Humanize | From Discovery Institute's Center on Human Exceptionalism

Medical syringe in the doctor's hands on the patient's in room h

^{Type
post

Author
Wesley J. Smith

Date
April 17, 2020

Categorized
Euthanasia

Tagged
assisted suicide, Belgium, Canada, Coronavirus, delirium, euthanasia, Germany, Groningen protocol, human experimentation, infanticide, Jack Kevorkian, Joseph Tushkowski, MAiD, medical assistance in dying, medical diagnosis, Michael Freeland, Netherlands, organ donation, pediatricians, Prescription Medicide, quadriplegia, sanctity-of-life ethic, The American Journal of Psychiatry, utilitarianism}

The Jack Kevorkian Plague

_{Wesley J. Smith

April 17, 2020

Euthanasia}

Death is in the air. No, I am not referring to the coronavirus. The pathogen I mean is a cultural pandemic, the embrace of doctor-prescribed suicide and of administered homicide as acceptable responses to human suffering. Let’s call it the “Jack Kevorkian Plague,” after the late pathologist who in the 1990s became world-famous by assisting the suicides of some 130 people. Before Kevorkian, the euthanasia movement was mostly a fringe phenomenon. After Kevorkian, although certainly not because of him alone, assisted suicide had been made legal in Oregon, and large swaths of the American public accepted the practice. Now, a mere 20 years later, lethal-injection euthanasia is legal and popular in Belgium, Canada, Colombia, Luxembourg, and the Netherlands. Doctor-assisted suicide is legal in Germany, Switzerland, the Australian states of Victoria and Western Australia, and nine U.S. states and the District of Columbia. Pressure to legalize euthanasia is increasing in Australia, France, India, Italy, New Zealand, Portugal, Spain, and the United Kingdom. The media report stories about euthanasia and assisted suicide generally through the limited prism of “compassion.” Kevorkian attempted to justify his campaign likewise. But compassion was never his true motive. As he wrote in his book Prescription Medicide: The Goodness of a Planned Death, “Helping suffering or doomed persons kill themselves” was “merely the first step, an early distasteful obligation…that nobody in his right mind would savor.” Not About Compassion So, if it wasn’t about compassion, what was the real point? Kevorkian saw euthanasia as the perfect means to steer culture in a sharply utilitarian direction. Indeed, his great insight was that once society embraced that “distasteful first step,” the sanctity-of-life ethic — which he disdained, seeing it as an irrational religious belief — would be obliterated, and the door would be opened to using the bodies of people who commit suicide as natural resources available for utilitarian purposes. Kevorkian gave several examples of what he meant. He thought that euthanasia clinics should be established that “make the quantum leap of supplementing merciful killing with the enormously positive benefit of experimentation and organ donation.” After all, he argued, if we are going to help people die, we might as well derive benefit from their deaths. In 1998 he assisted the suicide of Joseph Tushkowski, a former police officer with quadriplegia. After Tushkowski died, Kevorkian ripped out the man’s kidneys — the medical examiner called it “a bizarre mutilation” — and then at a press conference offered them to the public, “first come, first served.” Three Countries Today, three countries —Belgium, Canada, and the Netherlands — have legally effectuated Kevorkian’s idea to join euthanasia to organ harvesting, although they don’t do it in such a crude fashion. Rather, suicidal persons go to the hospital to be killed, and immediately afterward their bodies are moved to a surgical suite for organ procurement. Canada has gone so far down the road that organ-donation organizations are advised in advance so that suicidal persons can be solicited for their organs. Kevorkian also advocated child euthanasia. In 1988, in an article in Medicine and Law, he argued that babies born with disabilities “such as severe spina bifida, paraplegia, and hydrocephalus” should be candidates for euthanasia (and experimentation), provided that proper consent were given. Today, under a bureaucratic euthanasia checklist known as the Groningen Protocol, the Netherlands permits, although it has not explicitly legalized, infanticide for conditions of the kind that Kevorkian referenced. Netherlands law permits euthanasia more broadly for children twelve years of age and older. In Belgium, there is no lower age limit for euthanasia. According to official euthanasia reports, in the past few years at least three children in Belgium have been euthanized, including a nine-year-old. Children in Canada cannot be euthanized, but that restriction may soon be repealed. Some pediatricians there have volunteered to euthanize minors once it becomes legal, perhaps even without parental consent, if the children are “mature.” A Fundamental Right Kevorkian believed that access to assisted suicide and euthanasia is a fundamental human right that should be available to any competent person wanting to die. Canada’s Supreme Court has partially agreed. In 2015 it established a right to “medical assistance in dying (MAiD),” as it is euphemistically called, for all competent patients with a medically diagnosed condition that causes “irremediable suffering,” including “psychological pain.” An Ontario court has ruled that this right to be killed is fundamental and that it trumps Canada’s Charter right of “freedom of religion and conscience.” Under the province’s rules of medical ethics, physicians who by religion or conscience are opposed to lethally injecting a sick patient must do so anyway or refer the patient to a doctor they know is willing to kill. If they don’t want to be complicit in such deaths, the court sniffed, they should get out of medicine. Canada’s broad euthanasia license still requires an underlying medical diagnosis. Kevorkian opposed any such restriction. In Prescription Medicide he wrote that “optional assisted suicide” should be “available for individuals, sometimes in good physical and mental health who choose to be killed,” for whatever reason, including “physical (the end stage of incurable disease, crippling deformity, or severe trauma), mental (intense anxiety or psychic torture inflicted by self or others), or doxastic (religious or philosophical tenets or inflexible personal convictions).” In Germany, Death as a Right The Federal Constitutional Court in Germany recently ruled that such death on demand is a right. From the decision: The right to a self-determined death is not limited to situations defined by external causes like serious or incurable illnesses, nor does it apply only in certain stages of life or illness. Rather, this right is guaranteed in all stages of a person’s existence. . . . The individual’s decision to end their own life, based on how they personally define quality of life and a meaningful existence, eludes any evaluation on the basis of general values, religious dogmas, societal norms for dealing with life and death, or consideration of objective rationality. Kevorkian, too, thought that individuals should have a right to assisted suicide and that Read More ›

