The Case for Death Panels

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In the United States, Obama’s call for national health care reform has ignited a firestorm of controversy. One rather interesting result of the furor has been the accusation that Obama plans to create death panels. While the accounts vary, the general idea is that these alleged panels are intended to review cases and decide whether care (and the patient) should be terminated or not. Not surprisingly, this accusation is not true-there is nothing in the actual proposals about such death panels.

As I do every semester, I am teaching an ethics class in which the students have to write an essay on a moral issue. When the students ask what position they should take, I generally suggest that the argue for what they believe (rather than vainly trying to guess my view in the hopes of getting a better grade). But, I also suggest that they consider writing an argument against what they actually believe. Since I am against death panels, I thought I’d try my hand at my own suggestion and make a case for them. When reading, please keep in mind that what follows is not my actual view. Hence, there is no cause to accuse me of Nazi (or even socialist) leanings.

From an intuitive moral standpoint, private citizens are rather restricted in regards to when they can ethically end the life of another person. In general, such killing is restricted to clear cases of self defense. For example, if someone pulls a gun on me while I am out for a run and demands my fancy GPS watch, it would be morally acceptable for me to kill him on the spot. After all, he presents a clear and present threat to my survival (as Locke would say, I have no reason to think that someone who would rob me of my property would not take the next step and try to rob me of my life).

In the case of the death panel matter, it does not seem that this sort of individual right can be used as a justification. After all, a patient who is in need of critical and expensive care is not likely to be a clear and present threat to my survival.

Of course, it could be argued that such a person would be a threat because he is using resources that could save my life. However, killing an innocent person because they happen to have resources that could save my life does not seem to be morally defensible. For example, if am in a ship wreck and at risk of drowning, I have no right to kill another passenger and strip her of her life vest. As such, there seems to be little support for death panels here.

Perhaps, however, the matter changes when the focus is expanded to include society as a whole. After all, actions that would be blatantly immoral for an individual can often be transformed, by the “magic” of the collective, into acceptable actions. For example, what would be murder on the individual level becomes transformed to acceptable killing in the context of war (although, obviously, not everyone buys this).

In many cases, the moral transformation is brought about by an appeal to the general good (essentially an appeal to utilitarian considerations). For example, killing folks in war can be morally justified by appealing to the advantages of the war to “national security” or “national interest.” Not surprisingly, more cynical folks might point out that “national interest” is often the interest of a select few and it might be contended that such actions are no better than those of any organized gang of criminals.

Now, if such things as war can be morally justified, then justifying death panels should be easy enough on the same sort of grounds.

In the case of war, killing folks is most often justified on utilitarian grounds. For example, some folks must be killed (including the inevitable innocent bystanders) in order for the collective good (national security, for example) to be served. Now, let us turn to applying this sort of approach to the death panels.

While the United States and other Western countries have significant medical resources (enough so that certain folks, such as Michael Jackson, can have their own personal doctors) these resources are not unlimited. In fact, it can be contended that the resources are not sufficient to provide adequate health care to everyone.

Now, it is obvious that people who are in need of critical care use far more resources than other folks. It is also obvious that the elderly have more health issues than younger folks. Now, looking at the matter by the numbers, it seems likely that the resources used to maintain a critically ill person or an elderly person could be used to provide health care to a significant number of folks with less serious conditions. Typically, these would often be younger folks as well-folks who also still have years to contribute to the good of the state.

Looked at in terms of the general utility, it would seem to make practical and moral sense to allocate medical resources so that they do the most good for the general populace. As such, it would seem to be acceptable to terminate the care of the critical ill in favor of the less ill. It could also, on similar grounds, be argued that the focus of health care should be on the younger folks rather than the harder to maintain elderly folks. To use a car analogy, it makes more sense to spend less on maintaining a new car than to pour large sums of money in order to keep an old clunker going.

Since the United States is supposed to have a free market economy, the critical ill and the elderly who have the funds to purchase the medical care they need should be allowed to do so. After all, they are paying for the resources they are consuming and hence are not creating an undue burden on the health care system. Naturally, folks who are lacking in such funds would be imposing burdens on the system by consuming beyond what they can afford to pay for. As such, they would be robbing society of valuable resources.

Naturally, it might be pointed out that some critically ill people or elderly folks might have made valuable contributions that justify their being treated at the public expense. There might also be such folks who are making ongoing contributions or who can be expected to make such contributions in the future. For example, a medical student who is badly hurt in a accident may be expensive to treat, but it is likely that she will be able to contribute more than he treatment would cost.

