The Enlightened View

The following is an article I wrote a while back, again hoping to be published. The piece give a glimpse into the thinking of the post-modern, so-called medical intellectual community regarding abortion and common ground. As you might imagine, the conclusions are anything but prolife. Enjoy the read.

The Enlightened View

By

Matt Anderson, MD*

An article published in the December 16^th edition of the New England Journal of Medicine (NEJM) deserves comment as it provides insight into the thinking of the presumably-enlightened medical establishment. The NEJM may be the most widely know and respected medical journal in the world. Unfortunately, the journal has also never hesitated to engage in partisan political advocacy including the push for national health care.

Benjamin Corn, MD authors an article called Ending End-of-Life Phobia—A Prescription for Enlightened Health Care Reform in which he states Americans have a phobia of death. He decries the expense of end-of-life care which consumes a disproportionate concentration of expenditures. He views the “death panels” which were a part of the initial Health Care Reform Bill as a joke for late-night comedians, denigrating Sarah Palin for originating the phrase. He describes what he believes to be three unacceptable mechanisms doctors and patients use to face death—the use of hospital care at the end of life, gallows humor and deferred questions about death by patients.

He opines that facing death allows for healing of relationships, something a majority of folks don’t do apparently without his intervention. He states the health bill initially “permitted” Medicare payment to doctors for discussing end-of-life issues with Medicare patients, carefully avoiding mention of the mandatory nature of these encounters and the additional mandatory requirement for such a discussion any time a Medicare patient was admitted to a hospital. He calls these mandatory discussions a “cautious and reasonable approach.” He further states that patients avoid these discussions because they feel vulnerable and fear physicians are trying to save money by limiting services. He wants our society to achieve a level of maturity for end-of-life conversations. To achieve this maturity, these conversations would need to respect personal autonomy and the sanctity of life and also would need to develop a climate of balance. Dr. Corn would achieve this goal by arranging a meeting between the patient and a team of chaplains (to advocate for life) and medical experts (to advocate limited use of resources at life’s end).

He later asks questions about which reforms government health care should address, including “nuanced strategies” about medical futility, death with dignity and physician assisted suicide. By doing what he advocates, he states we may have truly comprehensive reform and better living.

On close examination, however, Dr. Corn’s advocacy is hardly enlightened and instead represents an ancient evil. Hastening someone’s death by denying care in the name of cost savings places physicians in the role of killer, a common problem before Hippocrates set doctors on the right path in 400BC with his marvelous life-respecting oath.

He contradicts his early angst about the cost of end-of-life care and need to save money by stating the lack of end-of-life discussions, for which he advocates, may be motivated by that very fear—less care to save money. The effect of a group of people meeting with a patient to discuss the cost of end-of-life care by doctors as opposed to the advocacy for life by a chaplain is disingenuous. Chaplains I have met in my medical career rarely advocated for life and generally felt euthanasia and cost savings were laudable goals. Such a meeting would not respect the sanctity of life.

That patients don’t discuss end-of-life issues with physicians is a condescending attitude implying doctors should be privy to intimate and private family interactions. Encouraging patients into meetings with doctors and chaplains as Dr. Corn advocates would make clear to patients they should reject available medical care and instead die. Such a group meeting could accurately be called a death panel.

Dr. Corn’s comments at the end of the article are revealing. Phrases such a “nuanced strategies” for medical futility, death with dignity and guidelines for physician-assisted suicide (a euphemism for euthanasia) illustrate his clear agenda. Deny care to save money. Subtlety coerce patients by committee. Condescend to patients. Denigrate politicians who accurately point out the effect of proposed laws. Encourage the very ill to reject hospital care. Consider euthanasia.

Patients have right to fear this enlightened approach.

*Dr. Anderson is a practicing obstetrician/gynecologist from Minnesota

Muddying the Water: The New England Journal of Medicine (NEJM), Health Care Reform and Abortion

It’s been a while since I’ve posted. OK, more than a little while.  Anyway, following is an article I wrote hoping to get published, which it was not. I still think it worth the read. I hope you enjoy it as much as I enjoyed writing it.

Muddying the Water: The New England Journal of Medicine (NEJM), Health Care Reform and Abortion

The NEJM in its 12-31-09 issue granted George J. Annas, JD, MPH a platform to defend the Senate version of health care reform as meeting President Obama’s promise that no federal funds would be used for abortion. Because passage of the bill may hinge on abortion, Mr. Annas makes his argument by providing understanding of the Stupak amendment and the current laws on federal funding for abortion.

