many truths. For example, conservatives who slavishly extol market virtues probably don’t want to talk about the fact that embedded throughout the private insurance industry, including the health plan that administer Medicare benefits, are coverage and reimbursement and technology assessment committess and officers whose job it is to determine when, how, and at what price covered members are granted access to particular technologies. Everytime the government or a private health plan makes a judgment about a technology/service and puts in place any kind of administrative or financial barrier, it influences outcomes, up to and including death because someone will be unable to surmount those barriers.

    Then, there are those pesky carriers and intermediaries, long empowered by the federal government to do the same thing for Medicare beneficiaries. Differences among them have created a patchwork quilt of coverage and reimbursement policy for what is supposed to be a national program. Any financial or administrative burden that limits access to a technology or service can impact outcomes, including death.

    As Bubba and Joel said: we can’t handle the truth. I especially like Joel’s point that we too often look for scapegoats. We’re the scapegoats. We are absurdly reliant on the healthcare system to mostly save us from ourselves.

    The conservative meme that Obamacare empowers/creates/promotes death panels is an ignorant position that willfully turns a blind eye to how healthcare in the US actually works and has worked for many decades. (And, I can assure you, I am no defender of this statutory atrocity.)

    Last but not least is the greatest irony of all. In a culture suffused with the concept of due process, one reason people grossly misunderstand the death panel issue, is that there is always a higher power to which an aggrieved party can appeal. For the poor it is God. But, for the wealthy, the connected, and the savvy, it is the courts, administrative law judges, legislators, and, when all else fails, the media, so that their particular case of death avoidance is adjudicated fairly for them, in their view. Thus, the burden of actually taking one for the team will always fall to someone else.

  4. So finally someone writes about the truth to the limits of health care. Bravo! And it is beyond people cannot handle truths, it is about people who can’t handle boundaries, reality, and limits to options.

    Everything going on in health care is limited, whether it be resources, infrastructure, compassion,and caregiving efforts whether it be by providers or family or other people trying to help.

    These idiots who write here at these threads who either are delusional, clueless, or trying to deflect, all are not defendable positions to claim there are infinite resources and efforts. People sometimes have lousy quality of life, have very few options, and die prematurely.

    It sucks but it is what it is. The real topic should be, why must there always be a scapegoat when something does not go well? I would bet some would want to put God on trial for not doing his/her alleged job in allegeldy allowing kids, parents, family members, friends, good people to die.

    Start with the mirror, and when you have honestly and effectively proven perfection and completion to your lives wihout dissent from others, then you can judge. Until then, sorry, but sit down and shut up!

    • If God appeared upon Earth and subjected himself to legal authorities I would imagine that a class action suit might be filed against him on behalf of all those who have died and certainly all those who have died at young ages. Obviously we cannot do so because he can never be taken in and I would not expect him to subject himself to our authority, but you are right I would love to sue God for all dead people since his only way out would be to explain one of the great questions that people have about the existence of a God. If there is an omniscient, omnipresent, and omni-powerful being, then why does he let people die.

      I can judge without being perfect. It would be hypocritical to not be perfect, judge people, and expect no judgement in return. However, since I am willing to be judged I can judge without hypocrisy.

      There are many potential great human goals. It is my belief that maximizing good, maximizing happiness, minimizing pain, minimizing death, minimizing sadness, minimizing anger, living up to our potential, and ensuring the perpetuation of the human race are among these great goals.

      Avoiding justice, judgement, or other trappings of civilization is not a goal that is the “real question.” Death panels must exist to accomplish the goals of the past paragraph. Allocation of resources is the most complex problem mankind has created. Yet, it is certainly better to have the problem than to lack the resources. It is also certainly better that people intend to judge and evaluate such decisions and groups making such decisions than to blindly accept such decisions because people are not perfect. I have never heard a more ill considered notion.

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