There's a consensus now apparently

Dr. Atul Gawande, a surgeon at Brigham and Women’s Hospital, is quoted in the Boston Herald celebrating a consensus reached in his state:

Massachusetts is really leading the way on this. It led the way on universal health care, on gay marriage, and it’s leading the way on this, too.

The two named successes were in politics superseding common sense and the desires of the customer (here called the “patient” for some reason). The people reaching the consensus are a coalition of four large teaching hospitals.

The issue on which they have now reached consensus, they call “quality of life.” No, that is a slogan on which they reached consensus. The issue is euthanasia.

“Death is not a failure,” reads the headline of this Herald op-ed, though most customers do not see the doctor for help dying but for help avoiding dying. “Medical students will be required to have conversations with people about breaking difficult news, prognosis and end-of-life planning.” No one can object to conversations, but when tin gods get to pick the “people” with whom one is required to converse, the result is not conversations but advocacy. Perhaps, in time, customers (patients) “will be required to have conversations” with the doctor about how comfortable death can be, compared to the awkwardness of imposing all that cost on the government budget to keep you alive. “It’s an important shift, [Gawande] said, from the fix-it mentality that many doctors are taught to possess.”

At the end of this road — the Massachusetts road, in which the doctor does not serve his customer (patient) but serves society by performing enlightened herd management (including culling the weak and infirm) — is Denmark, which triumphantly announced that it had eradicated Down’s Syndrome by simply aborting all who suffered from it. This is the road of blurring reality by holding that “health” is something that pertains to society and not the paying customer (patient). Ah, but he is rarely paying, these days.

Assuming death is the only option and studying how to maximize quality is a gigantic false choice, inevitable when the customer (patient) is not the one making the choices. This is the real, gigantic risk of making the government the paying customer.

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9 COMMENTS

    • With respect – bollocks.

      This has nothing to do with NHS budgets and everything to do with the rights of the child. This was addressed in the Gard case. I quote the relevant part of the judgement:

      “Thirdly, I think it my duty to comment briefly on the absurd notion which has appeared in recent days that Charlie has been a prisoner of the National Health Service or that the National Health Service has the power to decide Charlie’s fate. This is the antithesis of the truth. In this country children have rights independent of their parents. Almost all of the time parents make decisions about what is in the best interests of their children and so it should be. Just occasionally, however, there will be circumstances such as here where a hospital and parents are unable to decide what is in the best interests of a child who is a patient at that hospital. It is precisely because the hospital does not have power in respect of that child that this hospital makes an application to the court, to an independent judge, for a determination of what is in that child’s best interests.

      In circumstances where there is a dispute between parents and the hospital, it was essential that Charlie was himself independently represented and a guardian was therefore appointed to represent Charlie so that there was someone who could independently report to the court as to what was in his best interests. Our judges are fiercely independent of the state and make decisions, having heard evidence and having considered the law. Our law in relation to children in circumstances such as this is governed by section 1 of the Children Act 1989 which contains a proposition which I suggest would be hard to criticise. Section 1 provides as follows: “when a court determines any question with respect to the upbringing of a child the child’s welfare shall be the court’s paramount consideration”.

      The application which GOSH made in April and which they bring now is guided by that simple proposition. I set that out in April in detail in my judgment it is neither necessary nor appropriate for me to do so again now. However, I do encourage the many commentators who wish to opine on this case to have regard to what I said in that April judgment and to what was said subsequent to it by the Court of Appeal, Supreme Court, and the European Court of Human Rights.

      My task has been to consider what is in Charlie’s best interests and it is that that I have done. The hospital trust correctly applied to the family division of the High Court for the exercise of the
      High Court’s independent judgment.”

      American commentators are covering stuff which they have no understanding of. This case nothing to do with NHS budgets and everything to do with the law.

  1. Eric Burdon and the Animals sang, “It’s my life and I’ll do what I want.” Dr. Alban sang, “It’s my life.” Jon Bon Jovi sang, “It’s my life.” And we all cheered and applauded. But let someone say, “It’s my life and I’ll end it if I want,” and everyone loses their minds. We are not dealing with the sane and the rational here.

    • No sir, ownership implies disposition, and the option to commit suicide (with or without medical help) is an essential part of owning oneself. What I object to the attempt to convert the health industry into the demise industry, by gadflies indifferent to the values of the customer.

  2. While doctors should have a fix it mentality there is also a point where they have to realise they can’t and teaching them how to deal with that better wouldn’t hurt, my fathers palliative care was a battle and given his daughter in laws were both nursing sisters (ICU and Midwife) I hate to think how difficult it is for people who don’t have insight into the system

  3. My mother has already had a conversation with me as to the circumstances that I should end her life (and a proper conversation, not some half-comments). It is basically somewhere in circumstances between my Mum’s mum (pretty much blind but enjoying life) and my Dad’s mum (kept alive by the State but barely existing).

    I have no problems with palliative care being available, nor it being recommended in some circumstances. I do have an issue with treatment being the default under all circumstances. The main problem that I have is that if there isn’t anything specifically wrong with you but you no longer wish to continuing existing (I won’t call it living as it isn’t a life) that this isn’t an option to most people. Indeed when/if it comes to me making the arrangements to fly my mum to a more civilised country so that she can end her life, I will be breaking the law.

    What is it that feminists say? “My body, my choice”. This is one of the circumstances when this phrase is totally true.

    • Oh, and my Dad, being Catholic, is happy to leave it to God to determine how long his life should be. Which is his choice to make and a decision that I totally respect; even though it is a decision that I personally wouldn’t make for myself.

  4. Being married to a nurse who spent 15 years working in Intensive Care I have very explicit instructions as to what to do in various circumstances, as with James conversation they don’t all accord with current legal medical practices.