He rightly states the Stupak amendment prohibits use of federal funds for abortion and prohibits funding for health benefit coverage of any plan that includes coverage of abortion services. Abortion would be permitted if the pregnancy endangered the mother’s physical life or if the pregnancy resulted from rape or incest.

Mr. Annas sites the influence of Catholic bishops and, more importantly, a Christian group of political leaders who meet together outside of Congress as primarily responsible for the Stupak amendment. He refers to this Christian group of leaders as a fundamentalist, previously-secret group called the Family or the Fellowship.

He states abortion opponents defend the Stupak amendment as merely continuing the Hyde amendment, an amendment attached to every HHS Appropriation Act since 1976. He acknowledges that the Hyde amendment prohibits federal funding for any “health benefits coverage that includes abortion.”

He further acknowledges the health bill requires states to offer at least two health plans to the uninsured, one allowing abortion and one not. The plan allowing abortion must “segregate out” the source of funding allowing only state money, not federal money, be used for abortion. Additionally, insurance companies would receive subsidies, including those companies offering abortion. The Secretary of HHS would set the price to cover abortion services.

He adds that Senators Hatch and Brownback who have promoted the Stupak amendment in the Senate would oppose health care reform in general and therefore would vote against it even if the bill outlawed federal funding of abortion.

He then asks and answers three questions: Do the health care reform bills meet President Obama’s no-federal-funding promise? Do they follow the Hyde Amendment tradition? And do they represent good public health policy?

In response, Mr. Annas’ views regarding the influence of the Catholic bishops and this Christian group of leaders in promoting and passing the Stupak amendment ignore public feeling regarding government-funded abortion in the new health bill. A Quinnipiac poll of likely voters found 72% opposed government funding of abortion in any new health care system created by the government. Is such overwhelming public opposition insignificant? Certainly not. Does public opposition influence legislation? Yes, of course. In addition, are private meetings of Christian leaders allowed outside the halls of Congress? Isn’t freedom of association one of our most basic rights? Yet, Mr. Annas implies a sinister motive behind their association.

Mr. Annas has no trouble dispatching the abortion opposition of Senators Hatch and Brownback as disingenuous since they oppose this health care bill in general. However, his argument makes little sense. Just because they oppose the bill in general does not lessen their desire to eliminate abortion coverage from the bill.

Regarding his three questions, he answers yes to the first, assuring us the health care reform bill fulfills the Presidents wish of no federal funds for abortion. He explains the plan would require funds for abortion come from insurance companies or the states, not the federal government. He adds opponents call this language a “bookkeeping trick.” However, the contention that the funds for abortion come only from the other sources clouds the truth. The federal government provides funds to state plans for the uninsured including those offering abortion and provides funds to insurance companies who offer abortion. The federal government claims innocence as if one hand does not know what the other is doing. But the federal funds are there, subsidizing these plans which offer abortion. A “bookkeeping trick” is an accurate assessment of this proposal. He then equates the salary a federal worker gets from the government as the government funding abortion. His statement ignores what everyone knows. Once a person receives a paycheck, the money belongs to that person to use as he or she would please and is no longer a government fund. Private use of private funds is not government funding of abortion. Also, since the secretary of HHS sets the price the states will pay for abortion services, what is to prevent the secretary from setting the price at any rate? The states and insurance companies contribution for abortions could be next to nothing depending on the whim of that one person.

To the second question Mr. Annas implies the Stupak amendment goes far beyond the Hyde amendment in restricting abortion. A closer look finds otherwise. With the Stupak amendment, any insurer on the government-mandated, government-approved exchange could not offer abortion services effectively eliminating expansion of abortion much like the Hyde amendment. Without the Stupak amendment, however, the government could approve admission to the insurance exchange for a plan offering abortion service and deny admission to the exchange for a plan not offering abortion services since the bill mandates government approval of plans. Thus, abortion coverage could be greatly expanded, the opposite of the effect of the Hyde amendment today. Had the government required approval for every health plan in the US in 1978, the Hyde amendment would have been worthless.

Mr. Annas answers his third question by contending the Stupak amendment eliminates medically necessary abortion, defining medically necessary as allowing abortion for the health of the mother. Therefore, the Stupak amendment is not good public health policy. But, the health exception opens the door for abortion for nearly any reason, reasons as minor as “I’m stressed by the pregnancy.” That statement qualifies as anxiety, a diagnosis which would allow abortion to improve the woman’s “health.” The Stupak amendment rightly closes that door.

In spite of President Obama’s recent assurances, his past statements make clear his commitment to seeing abortion included in any health care reform law. The Senate version clearly allows that.

Matt Anderson, MD