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Principles for allocation of scarce medical interventions
Govind Persad, Alan Wertheimer, Ezekiel J Emanuel
Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favoring the worst-off , maximizing total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multi-principle allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and disability-adjusted life-years. We recommend an alternative system—the
complete lives system—which prioritizes younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.
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Dr. Ezekiel Emanuel and Obamacare – Angel(s) of Death!
Sure you've heard of Rahm Emanuel, the former Representative from Chicago turned Barack Hussein Obama's Chief of Staff and purveyor of dead fish wrapped in newspaper for enemies.
But have you heard of Dr. Ezekiel Emanuel? A bioethicist, Dr. Emanuel was chosen as a special advisor to the director of the White House Office of Management and Budget for health policy. He is "working on the "health care reform" effort." He is "detailed" to the OMB spot and is still officially an employee of The Clinical Center of the National
Institutes of Health.
Dr. Emanuel recently authored an article in the Lancet describing the various models of non-market health care rationing. Titled “Principles for allocation of scarce medical interventions”, which is co-authored with Govind Persad and Alan Wertheimer.
In the book its authors simply review the pros and cons of the various ways of deciding who gets treated and who doesn’t. The allocation mechanisms they discuss are divided into strategies and substrategies. The pros and cons of each are laid out.
Treating People Equally -
- Lottery
- First-come, first served
- Sickest first
- Youngest first
- Saving the most lives
- Saving the most life-years
- Saving the most socially useful
- Reciprocity (paying back people who have ‘contributed’, such as organ donors)
Because none of the currently used systems satisfy all ethical requirements for just allocation, we propose an alternative:
The complete lives system. This system incorporates five principles: (Emphasis LCs)
Youngest-first, prognosis, save the most lives, lottery, and instrumental value..… When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated … the complete lives system is least vulnerable to corruption. Age can be established quickly and accurately from identity documents. Prognosis allocation encourages physicians to improve patients’ health, unlike the perverse incentives to sicken patients or misrepresent health that the sickest-first allocation creates.
The paper concludes:
“The complete lives system combines four morally relevant principles:
Is the United States preparing for "scarce medical care" when we have the finest medical system in the world? Don't people play lotteries that fund more government programs because the politicians mismanage everything they touch? Do we have Dr. Mengele advising Obama on healthcare while debate on the issues of reform remains hidden from the public?In pandemic situations, it also allocates scarce interventions to people instrumental in realising [sic] these four principles. Importantly, it is not an algorithm, but a framework that expresses widely affirmed values: priority to the worst-off, maximising [sic] benefits, and treating people equally. To achieve a just allocation of scarce medical interventions, society must embrace the challenge of implementing a coherent multiprinciple framework rather than relying on simple principles or retreating to the status quo.”
- Youngest-first
- Prognosis
- Lottery
- Saving the most lives.
Presidential appointees are deciding what medical plans cover what, how much leeway your doctor will have and what seniors get under Medicare. These people want to have the government decide who lives and who dies?
Dr. Emanuel bluntly admits that the cuts will not be pain-free.
"Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely 'lipstick' cost control, more for show and public relations than for true change," he wrote last year (Health Affairs Feb. 27, 2008).Savings, Dr. Emanuel writes, will require changing how doctors think about their patients:
Doctors take the Hippocratic Oath too seriously, "as an imperative to do everything for the patient regardless of the cost or effects on others" (Journal of the American Medical Association, June 18, 2008).Dr. Emanuel believes that "communitarianism" should guide decisions on who gets care.
He says medical care should be reserved for the non-disabled, not given to those "who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia" (Hastings Center Report, Nov.-Dec. '96).Dr. Emanuel explicitly defends discrimination against older patients:
"Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years" (Lancet, Jan. 31).Obama and his medical ilk want to control costs by controlling innovation. Emanuel criticizes Americans for being too "enamored with technology" and is determined to reduce access to it.
However, Obamacare would involve technology telling doctors how to render treatment via electronically delivered guidelines called "embedded clinical decision support".
Dr. Emanuel sees even basic amenities as luxuries and says Americans expect too much:
"Hospital rooms in the United States offer more privacy . . . physicians' offices are typically more conveniently located and have parking nearby and more attractive waiting rooms" (JAMA, June 18, 2008).
Betsy McCaughey is founder of the Committee to Reduce Infection Deaths and a former New York lieutenant governor writes:
No one has leveled with the public about these dangerous views. Nor have most people heard about the arm-twisting, Chicago-style tactics being used to force support.Barack Hussein Obama wants a 90-year old person that currently has drugs and medical care available to live and have quality of life to take a pain pill instead.
In a Nov. 16, 2008, Health Care Watch column, Emanuel explained how business should be done: "Every favor to a constituency should be linked to support for the health-care reform agenda. If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration's health-reform effort."
Barack Hussein Obama wants a disabled child or child from a botched abortion to be allowed to die.
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