Death Panel Watch

Bankruptcy Boys

2010-02-23T15:49:00.000-08:00

http://www.nytimes.com/2010/02/22/opinion/22krugman.html?ref=opinion

February 22, 2010 by The New York Times
by The New York Times
by Paul Krugman

O.K., the beast is starving. Now what? That’s the question confronting Republicans. But they’re refusing to answer, or even to engage in any serious discussion about what to do.

For readers who don’t know what I’m talking about: ever since Reagan, the G.O.P. has been run by people who want a much smaller government. In the famous words of the activist Grover Norquist, conservatives want to get the government “down to the size where we can drown it in the bathtub.”

But there has always been a political problem with this agenda. Voters may say that they oppose big government, but the programs that actually dominate federal spending — Medicare, Medicaid and Social Security — are very popular. So how can the public be persuaded to accept large spending cuts?

The conservative answer, which evolved in the late 1970s, would be dubbed “starving the beast” during the Reagan years. The idea — propounded by many members of the conservative intelligentsia, from Alan Greenspan to Irving Kristol — was basically that sympathetic politicians should engage in a game of bait and switch. Rather than proposing unpopular spending cuts, Republicans would push through popular tax cuts, with the deliberate intention of worsening the government’s fiscal position. Spending cuts could then be sold as a necessity rather than a choice, the only way to eliminate an unsustainable budget deficit.

And the deficit came. True, more than half of this year’s budget deficit is the result of the Great Recession, which has both depressed revenues and required a temporary surge in spending to contain the damage. But even when the crisis is over, the budget will remain deeply in the red, largely as a result of Bush-era tax cuts (and Bush-era unfunded wars). And the combination of an aging population and rising medical costs will, unless something is done, lead to explosive debt growth after 2020.

So the beast is starving, as planned. It should be time, then, for conservatives to explain which parts of the beast they want to cut. And President Obama has, in effect, invited them to do just that, by calling for a bipartisan deficit commission.

Many progressives were deeply worried by this proposal, fearing that it would turn into a kind of Trojan horse — in particular, that the commission would end up reviving the long-standing Republican goal of gutting Social Security. But they needn’t have worried: Senate Republicans overwhelmingly voted against legislation that would have created a commission with some actual power, and it is unlikely that anything meaningful will come from the much weaker commission Mr. Obama established by executive order.

Why are Republicans reluctant to sit down and talk? Because they would then be forced to put up or shut up. Since they’re adamantly opposed to reducing the deficit with tax increases, they would have to explain what spending they want to cut. And guess what? After three decades of preparing the ground for this moment, they’re still not willing to do that.

In fact, conservatives have backed away from spending cuts they themselves proposed in the past. In the 1990s, for example, Republicans in Congress tried to force through sharp cuts in Medicare. But now they have made opposition to any effort to spend Medicare funds more wisely the core of their campaign against health care reform (death panels!). And presidential hopefuls say things like this, from Gov. Tim Pawlenty of Minnesota: “I don’t think anybody’s gonna go back now and say, Let’s abolish, or reduce, Medicare and Medicaid.”

What about Social Security? Five years ago the Bush administration proposed limiting future payments to upper- and middle-income workers, in effect means-testing retirement benefits. But in December, The Wall Street Journal’s editorial page denounced any such means-testing, because “middle- and upper-middle-class (i.e., G.O.P.) voters would get less than they were promised in return for a lifetime of payroll taxes.” (Hmm. Since when do conservatives openly admit that the G.O.P. is the party of the affluent?)

At this point, then, Republicans insist that the deficit must be eliminated, but they’re not willing either to raise taxes or to support cuts in any major government programs. And they’re not willing to participate in serious bipartisan discussions, either, because that might force them to explain their plan — and there isn’t any plan, except to regain power.

But there is a kind of logic to the current Republican position: in effect, the party is doubling down on starve-the-beast. Depriving the government of revenue, it turns out, wasn’t enough to push politicians into dismantling the welfare state. So now the de facto strategy is to oppose any responsible action until we are in the midst of a fiscal catastrophe. You read it here first.

