Sunday, August 02, 2009

Eugenics: coming to a neighborhood near you!

In the past, eugenics was the purview of Nazi mad doctors, science fiction stories, and academic debate. But now it’s rapidly moving from theory to policy.

The Obama administration is quietly appointing eugenicists to key positions in gov’t:

Washington, DC ( -- Barack Obama has named the lawyer who represented Terri Schiavo’s husband Michael in his efforts to kill his disabled wife as the third highest attorney in the Justice Department. Thomas Perrelli, who won an award for representing Schiavo's former husband, had served on Obama's transition team.
The incoming president made Perrelli an associate attorney general and his appointment is generating scorn from pro-life advocates.
Perrelli provided Michael Schiavo with legal advice during his response to the Congressional bill that President Bush signed allowing the Schindler family to take their lawsuit seeking to prevent Terri’s euthanasia death from state to federal courts.
He led the legal team that developed the legal briefs for Michael opposing appeals and he ultimately received the Albert E. Jenner, Jr. Pro Bono Award in October 2006 for representing Terri’s former husband at no cost.

I have been doing a little reading about Dr. Ezekiel Emanuel, the head bioethicist at the NIH and brother of the president’s chief of staff. He is a supporter of health care rationing, which is relevant to the current health care debate.

The same can’t be said of an article he wrote in the Hastings Center Report, in which he explicitly advocates rationing based on what appears to be a quality of life measurement. From the piece:
“This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity-those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.”

I note with dismay your appointment of Dr. John Holdren as Director of the White House Office of Science and Technology Policy, Assistant to the President for Science and Technology, and Co-Chair of the President's Council of Advisors on Science and Technology.

In 1977 Dr. Holdren and his colleagues Paul and Anne Ehrlich published the book Ecoscience. In it, Holdren and his co-authors endorse the serious consideration of radical measures to reduce the human population, particularly third world populations, such as India, China and Africa. The measures include:
• People who “contribute to social deterioration” (i.e. undesirables) “can be required by law to exercise reproductive responsibility” — in other words, be compelled to have abortions or be sterilized.
• Women — particularly women of insufficient means due to poverty, nationality, marital status, or youth — could be forced to abort their children and undergo sterilization.
• Implementation of a system of "involuntary birth control," in which girls at puberty would be implanted with an infertility device and only could have it removed temporarily if they received permission from the government to have a baby.
• Undesirable populations could be sterilized by infertility drugs intentionally put into drinking water or in food.
• Single mothers and teen mothers who managed to have their children despite measures to prevent fertility should have their babies seized from them and given away to others to raise.
• A transnational “Planetary Regime” and a transnational police force should be assembled to enforce population control.

Holdren also once wrote that a baby was not yet a human being. From the story:
“The fetus, given the opportunity to develop properly before birth, and given the essential early socializing experiences and sufficient nourishing food during the crucial early years after birth, will ultimately develop into a human being,” John P. Holdren, director of the White House Office of Science and Technology Policy, wrote in “Human Ecology: Problems and Solutions.”
This is radical personhood theory, beyond Peter Singer even, in which full moral status may not accrue until years after birth.

This could be bad. Cass R. Sunstein, just appointed by President Obama to be “regulatory czar,” is a big “quality of life” guy in determining the cost/benefit ratio of government regulations. This is the executive summary of a paper he wrote back in 2003 for the Joint Center for Regulatory Studies, entitled “Lives, Life-Years, and Willingness to Pay.” From the paper:
“In protecting safety, health, and the environment, government has increasingly relied on cost-benefit analysis. In undertaking cost-benefit analysis, the government has monetized risks of death through the idea of “value of a statistical life” (VSL), currently assessed at about $6.1 million. Many analysts, however, have suggested that the government should rely instead on the “value of a statistical life year” (VSLY), in a way that would likely result in significantly lower benefits calculations for elderly people, and significantly higher benefits calculations for children. I urge that the government should indeed focus on life-years rather than lives. A program that saves young people produces more welfare than one that saves old people. The hard question involves not whether to undertake this shift, but how to monetize life-years, and here willingness to pay (WTP) [what one would pay to obtain a good] is generally the place to begin…In fact, a focus on statistical lives is more plausibly a form of illicit discrimination than a focus on life years, because the idea of statistical lives treats the years of older people as worth far more than the years of younger people.”

Obama is recommending that the successor agency, IMAC, be smaller and potentially more decisive. Under his plan, the president would name five physicians or other health-care-savvy members to serve for five-year terms on its board, picking one of them as chairman. Like the nominees to the Fed and the Supreme Court, they would have to be confirmed by the Senate.
Each year, IMAC would have two responsibilities. First, it would recommend to the president updated fees that Medicare would pay doctors, hospitals, rehab centers, nursing homes, labs, home-care and ambulance services, equipment manufacturers, and all other providers. That is now done by Congress itself, and the lobbying by potent hometown individuals and institutions is one reason Medicare costs keep growing. To control costs, IMAC's recommendations could not exceed the "aggregate level of net expenditures" under Medicare.
Second, IMAC would annually recommend a set of broader reforms to improve the quality or reduce the cost of medical care. On each report, the president would have 30 days to approve or reject the recommendations, but he would have to act on the whole package, not pick it apart.
If he approved, the package would go to Congress and could be overruled only by joint action of the Senate and House within 30 days. Absent that, the secretary of health and human services would order the changes into effect.

