In Progressive politics, Death frequently comes in packages labeled "Life."
And so it is with legislation such as that which is now before the Senate. Think you are supporting pain relief and hospice legislation in order to prevent assisted suicides? Wrong. Thanks to Big Death - a collection of heavily funded non-profit hospice and palliative care groups1 - the line between palliative care (pain relief; symptom management) and imposed death has become blurred.
One Big Death "thought leader" who has helped create the confusion between life-affirming palliative care and imposed death is Ira Byock, Dartmouth physician and hospice guru. In a blog at the New America Foundation2 this summer, he illustrated our point. He suggests, using the example of one senior citizen, that we might improve seniors' lives simply by giving them "reliable transportation … to the local Senior Center [where they would] share nutritious group lunches and noon-time discussions on advance directives for health care". In other words, he wants to sell seniors a free trip to the Center for a fulfilling and healthy life … to persuade them to focus on death, of course.
Byock drew early attention and support from Andrea Kydd former organizer for the Welfare Rights Organization, and board member of the Tides Foundation. Kydd, who was health program director for the Nathan Cummings Foundation, directed the foundation's support to two end-of-life projects in 1995: one collaborated with the Commonwealth Fund to conduct a caregiver study directed by Ezekiel Emanuel and his wife Linda; the other was Byock's Missoula Demonstration Project. The grant from Cummings was followed by a grant from Soros one of the earliest grants awarded in Soros's Project on Death in America.
From there Byock moved to projects sponsored by the Robert Wood Johnson Foundation. He directed a massive $15 million end-of-life project "Promoting Excellence" that could have been called "Promoting Rationing." It tested methods of "moving hospice upstream" in various "difficult" clinical settings and on specific populations: veterans hospitals, native American reservations, African-Americans in urban centers, and prisons, for example. The project, headquartered in Montana, focused on financial savings and various ways to convince people to accept "palliative care" earlier in the game.
Blurring the distinction between life-affirming care and hastened death eases the path for bedside rationing, which of course lowers costs. How to convince "difficult" cases to forgo life-sustaining treatment? Offer them palliative care.
When Promoting Excellence moved to South Carolina, the effort was focused on reminding a group of chronically ill patients who "generally do not see themselves as dying" that, in fact, they were dying. Diane Meier and Sean Morrison of Mt. Sinai in New York worked with NJ-based Franklin Health and Blue Cross Blue Shield of South Carolina for intervention by case management teams using advance care counseling and a variety of other tools. Meier's group reported that the South Carolina population were "an 'upstream' population of very sick people, averaging 46 years of age, generally suffering from serious, progressive, and life threatening illnesses, who will likely consume high dollar amounts of resources" and were thus chosen for intervention.
When Byock delivered a provocative keynote address to a conference of over 275 end-of-life health professionals, researchers, policymakers, and community activists, he described the "levers" that could be used to change the US death-denying culture. Bureaucracy would be their ally. Byock noted that "German sociologist Max Weber said that social movements that become successful become routinized by the agency of bureaucracy. Therefore, ironically, bureaucracy is the means and the mark of our success to this point."
While Byock rallied the "levers" and "agents of change," he also quietly created a new right-to-die consumer's group that would organize caregiver and hospice groups, and pressure legislators to pass living will legislation. Byock brought AAHPM together with Choice in Dying (aka Euthanasia Society of America and Society for the Right to Die) to form "Partnership for Caring" (PfC) in 1999. PfC's mission was to articulate "a national policy agenda", and their first priority was "mandated universal access to high-quality care."
Just when we think we are supporting a partnership for caring, we end up with the choice to die.
Now, twelve years later, the Senate is poised to firmly establish Big Death's "agency of bureaucracy" by implementing the Obama/Pelosi/Reid plan.
According to the principle of subsidiarity, medical decisions should be made at the lowest level closest to the patient, with the least bureaucracy. That is the first step in protecting American health care. All current health "reform" legislation is the polar opposite.
1 A core group from Big Death showed up to support Rep. Blumenauer's death counseling bill: AARP, American Academy of Hospice and Palliative Medicine (AAHPM), American College of Physicians (ACP), American Hospice Foundation, Center to Advance Palliative Care (CAPC), Consumers Union, Gundersen Lutheran Health System, Hospice and Palliative Nursing Association (HPNA), Medicare Rights Center, National Hospice and Palliative Care Organization (NHPCO), National Palliative Care Research Center (NPCRC), Providence Health and Services, and Supportive Care Coalition. [Back]
2 "HEALTH REFORM: We Can't Fix Health Care By (Merely) Fixing Health Care", August 7, 2009. [Back]