I don’t want to go on the cart

by the Night Writer

There is a Monty Python-esque air to the current healthcare debate as I picture anyone actually reading the particulars of Obama-care striking themselves regularly in the forehead with the bill, ala the hooded monks in the opening of Scene 2 in Monty Python and the Holy Grail.  Of course, the rest of that scene bears an uncanny resemblence to the proposed care as well, as I noted back in 2005 in a post entitled “21st Century British Healthcare.” Things really haven’t changed much since 2005, or since 1100 for that matter:

(Monty Python and the Holy Grail, Scene 2)
CART MASTER: Bring out your dead!
CUSTOMER: Here’s one.
CART MASTER: Ninepence.
DEAD PERSON: I’m not dead!
CUSTOMER: Nothing. Here’s your ninepence.
DEAD PERSON: I’m not dead!

Terminally Ill Can Be Starved to Death, UK Court Rules
By Nicola Brent, CNSNews.com Correspondent, August 02, 2005(CNSNews.com) – An appeal court has denied a terminally ill British man the assurance that his wish not to be starved to death once he becomes incapacitated will be respected to the end.

Former mailman Leslie Burke, 45, has a progressively degenerative disease that although leaving him fully conscious, will eventually rob him of the ability to swallow and communicate.

He petitioned the High Court last year to ensure that he would not be denied food and water once he was no longer able to articulate his wishes.

CART MASTER: ‘Ere. He says he’s not dead!
CUSTOMER: Yes, he is.
CART MASTER: He isn’t?
CUSTOMER: Well, he will be soon. He’s very ill.
DEAD PERSON: I’m getting better!
CUSTOMER: No, you’re not. You’ll be stone dead in a moment.

Burke won that right when judge James Munby ruled that if a patient was mentally competent — or if incapacitated, had made an advance request for treatment — then doctors were bound to provide artificial nutrition or hydration (ANH).

But last May, the General Medical Council (GMC) — the medical licensing authority — took the case to the Appeal Court, arguing that doctors had been placed “in an impossibly difficult position.”

The appeal judges have now agreed, overturning the High Court judgment and upholding GMC guidelines on how to treat incapacitated patients.

CART MASTER: Oh, I can’t take him like that. It’s against regulations.
DEAD PERSON: I don’t want to go on the cart!
CUSTOMER: Oh, don’t be such a baby.
CART MASTER: I can’t take him.
DEAD PERSON: I feel fine!

Those guidelines give doctors the final say in whether a patient should be given life-sustaining “treatment,” a term legally defined to include artificial feeding or hydration.

The latest ruling obliges doctors to provide life-prolonging treatment if a terminally ill and mentally competent patient asks for it.

However, once a patient is no longer able to express his or her wishes or is mentally incapacitated, doctors can withdraw treatment, including ANH, if they consider it to be causing suffering or “overly burdensome.”

Ultimately, the court said, a patient cannot demand treatment the doctor considers to be “adverse to the patient’s clinical needs.”

CUSTOMER: Well, do us a favour.
CUSTOMER: Well, can you hang around a couple of minutes? He won’t be long.
CART MASTER: No, I’ve got to go to the Robinsons’. They’ve lost nine today.
CUSTOMER: Well, when’s your next round?
CART MASTER: Thursday.
DEAD PERSON: I think I’ll go for a walk.

Anti-euthanasia campaigner and author Wesley Smith told Cybercast News Service it was important Burke had taken the case to court because “it is now clear that a patient who can communicate desires cannot have food and water withdrawn.

“That is a line in the sand that is helpful.”

However, he added, the judgment had “cast aside” those who were mentally incompetent or unable to communicate their wishes — “those who bioethicists call non-persons because of incompetence or incommunicability.

“I believe that the judgment clearly implies that the lives of the competent are worth more than the lives of the incompetent since doctors can decide to end life-sustaining medical care, including ANH,” said Smith, a senior fellow at the Discovery Institute and author of Culture of Death: The Assault on Medical Ethics in America.

Burke was quoted as saying in reaction to the ruling that it held “no good news at all” for people who shared his concerns.

In the light of public health service cuts and underfunding, Burke said he was worried about “the decisions that will have to be made” by doctors in the future.

