The Twisted Morality of Death Panels
Canada has death panels – and that’s a good thing. So reads a headline at Slate, where author Adam Goldenberg defends letting a government committee intervene in healthcare to decide who lives and who dies.
The death panel Goldenberg refers to is Ontario’s Consent and Capacity Board, a unique institution among Canada’s jurisdictions which holds the legal authority to supersede healthcare decisions made by next of kin when a patient lays incapacitated.
The Supreme Court of Canada recently ruled in favor of a family seeking to sustain the life of Hassan Rasouli, who fell victim to complications from brain surgery and has remained comatose for three years. Goldenberg writes:
In Canada, with our single-payer health care system, Rasouli’s situation has a very public bottom line: Should taxpayers foot the bill for his family’s indefinite goodbye?
But American critics of Canadian health care will declare that merely asking this question is unacceptable, unethical, even unthinkable—and that it proves that the Canadian system gives doctors a dangerous incentive to kill off their patients as quickly as possible. They are wrong. The Hippocratic Oath’s promise to do no harm still applies. But they are also only wrong in part. When taxpayers provide only a finite number of acute care beds in public hospitals, a patient whose life has all but ended, but whose family insists on keeping her on life support, is occupying precious space that might otherwise house a patient whose best years are still ahead.
The incentives in the American health care system point in the opposite direction. In the United States, keeping an all-but-dead patient alive on life support in a hospital bed generates income for the hospital, for as long as its bills get paid.
Everything wrong with the Left’s view of economics, morality, and healthcare in particular can be observed in that passage. Goldenberg’s analysis ignores any consideration of individual rights.
The Canadian government manufactures Goldenberg’s “public bottom line” by exceeding its rightful role in the first place. Should taxpayers foot the bill for the Rasouli family’s indefinite goodbye? Of course not, because taxpayers shouldn’t foot the bill in any case. Canada’s single-payer system violates the rights of individuals by forcing them to pay for the healthcare of others while prohibiting them from seeking any care for themselves not offered under public subsidy. The Canadian government thus creates the circumstances which lead to Rasouli taking up a hospital bed on the public dole. In sails Goldenberg, building a case for pulling the plug, citing those conditions as if they were a natural occurrence.
Why should we take any comfort in the Hippocratic Oath while the fundamental moral principle of individual rights goes unrecognized? If the imperative of the Canadian system was truly “to do no harm,” it would not deprive individuals of their natural means to pursue their best interests – choice.
Choice of action defines individuality. The interaction of many individuals making choices in an unfettered market results in the most efficient allocation of resources possible, because individuals will always seek the highest value at the lowest cost. When Goldenberg bemoans how the market allocates resources, as he does when scoffing at Americans keeping their “all-but-dead” loved ones on life support, he reveals his disdain of individual rights and his resentment of an individual left free to pursue his own values.
It is inappropriate, in Goldenberg’s view, for a family to value their loved one’s life above the life of a stranger who might otherwise occupy the same bed. To correct that, someone needs to intervene. Later in his piece, Goldenberg uses the word “wise” in reference to the Canadian death panel. That’s how he views it. Family members cannot be trusted to make wise decisions on their own. Rather, they must defer to “experts,” whose judgment won’t be clouded by little things like familial love and natural affection. Merely proposing such an arrangement places the "expert" values of a death panel above those conceived by individuals. Like all property in a leftist worldview, medical resources should be allocated according to a ruler's determination of need, not mutual consent among freemen.
This is the crux of the healthcare fight, which can be extrapolated to every public policy debate. Who decides? Leaving decisions about the allocation of resources to individuals in a free market offends the Left, because market values invalidate their worldview. We learn through the market that a master's degree in oboe performance has lesser value than a certificate from a trade school. Such discrimination simply cannot be tolerated. A young student who wants to spend eight years pursuing women’s studies cannot have her choice demeaned by a misogynistic market. Something has to be done. Wisdom must be imposed!
Likewise, as Goldenberg plainly states, a family paying a hospital to keep their “all-but-dead” loved one alive cannot be tolerated. Such valuations should not be up to plebeian family members. Wise rulers must intervene.
In advocating for death panels, Goldenberg also reveals how the Left views the judiciary. Rather than as arbiters of law protecting individual rights, Goldenberg views judges as rulers who properly make decisions for us. Goldenberg writes:
Ontario’s Consent and Capacity Board provides an objective process for resolving these difficult, end-of-life dilemmas. The board is instructed by law to focus on the patient’s best interests, not the health care system’s, or the government’s bottom line. Still, the law recognizes that, though it is usually in the patient’s best interests to be kept alive, it is not always so. As Rasouli’s doctors told the Supreme Court, prolonging his life would entail the risk of infection, bedsores, and organ failure. When recovery is out of the question, in other words, there may be fates worse than death.
Yet, the question remains: Who decides? Remember that, outside of Ontario, the resolution of these end-of-life disputes is generally reserved for judges. Ontario has simply replaced them with experts and wise community members. That’s a lead other jurisdictions should consider following when families’ emotions and doctors’ judgments collide.
Goldenberg bowls over a crucial distinction. When a judge rules in a dispute, he determines which party in the case has a legal claim. The Consent and Capacity Board does something entirely different. Rather than determine who gets to decide, the death panel takes the decision upon themselves, superseding all other claims. It is as absurd as a judge ruling against both the plaintiff and the defendant and claiming disputed property for himself.
The question of who decides can only be properly answered by an objective consideration of individual rights. Families, being composed of individuals entitled to trade value for value, may decide to spend every dime they have to keep a loved one alive. Hospitals, being corporate entities representing the joint interests of several individuals, may decide whether to accept or reject fees for service. Any deviation from that violates individual rights. The violation which is Canada's single-payer system does not justify the further violation of a death panel. Instead, coercion ought to be removed from the system so the best interests of all parties can be determined through reason and by consent.