Copyright 2010 The New York Times Company

Palin's 'Lie of the Year' Was Not a Misunderstanding

2009-12-24T12:54:00.001-08:00

Palin's 'Lie of the Year' Was Not a Misunderstanding
By Matt Gertz, Media Matters for America
December 23, 2009
http://www.alternet.org/bloggers/http://mediamatters.org//144771/

Reporting on Sarah Palin's response to Politifact naming her claim that Democratic health care bills contain a "death panel," Politico's Ben Smith suggests that it's possible that this has all been a big misunderstanding:

She was talking about, she now says, the Medicare Advisory Board, in combination with forecasted declines in Medicare spending:

[...]

In the haze of confusion over this issue, some of Palin's defenders had equated her words with a measure, since dropped, to provide of end-of-life counseling.

Contrary to Smith's suggestion, back in September, when asked what Palin was referring to when she said that under reform, "Obama's 'death panel' " would "decide" whether her parents or her son Trig, who has Down syndrome, were "worthy of health care," Palin spokeswoman Meghan Stapleton responded in an email to ABC's Jake Tapper: "From HR3200 p. 425 see 'Advance Care Planning Consultation'."

That is, of course, the very provision serial health care misinformer Betsy McCaughey had referred to in claiming that the House health care reform bill would "absolutely require" end-of-life counseling for seniors "that will tell them how to end their life sooner." The media subsequently debunked McCaughey and Palin's claims more than 40 times.

Either Palin's own spokesperson was caught up in that same "haze of confusion"... or Palin is cynically changing her definitions in an attempt to preserve her credibility.

Oh, and the Medicare Advisory Board isn't a "death panel" either.

Sarah Palin: 'Death panels' may be in final healthcare reform bill

2009-12-23T14:06:00.000-08:00

Sarah and her death panels!

http://thehill.com/blogs/blog-briefing-room/news/73371-palin-death-panels-may-be-in-final-health-bill

Sarah Palin: 'Death panels' may be in final healthcare reform bill
By Jordan Fabian - 12/22/09 01:33 PM ET

Former Alaska Gov. Sarah Palin (R) on Tuesday said that the forthcoming merged healthcare bill could contain the so-called "death panels" she first mentioned over the summer.

Palin took to Twitter, saying that the merged bill could be "unrecognizable" from the House and Senate bills:

...merged bill may b unrecognizable from what assumed was a done deal:R death panels back in?what's punishment 4not purchasing mandated HC?

The 2008 GOP vice presidential nominee added that opponents of the healthcare bill should "pay more attention" now that President Barack Obama is "threatening" to pass the overhaul:

NOW w/the Prez "threatening" &Congress "rushing" is when we MUST pay more attention than ever 2what this HealthCare Takeover is all about...

Palin's comments come as the Senate is moving closer toward voting to end debate on its version of healthcare reform legislation. Should the Senate pass its bill, negotiators from both chambers will merge the two bills that have several substantiative differences.

Several House Democrats have said they would push hard to include provisions from their bill in the final version despite the fact that the Senate is expected to hold the upper hand in negotiations.

In her first "death panel" charge, Palin wrote in a Facebook note that seniors "have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,'" under the healthcare legislation favored by President Barack Obama and congressional Democrats.

The former governor also repeated the allegation in November.

The charge has raised the ire of the bill's supporters, who said it was not true.

On Tuesday, the office of House Speaker Nancy Pelosi (D-Calif.) circulated a Politifact.com report that had selected the "death panel" charge as its "Lie of the Year."

Palin said on Twitter she would write a new Facebook note about healthcare reform shortly.

Would euthanasia damage doctors?

2009-11-18T13:51:00.000-08:00

http://www.mercatornet.com/articles/view/would_euthanasia_damage_doctors/

Margaret Somerville | Wednesday, 18 November 2009
Would euthanasia damage doctors?

Legalising euthanasia will have incalculable consequences for healthcare professionals.
Last week, the Quebec College of Physicians and Surgeons tentatively approved euthanasia. That means it's essential that we look, specifically, at the impact that euthanasia would have on physicians and the profession of medicine, in order to understand why this approval is a very bad idea.