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post

Author
Wesley J. Smith

Date
April 15, 2020

Categorized
Conscience

Tagged
catholicism, faith-based organizations, new england journal of medicine, religious hospitals}

Catholic Hospitals Under Attack

_{Wesley J. Smith

April 15, 2020

Conscience}

Catholic hospitals are under unremitting attack — from prestigious medical journals, media, and lawyers in courtrooms. The goal is to coerce these venerable institutions into replacing their faith-based methods of medical practice with secular moral standards that deny the sanctity of human life.

A recent article in the New England Journal of Medicine — perhaps the world’s most influential medical publication — illustrates the threat to medical conscience rights. Ian D. Wolfe and Thaddeus M. Pope, two prominent bioethicists, fret that one in six U.S. hospitals is “affiliated with a Catholic health system.” This is a problem, in their view, because religiously-affiliated hospitals often “refuse to provide legally permitted health services on the basis of institutional belief structures.” The authors are referring to services like abortion, sterilization (absent a pathology), assisted suicide (where legal), and transgender sex reassignment surgeries that alter a body’s normal biological functions. Refusing such procedures, the authors claim, leads to “substantial risks for patient choice, patient safety, and the fundamental principle of autonomy.”

Patient choice? Yes, sometimes. If a woman requests an abortion and the hospital says no, she is not getting what she wants. But safety? The Ethical and Religious Directives for Catholic Health Care Services allow Catholic hospitals to refuse interventions that violate Church belief, but nonetheless require that all patients receive proper care. That includes providing “all reasonable information about the essential nature of the proposed treatment and its benefits; its risks, side-effects, consequences, and cost; and any reasonable and morally legitimate alternative.” In practice, this may also include referring patients to non-Catholic institutions.