This is, of course, where the death panels come in. These panels would serve to assess the relative worth of each patient and decide who will receive the medical resources and who will not. For those who balk at such an approach, the obvious reply is that this sort of thing is done in the case of triage. In this case, it is a triage of a different sort but would still seem to be justifiable on similar grounds. In this case, the person’s place in the medical queue is based not on her likelihood of survival but based on the value of her survival to the national good.

Of course, some folks might contend that the idea of having folks decide who lives and who dies is a horrific idea. It might also be wondered where people could be found with the adequate experience to make such calls. Fortunately, the United States has plenty of people who have experience in such things. For example, Governors in states that have the death penalty already serve on death panels. As another example, the folks who make decisions about going to war already are on a death panel as well. After all, they have an active role in deciding who will live and who will die. As a final example, folks in insurance companies sometimes make decisions that deny care to people. Since such decisions about life and death are fairly routine, there should be little problem finding people to serve on such panels.

So, death panels seem like a great idea and the United States should hope that Obama makes the rumors a reality. Obviously, philosophers and runners should get an automatic exemption from being reviewed by death panels. This is so obvious that there is no need to even argue.

  1. In any public healthcare system, doctors do make that kind of decision that you mention. For example, in a waiting list for transplants, a 15 year-old will have priority over a 80 year-old, all other things being considered. Generally, the choice is blind: that is, only age and medical data go into the choice. Names are not used nor is the person’s social position nor her supposed importance to society considered. That seems fair to me. I’m 63, and a transplant for me is less of a priority than for a 15-year old. Ditto for very expensive drugs and very complicated surgical treatments. The idea that money will buy 6 more months of life for a rich 63 year-old person, while a 15 year-old dies for lack for money is obscene: that’s the only word for it.

  2. If you pass money triage you will get all sorts of heroic interventions thrown at you up to the moment of death. I recall a pacemaker fitted to a 91 year old that was clearly dying which he did two weeks later. He had a good health plan (Ireland) and the procedure was done in a private hospital that was on the American model with a sculpted carpet in the foyer at the centre of which was a full-sized grand piano. Of course this greed passes on down to the premiums of the younger healthy. Alongside this is the public sector which I belong to which is free and though there may be delays the quality is the same but you won’t be offered that vital fortnight. Why me! Why me!

    We look on bemused whilst America that is putting the world to rights cannot manage what any country in Europe , all with their own variations, offers. Obama as saviour, forget it. Keep on with those platitudinous addresses to schoolchildren. Make a difference.

  3. Public healthcare is supposed to be used by those who can’t afford to pay for their own health cover… which in turn removes some of the burden from the public sector. Otherwise we’d all pay more tax.

  4. Perhaps the discussion in the last year or so in this forum and in other more elevated sectors of the thoughts of McMahan and Singer have led to worries about death panels. To go back in time, how much did the espousal of eugenics by the general mass of the chattering classes or intelligentsia of the ’30’s lead to practices which were world wide then and that were brought to their grim conclusion by the Nazis. Is there not an enabling factor in the polite discussion of whether the damaged neonate is equivalent to the life of a healthy Golden Labrador? Singer I read discussed the notion of the death panel in the NYT. No doubt he is deficient in tact and political nous but there’s a sort of bright eyed consistency amounting to blankness in his enthusiasm for his own ideas.

  5. A point I’d like to raise, is how would it reflect on the Death Panel if an elderly person that had remained throughout their life ‘a good citizen’, had been overlooked for expensive treatment in favour of a younger citizen who went on to become a serious criminal? Surely the justification for medical treatment is to provide necessary treatment to alleviate suffering and, if possible, prolong and improve quality of life?

  6. ways of ending (medically) an elderly persons life.
    The Ward Dementia and the elderly.
    administer anti psychotic drugs so they are doped up.
    Withold medication for infections etc. So as to “not prolong unnecessarily”
    Withold hydration so they are more prone to heart and resspiratory failure, and toxic psychosis. No hydration, food cannot be swallowed. \No food – “refuses to eat” ie cannot
    Take away the bed support so they are prone and cannot breathe without liquids and mucus accumulating in their lungs, thus hastening their end.
    Of course nobody has openly decided in conjunction with the relatives to do this. The death panel is simply a tacit set of practices to hasten the end and free a bed. Of course what I have said is naturally only conjecture to avoid any comeback from those who nurse rather than dispose of the elderly unnecessarily. I await a philosophical rejoinder or even a medical rebuttal on this one.

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