If I were to be asked why I am leery of the President’s Health Care bill, I Could tell you in one phrase:

It’s the bioethics, stupid.

You see, few lay people read bioethics journals, and so the public is blissfully unaware how many philosophers in academia are busy writing  “quality of life” formulas that will decide if your medical care should be paid for, or having discussions among themselves on if a mentally handicapped child is a “person” who has full human rights.

That is, until Mrs. Palin read what one of the President’s favorite bioethicist had actually written. She then came out on her Facebook page and cried: Death panels. And people listened…

Mrs. Palin’s “Death panels” was overblown, but it crystallized the major fear of having government control decisions on who shall live and who shall die.

Yet, as ethicist Arthur Caplan pointed out, the government already is deciding who needs care. Indeed, one of the worst examples of such “death panels” is the Texas “Futile Care” law (signed by one George W Bush) that can essentially mandate your treatment to be stopped if a hospital committee decides to do so (although you have their permission to take the patient home or find some other hospital to give the person care).

The problem is not the lack of money per se, or even an honest judgement if a treatment is needed or if an alternate, cheaper type of care would work just as well or almost as well.

The problem is that in the past thirty years that medicine has morphed from a profession into a business, where cost and profit can become more important than people.

That is why I went to work for the Federal Government instead of working for more money and less hours at an HMO: Because there was a lot more emphasis on caring for people rather than being cost effective.

There are ways to limit the budget, of course, by limiting elective care, or by emphasizing preventive medicine in caring for the chronically ill .

But parallel to this economic trend is the more sinister one that I mentioned above: The idea that bioethicists have the right (even the duty)to be in charge of helping the government make decisions on who gets health care and how much health care you should be allowed ( presumably using their “scientific” formulas of QALY and “personhood”)

This article from the AMA Journal of Ethics describes (and objects to) the modern denial of human dignity, as defined by modern philosophers:

Traditional thinking presupposes that all human beings—Homo sapiens— are persons and that this is an indisputable, self-evident truth….Many philosophers have argued against this conception of personhood and have distinguished ‘persons’ from ‘human beings.’ Engelhardt states bluntly, “Persons, not humans, are special” [3]. John Locke differentiated ‘person’ from ‘human being’ in the 17th century…

Singer believes that only human beings in the second sense are ‘persons’ who deserve rights and respect. He also suggests that ‘rationality’ and ‘self-consciousness’ are the crucial characteristics of persons. Similarly, Warren, Tooley, Harris, and Engelhardt [6-9]—all of whom propose definitions of personhood—emphasize that rationality, self-consciousness, and autonomous moral agency are key features..

If this sounds familiar, it should. Sixty years ago, the name for the mentally ill and handicapped was “untermensch”.

The article I cited is interesting, because it emphasizes the Confucian emphasis on filial piety and family ties to counteract this idea. His cultural approach is similar to a Catholic bioethics, which also has an emphasis on “empathy” and interconnectedness as part of human dignity. Indeed, the idea that men are endowed “by the Creator” with rights (i.e. not by government according to a philosophical criteria) is one of the basis of the American experiment.

And that is why most “religious” people support a universal health care bill, and would like to support the President’s bill if they were assured it didn’t include abortion mandates and the rationing of care for society’s most vulnerable.

So unless the President comes out and says in plain English that he rejects the writings of certain bioethicists that see some humans as “non persons” , and unless he distances himself from those who propose rationing care by a QALY formula in his health care policies, his plan will be open to suspicion by the thoughtful.

What is worse, demagogues will use these ethical ideas to destroy the idea of Universal health care, something that is badly needed in the United States.

Writing about “Hilary care” in a 1995 paper, ethicist Arthur Caplan  noted the Swedish approach to medical care:

. The Swedes basically argue that priorities should be set (and there is no indication in this report that anyone thinks they do not have to be set, and soon) in a way that treats everyone as a moral equal, that does not pick on any single vulnerable or frail group, and that takes cost-efficiency seriously. This may not seem like much, but if these simple moral rules are accepted, in both Sweden and the United States, their effect would be an enormous boon to health policy.

Yes, and one hopes that the president will recognize that one of his major problems is the writings of too many “bioethicists” whose writings contain statements that make the average American shudder.


Nancy Reyes is a retired physician living in the rural Philippines. She writes about medicine at HeyDoc Xanga Blog.

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