Worries over “safety” are more likely a deflection to mask anti-religious bigotry. Charles C. Camosy, associate professor of theological and social ethics at Fordham University, believes that in many circumstances, the motive for attacking Catholic medicine “is about raw power. Certain influential people don’t want certain [medical] choices denied, so they try to use their power make things the way they want them to be.”

COVID-19 Adult Stem-Cell Trials: A Hopeful Sign

_{Wesley J. Smith

April 3, 2020

Stem Cell Research}

I was disappointed in Governor Andrew Cuomo’s dour statement that “we will never be the same” and we that we won’t “get back to normal. There will be a new normal.” I understand he is dealing with excruciating issues of life and death, but given the history of the United States, such pessimism is unwarranted. We have faced far worse than this and have moved through the pain into a better tomorrow. We will this time too. Here’s a small reason for optimism. In addition to vaccine research, the potential of malaria drugs, and antiviral testing, adult stem cells are also being deployed in current or imminent human trials for treating the physical effects of the COVID-19 virus. One early study on seven patients with corona viral pneumonia has been completed with hopeful results. From the study published in Aging and Disease: The pulmonary function and symptoms of these seven patients were significantly improved in 2 days after MSC [Mesenchymal stem cells] transplantation. Among them, two common and one severe patient were recovered and discharged in 10 days after treatment. After treatment, the peripheral lymphocytes were increased, the C-reactive protein decreased, and the overactivated cytokine-secreting immune cells CXCR3+CD4+ T cells, CXCR3+CD8+ T cells, and CXCR3+ NK cells disappeared in 3-6 days. The scientists’ conclusion about the potential of these stem cells? The intravenous transplantation of MSCs was safe and effective for treatment in patients with COVID-19 pneumonia, especially for the patients in critically severe condition. Is This a “Cure”? No, it is not a cure. Much more work remains to be done to even get close to saying it is. But it is a hopeful sign (among many). As we mourn the dead, succor the ill, hunker down in social isolation, and aid the suddenly unemployed, let’s not lose sight of the fact that progress is being made. And that’s the point. With the public and private sectors energetically engaged in finding treatments and vaccines, manufacturing durable medical equipment, keeping food on our tables, electricity in our homes, and caring for the sick, this too shall pass. We will thrive again.

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post

Author
Wesley J. Smith

Date
April 2, 2020

Categorized
Patient Care

Tagged
age-based rationing, Coronavirus, Health Care Rationing, pandemic, rationing}

Coronavirus: Triage if Necessary, Health-Care Rationing, Never

_{A hard look at the worst-case scenario for medical treatment.} _{Wesley J. Smith