In mainstream media, and therefore in the general public forum, the euthanasia debate has been focused, almost entirely, on the impact that legalizing euthanasia (a term I use in this article to include physician-assisted suicide) would have at the individual level. But we must also consider the impact legalizing it would have at institutional, governmental and societal levels. We need to explore not only the practical realities, such as the possibilities for abuse, that allowing euthanasia would open up, but also, the effect that doing so would have on important values and symbols that make up the intangible fabric that constitutes our society.

For example, what would be its likely impact on major societal institutions, such as medicine and law, which help to establish those values and carry the message of the need to respect them?

Legalizing euthanasia would damage the foundational societal value of respect for human life. If euthanasia is involved, how we die cannot be just a private matter of self-determination and personal beliefs, because, as American philosopher Daniel Callahan says, "Euthanasia is an act that requires two people to make it possible and a complicit society to make it acceptable." The British House of Lords, likewise, rejects euthanasia because of the harm it would cause to societal values and institutions: "The prohibition on intentionally killing is the cornerstone of law and human relationships, emphasizing our basic equality."

One important reason to protect health-care institutions is that they are value-creating, value-carrying and consensus-forming for society as a whole.

In a secular, pluralistic society, medicine and law are the principal institutions that maintain the value of respect for human life in society as a whole. Changing the law to allow physicians to carry out euthanasia -- making an exception to the norm that we must not kill each other --would seriously damage these institutions' capacity to carry that value.

In short, we need to be concerned about the impact that legalizing euthanasia would have on the institution of medicine, not only in the interests of protecting it for its own sake, but also because of the harm to society that damage to the profession would cause.

And what might be the impact of the legalization of euthanasia, internally, on the profession of medicine and its practitioners?

As the Canadian Medical Association wrote in a letter distributed to all members of Parliament just before the first debate on Bill C-384, "CMA's policy on this matter is clear: 'Canadian physicians should not participate in euthanasia or assisted suicide'." And surveys consistently show that physicians in various countries are more opposed to euthanasia than the general public. For instance, a 2009 survey by the British Royal College of Physicians showed 73 per cent of its members opposed euthanasia, whereas up to 82 per cent of the British general public approved of it. Important insights could be gained by pondering the causes of such disparities.

Euthanasia takes physicians and medicine beyond their fundamental roles of caring, healing and curing, whenever possible. It involves them, no matter how compassionate their motives, in the infliction of death on those for whom they provide care and treatment. It can be described, as the London-based Institute of Medical Ethics does in its report, "Working Party on the Ethics of Prolonging Life and Assisting Death," as "a merciful act of clinical care," or, as the Quebec College of Physicians and Surgeons characterizes it, "part of appropriate care in certain particular circumstances" and, therefore, it may seem appropriate for physicians to administer. But the same act is also accurately described as "killing." This means, as American psychiatrist and ethicist Willard Gaylin put it, that euthanasia places "the very soul of medicine on trial."

There are very few institutions in today's secular societies, if any, with which everyone identifies except for those -- such as medicine -- that make up the health-care system. These, therefore, are of unusual importance when it comes to carrying values, creating them, and forming consensus around them. We must take great care not to harm their capacities in this regard and, consequently, must ask whether legalizing euthanasia would run a high risk of causing this type of harm.

The kinds of questions we need to ask include: How would legalizing euthanasia affect medical and nursing education? What impact would physician role models carrying out euthanasia have on medical students and young physicians? Would we devote time to teaching students how to administer death through lethal injection? (There has been a medical malpractice case in the Netherlands for "botched" euthanasia -- the patient didn't die.) Would they be brutalized or ethically desensitized? (And we cannot afford to underestimate the desensitization and brutalization from carrying out euthanasia.) Do we adequately teach pain-relief treatment at present? Would euthanasia be a required procedure, that is, a student must perform it competently, in order to graduate? Can we even imagine teaching medical students how to kill their patients?

A fundamental value and attitude that we reinforce in medical students, interns and residents, and in nurses, is an absolute repugnance to killing patients. It would be very difficult to communicate to future physicians and nurses such a repugnance in the context of legalized euthanasia.

