A program of the Center for Inquiry
The following article is from the Secular Humanist Bulletin, Volume 25, Number 3 (Fall 2009).
In the rhetorical pie fight that has largely supplanted serious debate about health-care reform, conservative ideologues have flung wildly false accusations about “death panels.” Reform advocates have been so eager to prove they weren’t really scheming to “pull the plug on Grandma” that many caved in on almost everything they were advocating that might have catalyzed real change.
There’s a bigger problem here. If out-of-control health-care costs truly constitute the crisis everyone says they do, why aren’t we hearing more about euthanasia, physician-assisted suicide, or decisions patients and their families can make to scale back bloated end-of-life care? Why aren’t we hearing that dreaded R-word—you know, rationing? Let me ask the unthinkable: Why aren’t we talking about death panels?
And why isn’t the secular humanist community front-and-center in launching this debate?
Let’s begin by admitting that we face a true crisis. Thirty percent of all Medicare dollars go to patients in their last year of life. Half of that is expended in the final sixty days. According to physician Jeff Gordon, author of a forthcoming book, A Death Prolonged, that’s something on the order of $70 billion a year squandered on care most of which neither cures nor palliates but simply prolongs suffering. Even a fraction of that $70 billion could go a long way toward insuring the uninsured. This raises a moral dilemma: Where resources are limited, health-care dollars are far better spent curing a child of a treatable disease or preventing diabetes in a young adult than in keeping the heart of a terminal patient beating for another day. And remember, resources are limited; spending $70 billion on terminal care means that those dollars are unavailable for uses that might do far more good.
Which is where I’d suggest the secular humanist community comes in. Think back to the 1960s when organ transplantation and new technologies to extend basal metabolism forced society to modify traditional definitions of life and death. Secular humanist thinkers like Joseph Fletcher and Marvin Kohl were at the forefront of sweeping reforms. Death was redefined as the cessation of brain function, making possible the harvesting of viable organs. The idea that patients or their families could opt for less than “everything that can be done” in the face of terminal illness was established. These ideas were hugely controversial at the time. Early on, they seemed unthinkable. We owe a great debt to secular humanist ethicists and philosophers who kept thinking, writing, and debating the unthinkable until genuine reform took hold.
Today, reform is urgently needed once again. In part because of our aging population, in part because there is so much more that medicine can do to prolong basal metabolism in patients who are never, ever going to recover quality of life, health care is becoming unsustainable. Public debate about the crisis consumes vast energies, yet doesn’t reach meaningful conclusions—not surprisingly, because so many solutions that cry out for exploration remain unthinkable.
Even such mainstream commentators as Peter Steinfels and Jane Brody of The New York Times have admitted discomfort about what’s not being said in today’s health-care debate. (See the articles cited below.) Thinking the unthinkable is one of the things secular humanists do best. It’s time for our community to come forward and, if need be, force a discussion of the hard questions that fester beneath the shallow analysis exchanged between television talking heads. Studies show that patients and family members significantly—and voluntarily—reduce their consumption of costly end-of-life care if physicians simply have frank conversations with them about terminal-care options. More directive measures, including rationing and yes, even “death panels,” may be needed when patients or family members insist—all too often, out of religious commitment—that doctors “do all they can.” If nothing else, American society needs to engage with the unthinkable, as it did in the 1960s, if we hope to find a responsible solution to today’s health-care funding crisis.
Tom Flynn is the executive director of the Council for Secular Humanism and the editor of Free Inquiry.