April 2, 2020

Patient Care}

With the raging coronavirus pandemic threatening millions with infection, people are rightly worried that we could face the awful circumstance in which there are insufficient life-saving medical resources available for all catastrophically ill patients needing care. If that dark day comes, decisions will literally have to be made as to who among the seriously ill will be given an optimal chance to fight for life under intensive medical care, and who may have to face a likely death, albeit under palliative care. All over the country, doctors, bioethicists, policymakers, hospital administrators, and media commentators are discussing how to make such extremely difficult decisions if they become necessary. That’s proper and fitting. As the old saying goes, hope for the best and plan for the worst. Moreover, it is wise to create a well-thought-out plan that can be followed consistently in awful contingencies to prevent ad hoc approaches that invite life-and-death decisions to be based on cronyism, discrimination, or other unjust non-medical factors If doctors must refuse needed care, morality and maintaining the people’s trust require that they always be executed in a manner wholly consistent with upholding the equal moral worth of all patients. In other words, decisions to withhold or withdraw treatments — chance for life or likelihood of death — should never be predicated on invidious distinctions, such as race, sex, wealth, age, sexual orientation, disability, etc. Or to put it another way, each patient who enters the regrettable to treat or not to treat decision-making process must do so as the inherent equal of every other patient. In this regard, we should distinguish between “triage” — which is ethical — and “health-care rationing,” which, as I use the term in this article, is not. Triage involves doctors or other medical professionals assessing the differing chances for survival among patients who would all be eligible for extensive treatment, but all of whom can’t be served because of resource limitations. In that circumstance, those patients with the greater likelihood of surviving the crisis because of the intervention will receive priority in receiving treatment over those more likely to die even with care. In this sense, triage is a medical determination, not an ideological one. It treats all patients as equals and bases hard decisions on the same objective criteria of assessing survivability regardless of the personal characteristics of each person. A subset of survivability has to do with the number of years a patient is likely to live if they receive the care. Assume three patients arrive at a hospital emergency room who are all likely to survive with an intensive intervention, but there is only one available ICU unit. The patients are ages 10, 45, and 80. In this awful circumstance, all other factors being equal, the 10-year-old should receive the intervention because he or she is likely to live more years than either the 45- or 80-year-old. Now assume that two coronavirus patients need ICU care, with only one such bed available. Both are equally likely to benefit. One has terminal cancer and will probably die within a year, while the other patient is otherwise healthy. In all likelihood, the healthy patient would receive the care over the dying patient, again not because the healthy patient’s life is deemed to be more important but because of the likelihood that patient will experience more years of living after recovering. Note, we are not talking about judgments based on the supposed quality of those years. A disabled 10-year old would still receive priority over the able-bodied middle age and elderly patients unless the disability were so severe that it would limit the patient’s odds of survival. In this way, the judgments are based on objective criteria, not decisions about which patient life has greater value. Now, let’s contrast the triage approach with discriminatory health-care rationing. Rationing is a very broad concept, of course, but as I am using the term in this article, it means medical discrimination, e.g., offering medical care to some patients but withholding it from others based on an ideological approach that sees some lives as being more important or as having greater value than others. Age-based rationing is a classic example of this unethical approach. Thus, in parts of Italy, all patients with coronavirus over age 60 are reportedly being refused intubation — regardless of the likelihood that the treatment would save the life of a particular patient. This is inherently discriminatory and unethical. As Dr. Daniel Sulmasy wrote recently in the New York Daily News: Older age or disability might be factors in determining the chances that a patient will benefit from treatment, but age and disability per se should not be reasons to withhold treatment in the first place. Our judgments about who gets treatment should be based on whether the treatment is worthwhile, not on whether the patient is “worthy” of treatment. The “QALY” system of rationing also should never be allowed because it is inherently discriminatory and crassly utilitarian. QALY stands for “quality adjusted life year,” a system that presumes that all lives are not equal. Here’s a brief — and very simplified — overview of how the QALY system might operate in the current crisis: Let’s say Mark and I both need ICU care to survive the virus, but there is only one bed available. At age 70, I am able-bodied and generally healthy, and if I survive the crisis, I could be expected to live another 10 years. Under the QALY system, my 10 years of physical life expectancy might be measured as, say, eight QALYs (with a two-year demerit for the potential losses associated with advancing age). Now, let’s say Mark is 65 and has diabetes currently being successfully treated. A few years previously, he was injured in an auto accident, which left him using a wheelchair and in continual pain only partially controlled with medication. Under a QALY approach, his life could be deemed of lower “quality” than mine because of his illness and disability. Even though coronavirus treatment would be expected to give him more years of life than me, he might be denigrated as having only Read More ›