Physicians' and nurses' absolute rejection of intentionally inflicting death is necessary to maintaining people's and society's trust in both their own physicians and the profession of medicine as a whole. This is true, in part, because physicians and nurses have opportunities to kill that are not open to other people.

Physicians and nurses need a clear line that powerfully manifests to them, their patients, and society that they do not inflict death. Both their patients and the public need to know with absolute certainty -- and be able to trust -- that is the case. Anything that blurs that line, damages that trust, or makes physicians or nurses less sensitive to primary obligations to protect and respect life is unacceptable. Legalizing euthanasia would do all of these.

Consider the outraged reactions against physicians carrying out capital punishment through lethal injection -- the same procedure as euthanasia -- when laws provide for them to do so. We do not consider their involvement acceptable -- not even for those physicians who personally are in favour of capital punishment. We, as a society, need to say powerfully, consistently, and unambiguously, that killing each other is wrong (except as a last resort to save human life, as in self defence), and we can't do that if we legalize euthanasia.

It is sometimes remarked that physicians have difficulty in accepting death, especially the deaths of their patients. This raises the question of whether, in inculcating a total repugnance to killing, we have evoked a repugnance to death as well. In short, there might be confusion between inflicting death and death itself. We know that failure to accept death, when allowing death to occur would be appropriate, can lead to overzealous and harmful measures to sustain life. We are most likely to elicit a repugnance to killing, while fostering an acceptance of death, and to avoid confusion between these, if we speak of a repugnance to killing (although that is an emotionally powerful word).

Moreover, it is a very important part of the art of medicine to sense and respect the mystery of life and death, to hold this mystery in trust, and to hand it on to future generations -- including future generations of physicians. We need to consider deeply whether legalizing euthanasia would threaten this art, this trust, and this legacy.

Finally, it's a controversial suggestion, but it has been proposed that if we were to legalize euthanasia, we should take the "medical cloak" off it, that is, physicians should not be the ones to carry it out. Some of the reasons are discussed above, but other reasons include that it causes people to fear physicians, to fear accepting pain relief treatment, and to fear hospice and palliative medicine and care. As well, placing a medical cloak on euthanasia makes it seem safe, ethical and humane, because those are the characteristics we associate automatically with medical care, when, in fact, we all need to question the acceptability of legalizing euthanasia.

One suggestion for alternative practitioners, that has shocked even people who are euthanasia advocates, is to consider having specially trained lawyers. The justification put forward for this choice is that they understand how to properly interpret and strictly apply laws and, for these people, ensuring that is the major concern, not euthanasia itself. One of my physician friends, who supports euthanasia, responded to this suggestion with, "Margo, we can't have lawyers killing people!" I agree wholeheartedly, and neither should we have physicians killing people.

Margaret Somerville is director of the Centre for Medicine, Ethics and Law at McGill University, and author of The Ethical Imagination: Journeys of the Human Spirit.

Give me ObamaCare and my grandmom is doomed?

2009-11-15T11:45:00.000-08:00

http://www.mercatornet.com/articles/view/give_me_obamacare_and_my_grandmom_is_doomed/

Summer Johnson | Friday, 13 November 2009
Give me ObamaCare and my grandmom is doomed?

The case for: a leading American bioethicist defends the Obama Administration’s proposals as fairer, cheaper and more trustworthy.

What is the system now?

The current United States healthcare system can be summarized in a few words: under-performing, over-priced, and inequitable. Unlike the UK or Canada, the US has for a large employer-based healthcare system, which means that many -- children and adults -- receive healthcare benefits via their employer. The remainder receives benefits from three other government sponsored programs: Medicaid (for those of a socioeconomic status too low to be able to afford to pay for health insurance and do not qualify for employer-based insurance) and Medicare (for those over the age of 65) and the Veterans Administration system. There are a few other categories of individuals who qualify for these government programs including the chronically disabled, etc, but this is it in a nutshell.

