If you are wondering about Puffball Palin’s comments about the so called “death” panels, you should be aware that there have been calculations proposed by many “bioethicists” to limit care according to one’s quality of life.

Here is how the UK does it:

The basic idea of a QALY is straightforward. It takes one year of perfect health-life expectancy to be worth 1, but regards one year of less than perfect life expectancy as less than 1.

Thus an intervention which results in a patient living for an additional four years rather than dying within one year, but where quality of life fell from 1 to 0.6 on the continuum will generate:-

1. 4 years extra life @ 0.6 quality of life values 2.4
2. less 1 year @ reduced quality (1 – 0.6) 0.4
3. QALYs generated by the intervention 2.0.

So her son Trig or her elderly grandparents would maybe list only 0.5 on the perfect health level, so they would be half as likely to get treatment just from the get go. To call it a “death panel” is an exaggeration, but there is a truth behind her claim, and as the saying goes: even a stopped clock is correct twice a day.

And one dirty little secret about the QALY index is that it is “subjective”. For example, an elderly black lady who had a stroke is less likely to get a good rehab afterward, so she would probably be lower in the “Health” level, since she would be more dependent on others for her “activities of daily living” (such things as dressing and bathing and walking).

One experiment with a similar “scientific” formula to decide who gets treatment shows the problem.

Back in the 1980’s, there was a lot of discussion on which children with Myelomeningocele should be treated, so the Children’s Hospital in Oklahoma City used a formula to decide who gets treatment, and who would  be offered surgery.

Part of their formula included such pseudo scientific criteria as if there was hydrocephalus (meaning the kid might need more surgery, but not associated with IQ) and the level of the lesion (ignoring that a L 2-3 level lesion vs a T10-11 level is not clinically much different for the patient, in either IQ or paralysis).

But the criteria that they used also included the ability of the family to cope with the problem: meaning that if the doctors thought the parents were poor, or had a low IQ, or the mom was unmarried or there were social problems in the family, that also went against fixing the problem.

Between 1977 and 1982, four doctors and a social worker at the Children’s Hospital of Okalahoma, in Oklahoma city, monitored the births of babies with myelomeningocele (the medical term for spina bifida). Parents who were poor were told that it would not be appropriate to treat their baby and given an extremely pessimistic picture of their child’s future life. Parents from better-off families were told more about the treatments for spina bifida and given more information about their child’s potential. None of the parents knew they were part of an experiment. Parents who were assigned to the “pessimistic outcome” group chose, by a factor of nearly five to one, not to have their babies with spina bifida treated. The experiment was not conducted to prove that babies with spina bifida will die if they are not treated. Doctors already knew that. The goal of the experiment was to prove that the families would accept a “do-not-treat” recommendation from their doctors. [John R. Woodward, It can happen here, The Disability Rag & Resource, Jan/Feb 1994, p. 16. (emphasis added).] 

I’m old enough to remember that there was little outcry against the article, which had it’s findings published in a major medical journal.

But later, in the  mid 1990’s, a black Congressman actually looked at the data and found that almost all the black parents didn’t get their children treated, and most of the white parents did. And interviews with the black parents found that they might have decided differently if they had been advised that their child could have lived with treatment, albeit with paralysis.

So there is a lot of worry that  if rationing is imposed, it will not be like that of the Indian Health Service, which I described in an earlier article, that limited “unnecessary”  or elective treatment for the healthy, but allowed all treatment for the handicapped and elderly.

One only has to worry that instead it will be based on one of the many “quality of life” rationing ideas so beloved of the bioethics community.


Nancy Reyes is a retired physician living in the rural Philippines. She writes medical essays at Hey Doc Xanga Blog.

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