Andrew Breitbart as Pro-Life Warrior

Thanks to the American Catholic for posting this gem in tribute to Andrew Breitbart:  Andrew Breitbart – One Year Later

Donald McClarey notes that Breitbart’s “keen insight for conservatives is that there can be no long-lasting success politically if the culture is ceded to the other side.”

That is true on the issue of abortion, and it is equally true in the so-called “end-of-life” issues.  Human life will remain in jeopardy as long as the culture assumes Better-Off-Dead Values and accepts the Quality-of-Life Imperative.

Emanuel: New “independent entity” would save federal dollars by convincing patients to forgo treatments

In an article just published in the New England Journal of Medicine, former Obama adviser Ezekiel Emanuel (infamous for his “complete lives system”) and Emily Oshima Lee of the Center for American Progress have an idea on how to cut costs:  “share” in patients’ decisions to request expensive treatments by providing patients with “certified” decision aids.  Lee and Emanuel write:

Section 3506 of the ACA aims to facilitate shared decision making. Primarily, it funds an independent entity that would develop consensus-based standards and certify patient decision aids for use by federal health programs and other interested parties.

Not surprisingly, “shared decision making” (as opposed to ordinary decision making), is proven to cut costs:

In 2008, the Lewin Group estimated that implementing shared decision making for just 11 procedures would yield more than $9 billion in savings nationally over 10 years.

The authors suggest that HHS can bypass Congress in making the tools mandatory:

For approaches that provide savings or improve quality of care, implementation can be mandated throughout Medicare without additional legislation.

Lee and Emanuel do not offer specific examples of patient decision aids, but one that comes to mind is a video tool that made news in 2009.  Researchers affiliated with Harvard Medical School, Massachusetts General, and Boston University created a video of a woman with advanced dementia who could not talk or eat.  After viewing the video, almost all dementia patients (96%) declined life-saving treatment, while in the control group (decision-making without the video) only 86% chose to forgo life-saving measures. (Read about the study: Video Images of Advanced Dementia Help Patients Plan Care.  The study and video are online:  Volandes, Angelo E et al.Video Decision Support Tool for Advance Care Planning in Dementia: Randomised Controlled Trial.” BMJ 2009;338:b2159)

Don’t worry; CMS can get started even without the independent entity in place.  International guidelines are available:

The Department of Health and Human Services could quickly launch pilot programs for shared decision making while it works to standardize and certify decision aids. The International Patient Decision Aid Standards Collaboration has developed evidence-based guidelines for certification indicating that decision aids should include questions to help patients clarify their values and understand how those values affect their decisions . . .

The Center for American Progress urges immediate action.

Diane Meier to the brain injured: We respect your choice for life-support, but most people “make sane decisions”

It is difficult to say which was more disturbing: the doctor’s contempt for families who choose life for brain-injured loved ones; or Wesley J. Smith’s bizarre spin on the doctor’s speech.

On April 8, Smith blogged about a talk given by Dr. Diane Meier to a group of Vermont end-of-life activists. (“Assisted Suicide Ex Proponent, Dr. Diane Meier, Speaks Wisdom.”)

The item seemed contrived.  Meier’s about-face on assisted suicide is old news.  She was an assisted suicide activist until 1998, when she announced via the New York Times that she had changed her mind.  Now she is ostensibly against legalization of assisted suicide, though even Smith himself says “she is not an activist in the sense that I [Smith] am against that doctor prescribed death agenda.”  Moreover, her short comments on assisted suicide, quoted by Smith, were not very different from what she has been saying for many years.

The Q&A that Smith quoted was just a footnote to Meier’s hour-long speech.  Smith never commented on the ethical implications of Meier’s central arguments, which were taken right out of the Cass Sunstein/Zeke Emanuel/Donald Berwick playbook.  Meier argued  that via incremental change Obamacare will succeed in transforming American medicine to a public health model, will do away with the “original sin” of “unrestricted fee-for-service,” and will extend citizens’ quality years. More importantly, Meier argued that Obamacare won’t break the bank if palliative care – symptom treatment for people with five or more chronic conditions – is an essential part of the program.

The real kicker came roughly 44 minutes into the talk when Meier let slip what she really thinks about people who choose life   (video available here). Meier said 90% of the time severely brain-injured patients and their families choose to forgo or withhold life support; 10% of the time they don’t. She continued (note the mocking tone):

“10% of the time they say ‘I want everything; I don’t care if my brain is gone; I want to stay on a ventilator; I’m waiting for a miracle.’ Palliative care teams respect those choices . . . but nine times out of ten people make sane decisions.”

Just in case you missed it, that wasn’t respect, it was sarcasm. Meier was questioning the sanity of families who choose life-support for a loved one with severe brain damage.

Meier is a leftist ideologue. It is not surprising to hear her malign pro-lifers and bash American health care. However it is a surprise, and disappointing, that Wesley Smith covers for her.