So if I had to add a fourth word to describe the United States healthcare system I would use: potpourri; and I don’t mean the good smelling kind. I mean a mish-mash of systems and providers. Worst of all, when the United States has an unemployment rate of 9.5 percent as of October 2009, this adds another nearly 10 percent of people who cannot receive insurance via their employer. This is where an employer-based system of providing healthcare coverage breaks down.

There must be another way. Millions of Americans are using COBRA (short-term gap coverage for recently terminated employees offered by employers) now subsidized by the government now under ARRA, plus Medicare, plus Medicaid. Thus, the public option so hated by critics of reform is doing quite well, thank you, IS effectively providing health insurance for a HUGE proportion of the nation. Failing to extend insurance options to the rest of the American 45.7 million Americans is a true moral failing.

What will the new system probably look like?

The "new system", most commonly known as the "public option", scares many people because critics have obscured the fact that most Americans use government sponsored healthcare -- including everyone in Congress.

However, in fact the current proposal passed by the House of Representatives this past Sunday simply adds one more option to what everyone has. There will still be private insurers; patients will still be able to choose whatever doctors they want. Choice will still be a huge part of the "new system."

"So what has changed?" one might ask. The federal government is guaranteeing that there will be a federally run insurance program that will be available to all Americans, the same insurance program that Senators and Congressmen use, and it will allow an additional 90 percent or more of uninsured Americans to have access to health insurance. This program is most likely to be utilized by the young who cannot afford insurance premiums in the earliest years of their careers and the working poor who cannot afford premiums or who are not offered insurance in their jobs. The program will compete directly with private insurers, hopefully driving prices down, and creating greater competition in the healthcare market -- something all free market capitalists love! This could result in a reduction of premiums by 25 percent within the next 5 years. Yet private insurance plans will still exist and will still be available just as they always have been -- so the employer-based insurance system we know and some love will persevere.

This system would allow for public provision of health insurance options with the provision of care from any provider patients choose. This kind of system would put us in very good company. Canada, Western Europe, Japan, Australia, New Zealand and Taiwan all do it -- and with far better health outcomes and far less healthcare spending.

Is the fear over Obamacare "death panels" exaggerated?

Absolutely.

I mean, come on, "death panels"? When I first heard this expression, I assumed that the Grim Reaper would be one of the committee members.

Then I read the ridiculous stories about how Ezekiel Emanuel wanted to kill my grandmother, I laughed out loud. Anyone who ever has even met Zeke knows that he’s an oncologist by medical training and would prefer that people NOT die of cancer, for one, or anything else for that matter.

Second, his argument -- —which is actually quite sound -- simply says that we have to allocate effort to different cases according to those who will receive the most benefit from the care we give them. This is the nature of rationing, which all healthcare systems have. So tough choices have to be made in situations when there are scarce resources. But on these panels, no one is going to make decisions about individuals. No one is going to say, "Washington is calling. It’s time to turn off Grandmother’s ventilator. She’s costing the public health insurance plan too much money."

Americans have to trust someone to make the big decisions. For more than 40 years they have trusted private insurance companies, whether they have been aware of it or not, to make the decisions about whether Aunt Sue gets that angioplasty or that new drug. It really isn’t the doctor. Doctors recommend; insurers approve. Anyone who has ever received a denial letter from an insurance company knows that.

So the question is whether Americans are willing to trust the United States government to set the healthcare budget and provide a third way to have access to healthcare for all, reduce overall healthcare spending, and hopefully over the long term improve healthcare outcomes.

I can’t see how we can do worse than we are doing now. I really can’t.

Can you trust members of the ethics committee to treat patients with dignity?

Healthcare professionals treat patients with dignity, not government panels. They take their needs and interests into account. But it is doctors who provide the care, not health policy advisors.

In the context of health reform, it is the job of policy analysts and health advisors to ensure that the system will provide the well, the sick and the dying with adequate care.

Much ado has been made of President Obama’s "Independent Medicare Advisory Panels", but I would happily put Harvard’s Atul Gawande MD and the National Institutes of Health’s Ezekiel Emanuel MD, PhD in a room with former Governor and vice-presidential candidate Sarah Palin and let them duke it out over health reform any day and let the chips fall where they may. They have two MDs and one PhD on their side; she has rhetoric and a moose gun.