“I have come to realize that there are quite a few people who feel the same way I do,” the Yorkshire Post quoted him as saying. “Not everyone wants to be put down. Not everyone wants their life to be ended prematurely.”

CUSTOMER: You’re not fooling anyone, you know. Look. Isn’t there something you can do?
DEAD PERSON: [singing] I feel happy. I feel happy.
[Cart Master hits him in the head.]

Responding to the court’s ruling, the GMC said it should reassure patients.

The council’s guidelines made it clear “that patients should never be discriminated against on the grounds of disability,” said GMC President Prof. Graeme Catto in a statement.

“We have always said that causing patients to die from starvation and dehydration is absolutely unacceptable practice and unlawful.”

A professor of palliative medicine at Cardiff University, Baroness Ilora Finlay, supported the court ruling. “Stopping futile interventions allows natural death to occur peacefully,” she argued in a British daily newspaper. “This is not euthanasia by the back door.”

But the Disability Rights Commission (DRC) took a different view.

The commission was one of several campaigners, including right-to-life activists and patients’ groups, which had strongly supported Munby’s earlier ruling.

DRC Chairman Bert Massie expressed the group’s dismay at the Appeal Court decision, saying it did nothing to dispel the fears of many disabled people that “some doctors make negative, stereotypical assumptions about their quality of life.”

It had also “totally ignored” the rights of those who were unable to express their wishes, he added.

CUSTOMER: Ah, thanks very much.
CART MASTER: Not at all. See you on Thursday.

The Night Writer’s vote for the funniest line: “Ultimately, the court said, a patient cannot demand treatment the doctor considers to be ‘adverse to the patient’s clinical needs.'” You mean, such as, “Please don’t starve me to death?”

See also Suing to Stay on Life Support.

(Monty Python and the Holy Grail excerpt available here.)

Thanks, Boss, but isn’t there a better way?

I didn’t take in any shows while in Las Vegas, but I did see a presentation on healthcare trends by futurist Andrew Zolli that was almost as eye-popping. According to Zolli, the price of a typical new car in the U.S. includes about $1,000 in materials…and $1,200 in health insurance costs for the men and women who built it.

One of the most significant factors in the perpetually rising cost of healthcare is the distorting effects of employer- and government-paid health insurance that insulates the market from supply and demand. If you have health insurance today it is most likely an employee benefit from your job, thanks to an act of Congress more than 60 years ago. Today at least 25 congressmen would like to undo that. Before you reach for the tar and feathers, however, allow me excerpt a couple of articles that set the stage.

For a little history, here’s what Karl Zinsmeister wrote in the March issue of The American Enterprise magazine (boldface emphasis mine):

The root of this is very simple–and it is an accident of history. During World War II, while strict wage controls forbade companies from paying higher salaries, firms short on labor grew desperate for ways to attract and keep badly needed workers. They discovered the government would let them pay the health costs of employees as a kind of backdoor substitute for increasing their wages. And health benefits, unlike wages, weren’t taxed, a loophole that made them even more attractive to both workers and companies than cash wage increases. Employer-paid health benefits soon became universal and permanent.

The unforeseen side effect was that it became uneconomic for Americans to buy health care for themselves. Why pay your own doctor and insurance bills with after-tax income when your employer can do it with pre-tax dollars? Soon health care seemed like a “free” entitlement to average Americans. Given that something like 80 or 90 percent of our health care costs are now picked up by someone else, it’s no wonder that medical expenditures in the U.S. have soared to 15 percent of our national income (roughly twice the level of countries like Japan, the U.K., and Italy).

What if those World War II employers had offered instead to pay the grocery bills of their workers? Imagine if today hardly anyone handed his own cash to checkout ladies, but instead a food co-op or insurance company selected by your boss covered the costs of whatever food you consumed. You can be sure that 1) You’d be spending a lot less carefully (and a lot more) on groceries today. 2) You’d have much less individual control over your diet. 3) The grocery and food-provision business would be far less efficient and varied and competitive and cost-controlled–almost certainly it would be one of the more troubled sectors of the U.S. economy.

Hmmm, I wonder if opportunistic politicians might be organizing bus rides for seniors to Canada to buy back bacon? Similarly, do you think you’d be happy if the groceries by government plan required you to spend a large chunk of your “benefit” on groceries you didn’t like and didn’t need, even if you never consumed them?