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post

Author
Wesley J. Smith

Date
March 25, 2020

Categorized
Human Exceptionalism}

Nevada Governor Partially Bars Use of Malaria Drug for Coronavirus

_{Wesley J. Smith

March 25, 2020

Human Exceptionalism}

Some not bright people tragically poison themselves with a fish-tank cleaner because an ingredient in the compound is similar to those in the anti-malaria drugs that anecdotally have helped people deathly ill with coronavirus. Then, Nevada governor Steve Sisolak signs an emergency order preventing the medications’ use treating the virus in Nevada, which certainly seems extreme. What’s going on? Predictably, the AP story blames Trump: Nevada’s governor has signed an emergency order barring the use of anti-malaria drugs for someone who has the coronavirus. Democratic Gov. Steve Sisolak’s order Tuesday restricting chloroquine and hydroxychloroquine comes after President Donald Trump touted the medication as a treatment for the virus. Trump last week falsely stated that the Food and Drug Administration had just approved the use of chloroquine to treat patients infected with coronavirus. After the FDA’s chief said the drug still needs to be tested for that use, Trump overstated the drug’s potential benefits in containing the virus. Sisolak said in a statement that there’s no consensus among experts or Nevada doctors that the drugs can treat people with COVID-19 . . . The governor’s rule comes a day after a Phoenix-area man died and his wife was in critical condition from taking an additive used to clean fish tanks known as chloroquine phosphate, similar to the drug used to treat malaria. Where to start? First, the medicine has to be prescribed by a doctor. You can’t just go out and buy it. Second, Trump never said the FDA had approved the drug for this use. He said he was ordering the FDA to fast-track the testing for this use since the drug had already gone through the approval process for other uses. That is absolutely true, and that included safety testing and an understanding of the potential side effects. Prescribing hydroxychloroquine for coronavirus before that investigation is complete would be what is known as an “off-label” use — which is legal. Indeed, Trump specifically said it was for “compassionate use,” that is, to save someone who would otherwise be likely to die. There have been cases in France, for example, where it seems to have helped. Dr. Fauci did not say he opposed using the drug for compassionate prescribing, but that (properly) he couldn’t say it would work because it hadn’t been tested. New York governor Andrew Cuomo has also supported trying the drug because of its positive anecdotal potential, to the point that the state obtained 70,000 doses and is about to start clinical use trials in New York. A more accurate story about the governor’s order says it was done at the request of the Nevada State Board of Pharmacy as a preventative against hoarding, to make sure that patients who need it for FDA-approved purposes don’t run out. There are ways to do that. For example, the governor’s order prevented prescriptions for more than 30 days for its other uses, which is fine. The new regulation contains an exception for inpatient prescribing. The medication may have saved at least one patient already in the United States. From a New York Post story: [Rio] Giardinieri said he contacted an infectious disease doctor about the drug [when his other doctors told him there was nothing they could do]. “He gave me all the reasons why I would probably not want to try it because there are no trials, there’s no testing, it was not something that was approved,” said Giardinieri. “And I said, ‘Look, I don’t know if I’m going to make it until the morning,’ because at that point I really thought I was coming to the end because I couldn’t breathe anymore,” Giardinieri continued. “He agreed and authorized the use of it and 30 minutes later the nurse gave it to me.” After about an hour after taking the pills, Giardinieri said, it felt like his heart was beating out of his chest and, about two hours later, he had another episode where he couldn’t breathe. He says he was given Benadryl and some other drugs and that when he woke up around 4:45 a.m., it was “like nothing ever happened.”33 He’s since had no fever or pain and can breathe again. Giardinieri said doctors believe the episodes he experienced were not a reaction to the medicine but his body fighting off the virus . . . “To me, there was no doubt in mind that I wouldn’t make it until morning,” said Giardinieri. “So to me, the drug saved my life.” This situation needed a scalpel, not a sledgehammer. Update: The Nevada governor’s office has now contacted me to advise that the regulation does contain an exception for inpatient prescribing. The post has been corrected.