Yet, Palin tries -- and fails. She has supported reimbursement for time spent counseling for living wills and advanced directives (even though the latter do not work); it’s the prior conversations between loved ones and the dying that matter, not the piece of paper

Yet Palin’s attacks upon the (imaginary) pro-euthanasia bioethicists are clear. When talking about "Obamacare", she has described it as a "system [that] is downright evil". She refuses to accept a healthcare system where her parents or her child would have to stand "in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society' whether they are worthy of healthcare".

Yet I wonder what Ms Palin (and others who support her view) find more morally reprehensible: leaving 47 million Americans without any access to health insurance AT ALL or creating a government panel that would make decisions about how much care would be given to which Americans, all of them having had access to health insurance over their life span.

And yes, Ms Palin, that might mean that your aging parents might not get that third bypass surgery or that state-of-the-art hip replacement over providing well care for all children. Or is it "downright evil" in your view to leave the most productive members of our society -- the chronically underinsured or uninsured Americans aged 18 to 34 -- without access to affordable healthcare coverage? I wonder, is she or anyone else okay with leaving young women to die because they are unmarried and uninsured?

Generally, though, I am more sanguine than most about the ability of ethics committees or commissions to make good decisions about what should be done in terms of making policy. I think what patients don’t realize is that most decisions about what kinds of care and what procedures are covered and in what amounts, about what percentages of procedures are paid versus unpaid, and about the reasons for all this, are actually done by committees. But in the current system, it’s all done behind closed doors inside meetings of actuarial scientists and executives at pharmaceutical benefits companies and insurance companies.

So let me ask you this.

Would you rather have your healthcare decisions made out in the open as part of public debate by a public committee comprised of ethicists, public members, politicians, health policy analysts and others who specialize in making these kinds of decisions on a large scale to save taxpayers money -- or by the (much more) self-interested persons who work for the companies who have a bottom-line to make for their pharmaceutical benefit management company, insurance company and its shareholders?

For my money (and my health), I’d opt for the public panel any day.

Have death panels already arrived?

2009-11-15T11:43:00.000-08:00

http://www.mercatornet.com/articles/view/have_death_panels_already_arrived/

Have death panels already arrived?
Nancy Valko | Friday, 13 November 2009

The case against: an experienced nurse worries that Obamacare will entrench an existing quality-of-life ethic.

Medical ethics are concerned with care for a patient’s welfare, something huge institutions are not very good at. The controversy about "death panels" in proposed health care reform legislation is to be expected. As a nurse, despite all the soothing noises from the Obama administration, I do believe there is cause for serious concern.
For example, Compassion and Choices (the name of the pro-euthanasia Hemlock Society after its merger with another "right to die" group) boasted that it "has worked tirelessly with supportive members of Congress to include in proposed reform legislation a provision requiring Medicare to cover patient consultation with their doctors about end-of-life choice."

"End-of-life choice" might have been an innocent term a generation ago, but now in three American states "end-of-life choice" includes legal assisted suicide. No wonder people were worried when they read these words in HR 3962 (also known as the Pelosi bill). It even includes a whole section on "Dissemination of Advance Care Planning Information" that is problematic and misleading.

In addition, although the idea of health care rationing was originally dismissed as a myth, ethicists and the mainstream media admit that health care rationing is necessary. Government committees have been proposed to set rules for health care services.

Is ethical health care reform needed? Of course. In 2003, I was privileged to serve on a Catholic Medical Association task force on health care reform. Many good ideas, such as health-savings accounts, ways to help the uninsured poor, and strong conscience-rights protections, were discussed. The results were published in a 2004 report entitled "Health Care in America: A Catholic Proposal for Renewal". The Obama Administration has rejected most of these proposals.

