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Medicine in the Nanny State

The opinions expressed by columnists are their own and do not necessarily represent the views of

Most people are familiar with the old adage that says "the hand that rocks the cradle is the hand that rules the world." Originally the refrain of a poem honoring motherhood, today this phrase is perhaps more applicable to the omnipresent hand of the modern nanny state. Think of the Obama campaign's cradle-to-grave welfare avatar "Julia" and you get an idea of just how pervasive the idea of government involvement in virtually every aspect of life has become.

If Americans wish to see the inevitable results of such government patronage in our everyday lives, we need look no further than to our northern neighbor Canada, where the Supreme Court is being asked to give doctors the authority to decide if and when to remove life-sustaining medical care from patients, even if those patients are deemed to be conscious and even against their family's objections. From an article published in the British Medical Journal:

Canada's Supreme Court will next week consider an appeal from two Canadian doctors who seek, against a family's objections, to withdraw life sustaining treatment from a patient they originally diagnosed as being in a persistent vegetative state, but whom they now describe as minimally conscious. Hassan Rasouli, 60, a retired Iranian born engineer, contracted bacterial meningitis in late 2010 after surgery to remove a brain tumour, and has since been on mechanical ventilation at Toronto's Sunnybrook Health Sciences Centre. All parties agree, however, that he is no longer in a vegetative state and has repeatedly given the thumbs up at his wife's request. . . . Given the change in the patient's diagnosis, the family has submitted a motion to dismiss the case as moot, to be heard on 17 May. But the doctors argue that the full case should still be heard in December, citing in court documents "a great need for guidance from this Court . . . when the law is unsettled." "The Court of Appeal misapplied the law of informed consent in order to confer upon patients a right to insist upon the continuation of a particular treatment when the medical standard of care requires it to be withdrawn," they argue.

In essence, as Wesley J. Smith recently observed on his bioethics blog "Secondhand Smoke," the doctors aren't petitioning to remove life support from Rasouli now, but they are arguing that they should have had the authority to do so back when they "had the chance," before the patient showed signs of consciousness. "What does that tell us," Smith wonders, "about permitting bureaucratic 'standards of care' guidelines to become mandatory rules of medical practice?"

To answer Smith's question, this case highlights the primary problem with government-controlled healthcare. Quite simply, when the government pays the bills, it has the right to call the shots. The one that pays the piper, as they say, is the one who calls the tune. In the case of critical healthcare decisions, individualized care based on patient needs and responses goes by the boards, and cookbook medicine becomes the norm. Bureaucrats are masters at crafting "policy" after all, and they approach healthcare in the same way they'd approach any other policy issue: gather a panel of so-called "experts" to craft a broad-based, generalized set of guidelines designed to achieve the "greatest good for the greatest number" based on the latest cost-benefit analyses and ratios (yes, in the end, it's really all about money), and then follow these guidelines to the letter even when they aren't applicable or don't make sense given the particular situation at hand.

This approach may work out okay for many people much of the time, but in life or death cases, or in situations where the government's values come into conflict with the values of a patient and his or her family, there is potential for huge problems as this story illustrates. "Futile" care is a matter of definition. In this case, the doctor's felt that continuing treatment for a patient whom they mistakenly diagnosed as merely "vegetative" was a waste of resources, even though his family wasn't ready to give up on him. If the doctors had had their way they would have pulled the plug on what turned out to be a conscious human being. This will inevitably occur more often if the Canadian Supreme Court decides in favor of the government in this case.

There's no doubt that the concept of universal health care has its appeal, but at the end of the day what individuals must consider is who they want making decisions for them in the event of a serious or life-threatening medical situation. Do they want the liberty to decide what care is best for them based on their individual circumstances and the opinion of their doctor, or do they want a bureaucrat in a faraway government office making these decisions based on manual of "cookbook medicine"? If you prefer the former, then you must be prepared to assume responsibility for securing your own health care coverage. Nothing's free in this world, after all, and if the government is going to assume the cost of your medical care then you can bet that it will assume the power to make decisions about that health care on your behalf. Which do you prefer?

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