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post

Author
Wesley J. Smith

Date
March 22, 2020

Categorized
Abortion, Conscience

Tagged
argentina, medical conscience}

Argentinian Doctor Sentenced to Prison for Refusing to Terminate Pregnancy

_{Wesley J. Smith

March 22, 2020

Abortion, Conscience}

In Sweden, midwives can be fired and deemed unemployable for refusing abortion. In Ontario, Canada, doctors can face professional discipline for refusing to administer (or refer for) euthanasia. Ditto to refusing an abortion in Victoria, Australia. In California, a Catholic hospital is being sued — with the explicit blessing of the courts — for refusing to allow a transgender hysterectomy. But now in Argentina, the right to obtain an abortion has been declared so fundamental that an objecting M.D. can be held criminally culpable for refusing to terminate a pregnancy. An Impossibility? That would seem to be a moral and legal impossibility. But Argentina just elevated the “medical conscience” controversy to a whole new level of concern — from the potential of not “only” having one’s professional license revoked, but also, to the loss of personal freedom for refusing to act against personal conscience based on deeply held religious, moral, or professional beliefs. From the BioEdgestory: An Argentine court has upheld the criminal conviction of a gynaecologist who refused to abort the child of a rape victim in 2017. Dr Leandro Rodriguez Lastra was sentencedto a 14-month suspended jail term, plus 28 months of disqualification from holding public office. Dr Rodriguez Lastro will appeal. The victim was a 19-year-old in her fifth month of pregnancy, the result of sexual abuse by a relative. At first she used an abortion drug provided by an NGO. That failed and she was referred to the hospital where Rodríguez Lastra was head of gynecology. The doctor said that abortion posed a risk to both the unborn child and the mother. However, the judges said that the only thing necessary for a legal termination of pregnancy was a formal request from the rape victim. The child was later given up for adoption. It’s almost as if the court considered the doctor to be a co-conspirator with the rapist. Adding to the topsy-turvy nature of that decision, instead of being dead the baby is alive in the world. Shouldn’t that outcome, at least, be a cause for celebration instead of condemnation in this difficult circumstance? An Affront to “Autonomy” How can a doctor be imprisoned for obeying the Hippocratic Oath? Lastra is a licensed professional and the court decided that refusing to abort constituted a “failure to comply with the duties of a public official,” which was an affront to the mother’s “autonomy.” The BioEdge story quotes the court’s ruling: “Faced with the intersection of so many vulnerabilities, the accused ignored the autonomy of the young woman, giving priority to the reproductive function that she symbolized as a woman, over her dignity, over her right to health and to be informed, accompanied, contained and respected in the process of interrupting the pregnancy, an interruption to which she had a right over any other right or interest”. “ … ignoring a woman’s voice, ignoring her vital needs, subjugating reproductive rights, devastating the psyche and enslaving the body in order to force pregnancy after a rape, means denying the victim’s status as a subject of rights and is the incarnation of gender violence in its most painful form”. And here’s a telling twist to the story: A few years ago, a different Argentinian court granted an orangutan a writ of habeas corpus to be released from a zoo. So, an ape was declared a wrongfully imprisoned “person,” while a doctor was declared a criminal for refusing to take innocent human life. I can write those words. I understand their meaning. But I can’t comprehend such an utter rejection of human exceptionalism.

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post

Author
Wesley J. Smith

Date
March 20, 2020

Categorized
Patient Care

Tagged
quality of life, rationing}

No to “Quality of Life” Coronavirus Healthcare Rationing

_{Wesley J. Smith

March 20, 2020

Patient Care}

In a world of bioethicists who primarily eschew the sanctity/equality of life ethic, Fordham University’s Charles Camosy is a refreshing ethicist worthy of the title. Read More ›

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post

Author
Wesley J. Smith

Date
March 16, 2020

Categorized
Euthanasia}

Creating a Disposable Caste of People is a Bad Idea

_{Wesley J. Smith

March 16, 2020

Euthanasia}

I write in National Review this morning on the latest push to make euthanasia lawful: If you want to see what may soon go wrong in public policy, just read the professional literature. Bioethics journals are particularly illuminating in this regard because many of the leading voices in the field long ago discarded the sanctity/equality of life for the utilitarianish “quality of life” ethic, which grants higher value to some over others based on invidious distinctions such as disability, age, and health. An advocacy article in the current Clinical Ethics provides a case in point. In, “Counting the Cost of Denying Assisted Dying,” an academic bioethicist and a business management professor support legalizing euthanasia… You’ll have to read the full piece to understand the complete “why” behind this push. I underscore that “the authors hope to persuade us that society has a utilitarian stake in allowing the sick, the mentally ill, the elderly, and people with disabilities to be killed.” As with so many attacks on human dignity and human rights, the activists pushing here for euthanasia don’t simply want it to be a legal option—”safe, legal, and rare”, if you will—but rather the logic behind the push seeks a broad social acceptance of euthanasia as if it were a positive social good. “This advocacy,” I note, “is both immoral and amoral. It creates a disposable caste of people and reduces the sick and suicidal to mere beans for the counters to enter on spreadsheets.” We must do better.