Ethics and health care reform

Since I first started writing about medical ethics and serving on hospital ethics committees, I have seen ethics discussions evolve from "what is right?" to "what is legal?" to "how can we tweak the rules to get the result we think is best?" This attitude is not very reassuring when we are considering a massive overhaul of the US health care system.
Former vice-presidential candidate Sarah Palin has been ridiculed for coining the term "death panels". But it resonated with me. In 1983 my daughter Karen was born with Down syndrome and a severe heart defect. Even though Karen’s father and I were told that her chances for survival were 80 to 90 percent after open heart surgery, we were also told that the doctors would support us if we refused surgery and "let" Karen die. We refused to allow such medical discrimination against our daughter.

Later on we were shocked to learn that one doctor had written a "do not resuscitate" order without our knowledge. Apparently he thought I "was too emotionally involved with that retarded baby".

In later years, I was asked if I was going to feed my mother with Alzheimer’s. And then, after my oldest daughter died from an apparently deliberate drug overdose, I was told that it is usually a waste of time to save suicide attempters.

Did evil people say these things? No. These doctors and nurses were otherwise compassionate, caring, health care professionals. But they are just as vulnerable as the general public to the seductive myth that choosing death is better than living with terminal illness, serious disability or poor "quality of life".

When government committees and accountants take over health care, will things get better?

Common sense and ethics

Health care does not occur in a vacuum. Real people -- patients, families and health care providers alike -- are affected when economics and new ethical rationales trump basic needs. The Good Samaritan did not ask whether the man lying on the road had health insurance. The Hippocratic Oath established a sacred covenant between doctor and patient, not health care rationing protocols. I strongly disagree with ethicists who contend that new technologies and economics demand new ethics.

I am tired of hearing some of my medical colleagues talk about patients who "need to die". I am saddened to hear many of my elderly, frail patients fret about being an emotional and financial burden on their families. I am outraged when I read editorials arguing that those of us who refuse to participate in abortion or premature death should find another line of work.

I recently attended a 40th anniversary nursing school reunion. We remarked on how much has changed. Some things are better -- uniforms, equipment and technologies, for example. But some things are worse, especially ethics.

People are often surprised that even back in the late 1960s, we had do-not-resuscitate orders and spoke to families about forgoing aggressive medical treatment when patients seemed to be on the terminal trajectory to death.

But, unlike today, we did not immediately ask them whether we could withdraw food, water and antibiotics to get the death over with as soon as possible. Back then, we were often surprised and humbled when some patients recovered. Today, too many patients don’t even get a chance. Doctors and nurses are too quick to give up hope.

Back then, ethics was easily understood. We didn’t ever cause or hasten death. We protected our patients’ privacy and rights. We were prohibited from lying or covering up mistakes. We assumed that everyone had "quality of life"; our mission was to improve it, not judge it.

Medical treatment was withdrawn when it became futile or excessively burdensome for the patient -- not for society. Food and water was never referred to as "artificial" even when it was delivered through a tube. Doctor and nurses knew that removing food and water from a non-dying person was as much euthanasia as a lethal injection.

"Vegetable" was a pejorative term that was never used in front of patients or their families. And suicide was a tragedy to be prevented, not an alleged constitutional right to be assisted by doctor and nurses.

Today we have ethics committees developing futility guidelines to overrule patients and/or their families even when they want treatment continued. We have three states with legal assisted suicide. We have even non-brain dead organ donation policies (called non-heartbeating organ donation or donation after cardiac death). Some ethicists even argue that we should drop the dead donor rule.

We see living wills and other advance directives with check-offs for even basic medical care and for incapacitated conditions like being unable to regularly recognize relatives. We are willing to sacrifice living human beings at the earliest stages of development to fund research for cures for conditions like Parkinson’s rather than promote research on ethical and effective adult stem cell therapies.

We are inspired by the Special Olympics but support abortion for birth defects. We now talk about a newborn child as another carbon footprint instead of as a blessing and sacred responsibility.

I could go on and on but I think you get the idea.

Death panels are not the overwrought fantasy of right-wing nut cases. Real "death panels" are already at work. They have been created by apathy, misplaced sympathy, a skewed view of tolerance and an inordinate fear of a less than perfect life. Death panels? In the famous words of the comic strip character Pogo, "We have met the enemy and he is us."

Nancy Valko is president of Missouri Nurses for Life and a spokeswoman for the National Association of Pro-life Nurses.