Given that such a board would consist of the ilk of Ezekiel Emanuel, Dan Brock, and Alta Charo–all prominent left-leaning “quality of life” bioethicists–we permit the IMAC to gain control at all our peril.

THE health bills coming out of Congress would put the de cisions about your care in the hands of presidential appointees. They'd decide what plans cover, how much leeway your doctor will have and what seniors get under Medicare.
Yet at least two of President Obama's top health advisers should never be trusted with that power.
Start with Dr. Ezekiel Emanuel, the brother of White House Chief of Staff Rahm Emanuel. He has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research.
Emanuel bluntly admits that the cuts will not be pain-free. "Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely 'lipstick' cost control, more for show and public relations than for true change," he wrote last year (Health Affairs Feb. 27, 2008).
Savings, he writes, will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, "as an imperative to do everything for the patient regardless of the cost or effects on others" (Journal of the American Medical Association, June 18, 2008).
Yes, that's what patients want their doctors to do. But Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else.
Many doctors are horrified by this notion; they'll tell you that a doctor's job is to achieve social justice one patient at a time.
Emanuel, however, believes that "communitarianism" should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those "who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia" (Hastings Center Report, Nov.-Dec. '96).
Translation: Don't give much care to a grandmother with Parkinson's or a child with cerebral palsy.
He explicitly defends discrimination against older patients: "Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years" (Lancet, Jan. 31).
The bills being rushed through Congress will be paid for largely by a $500 billion-plus cut in Medicare over 10 years. Knowing how unpopular the cuts will be, the president's budget director, Peter Orszag, urged Congress this week to delegate its own authority over Medicare to a new, presidentially-appointed bureaucracy that wouldn't be accountable to the public.
Since Medicare was founded in 1965, seniors' lives have been transformed by new medical treatments such as angioplasty, bypass surgery and hip and knee replacements. These innovations allow the elderly to lead active lives. But Emanuel criticizes Americans for being too "enamored with technology" and is determined to reduce access to it.
Dr. David Blumenthal, another key Obama adviser, agrees. He recommends slowing medical innovation to control health spending.
Blumenthal has long advocated government health-spending controls, though he concedes they're "associated with longer waits" and "reduced availability of new and expensive treatments and devices" (New England Journal of Medicine, March 8, 2001). But he calls it "debatable" whether the timely care Americans get is worth the cost. (Ask a cancer patient, and you'll get a different answer. Delay lowers your chances of survival.)
Obama appointed Blumenthal as national coordinator of health-information technology, a job that involves making sure doctors obey electronically deivered guidelines about what care the government deems appropriate and cost effective.
In the April 9 New England Journal of Medicine, Blumenthal predicted that many doctors would resist "embedded clinical decision support" -- a euphemism for computers telling doctors what to do.
Americans need to know what the president's health advisers have in mind for them. Emanuel sees even basic amenities as luxuries and says Americans expect too much: "Hospital rooms in the United States offer more privacy . . . physicians' offices are typically more conveniently located and have parking nearby and more attractive waiting rooms" (JAMA, June 18, 2008).

Bioethicist Dan Brock–one of the radicals in a radical movement–pushes health care rationing over at the Hastings Center Report. (To give you an idea about his views: In Children of Choice, a book he coauthored with two other bioethicists, Brock argued that the state has “a eugenic role…as guardian of the genetic well-being of future generations.”)

Three bioethicists–G. Owen Schaefer, Ezekiel J. Emanuel (Obama Chief of Staff Rahm Emanuael’s brother), and Alan Wertheimer, argue in the JAMA (”The Obligation to Participate in Biomedical Research,”July 1, 2009—Vol 302, No. 1) that we all have a moral “obligation” to “participate in biomedical research.” From the article (no link):
“The obligation to participate in biomedical research makes reasonable demands on all individuals in a society. Participating in research is much less burdensome than contributing to many other public goods; joining the army is more risky and time-consuming than any clinical trial that has been approved by a well-functioning institutional review board. Indeed, paying taxes may be much more burdensome than participating in many research trials…The standard view of research participation must be changed from one in which participation is supererogatory to one in which individuals need to give a good reason not to participate. The shift should be from participation in biomedical research being, like charity, above the call of duty, to such participation being a moral obligation for everyone to do his or her part.”

In addition to the Obama administration, Congressional Democracts have been quietly including eugenic provisions in healthcare legislation:

This current legislation, however, seeks to prevent such costly overuse of health resources through a program of "advance care planning consultation," wherein those on Medicare, or their families, could meet with a "practitioner of advance care planning" every five years, or sooner if illness supervened. Such an adviser need not be a physician, either.
This specialist would discuss care issues such as "the individual's desire regarding transfer to a hospital ... the use of antibiotics and the use of artificially administered nutrition and hydration."
The discussion may, in fact, be triggered if "there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease."
I would be loath to talk a person on dialysis or in a wheelchair from a stroke into forgoing antibiotics for a pneumonia that may itself be treatable.
HR3200 has created tiers of administrators, who do not necessarily have medical experience. They will attempt to facilitate your end-of-life care, probably with the assistance of the electronic medical records each medical facility will shortly be required to use.

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