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post

Author
Wesley J. Smith

Date
March 12, 2020

Categorized
Human Exceptionalism

Tagged
Coronavirus}

Biden’s Coronavirus Adviser Wants to Die at 75

_{Wesley J. Smith

March 12, 2020

Human Exceptionalism}

Joe Biden has announced the creation of a “Public Health Advisory Committee,” consisting of Democratic experts to advise him about how to best grapple with the coronavirus during the campaign. The bioethicist Ezekiel Emanuel — the most famous person on the committee — made headlines a few years ago by writing that he wants to die at age 75 before becoming "feeble, ineffectual". Joe Biden is 77. Read More ›

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post

Author
Tom Shakely

Date
March 11, 2020

Categorized
Conscience, Human Dignity}

Bloomberg: A Patient’s Care is ‘Futile’ if We Decide the Patient Has Little Value

_{Tom Shakely

March 11, 2020

Conscience, Human Dignity}

Mike Bloomberg’s presidential campaign is over, but I want to return to something Bloomberg once said that was brought up by reporter Peter Hasson during Bloomberg’s most recent campaign that speaks to a fundamental issue in healthcare issue: Billionaire and Democratic presidential candidate Michael Bloomberg said in a 2011 video that some elderly cancer patients should be denied treatment in order to cut health care costs. He drew on a hypothetical example of a “95-year old” with “prostate cancer” to signal an openness he would have to reform how Medicare provides treatment. “All of these costs keep going up, nobody wants to pay any more money, and at the rate we’re going, health care is going to bankrupt us,” said Bloomberg, who was then New York City’s mayor. “We’ve got to sit here and say which things we’re going to do, and which things we’re not, nobody wants to do that. Y’know, if you show up with prostate cancer, you’re 95 years old, we should say, ‘Go and enjoy. Have a nice [inaudible]. Live a long life. There’s no cure, and we can’t do anything.’ If you’re a young person, we should do something about it,” Bloomberg said in the video. “If those of us in positions of power, from our perspective, decide your life isn’t very valuable, then we’ll lie to you and let you die from a curable ailment,” to put Mike Bloomberg’s point more directly. I’m grateful for Bloomberg’s candor, even as I abhor his moral indifference to distinctly vulnerable persons, because he’s saying what no other politicians can say so bluntly: their plan is to constrain costs by denying care—even care that works and would save lives. Hello, death panels. When politicians advance rationing in healthcare, and especially when they advance rationing of care that would work, they’re stigmatizing particular types of patients and warping a medical phrase called “futile care”. “Futile care” once referred to situations where specific medical interventions no longer achieved their purpose of sustaining human life. If a person’s body is failing, and, for instance, can no longer metabolize food and water, then the specific intervention of food and water by tube would become “futile” as the patient nears death. No amount of food and water will help a person who can no longer metabolize it. That intervention is no longer efficacious, although the person herself remains equally valuable and retains her basic dignity even as she approaches death from natural causes. To put it simply, care becomes “futile” when it stops working. This is the traditional and medical understanding of futile care. It’s simple and it makes sense. Bloomberg was advocating categorizing certain persons as “futile”—i.e. medical discrimination based on invidious categories such as age. Making matters worse, Bloomberg endorsed lying about it: Tell older patients facing a curable disease, “There’s no cure, and we can’t do anything,” and tell younger patients we can “do something about it”. What would that do to trust in medical professionals? “We have the best healthcare system in the world and simultaneously the worst healthcare financing system in the world.” I’ve heard some version of this from many people. It’s helpful for thinking about the true challenge of American healthcare. We should be working to achieve accuracy and transparency when it comes to the problem of the inflated and inscrutable prices associated with healthcare delivery. The answers cannot lie in sanctioning professional mendacity or creating disposable categories of patients to be abandoned because we think their lives have less value than other patients. Certain cures are worse than the disease.