The subject of how best to honor and care for those facing death due to terminal illness or old age has always been controversial. As talk of "death panels" and "rationing" stirs debate over the government's proper role in health care, two new studies funded by the National Institutes of Health are lending new weight to the argument that, when it comes to providing end-of-life care for the elderly and terminally ill, sometimes less is better. The studies, featured in the New England Journal of Medicine, document how certain medical therapies implemented in the final months of a patient's life often cause emotional and physical stress and pain, effectively negating any positive benefits associated with such treatments.
However, those worried that a government takeover of health care will result in health care rationing in keeping with Dr. Ezekiel Emanuel's "complete lives" theory view these studies with alarm-and for good reason. In a culture where "quality of life" is increasingly viewed as the predominant justification for abortion, assisted suicide, and even infanticide , there is a legitimate concern that these kinds of studies will be used by the government to advance policies that endanger society's most vulnerable members.
The pivotal question is not whether difficult end-of-life decisions must sometimes be made, or whether-as the NIH studies indicate-sometimes the best decision is to forego heroic measures in favor of simply keeping a patient comfortable in his or her final days. The traditions of hospice and palliative care, for example, both work to keep dying individuals in a state of dignity and comfort without resorting to extraordinary, and ultimately futile, measures. The question is who should make these decisions.
Government-run health care has ominous implications because it supplants individual doctor-patient relationships with generalized protocols crafted by bureaucrats who have no way of accounting for the particular needs of the human beings affected by them. These protocols are often drafted with cost-cutting goals and resource management in mind-not the criteria most want at the top of the list when it comes to life and death medical care.