On Health Care and Death Panels

by Rabbi Philip Lefkowitz

Dr. Ezekiel Emanuel, brother of Chicago’s Mayor, has been traveling the talk show TV circuit explaining the virtues of Obamacare. It is worth revisiting the good doctor’s views on health care as he was a major player in the creation of Obamacare.

Dr. Ezekiel Emmanuel, healthcare guru to President Obama, wrote the following in the Feb. 27, 2008, issue of the Journal of the American Medical Association (JAMA): “Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely ‘lipstick’ cost control, more for show and public relations than for true change. True reform, must include redefining doctors’ ethical obligations.”

In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the ‘overuse’ of medical care. “Medical school education and post graduate education emphasize thoroughness. This culture is further reinforced by a unique understanding of professional obligations, specifically the Hippocratic Oath’s admonition to ‘use my power to help the sick to the best of my ability and judgment’ as an imperative to do everything for the patient regardless of cost or effect on others. He stated, “The progression in end-of-life care mentality from ‘do everything’ to more palliative care shows that change in physician norms and practices is possible.”

With the recent revelations that the first day of the signing in on the web site for Obamacare saw only six individuals sign in, the revealing statistics that the majority of folks signing up ended on Medicaid, and that most of the healthy young members of our society are not signing up and are probably going to elect to pay the $95.00 fine instead, requires us to consider the opinions of Dr. Emanuel as they no doubt more than in the past will serve as the touchstone for the provision of Obamacare, as the financial base upon which it was predicated seems to be no longer attainable.

Emanuel’s belief that Doctors’ approach to healing must not only consider the needs of the patient, but also the “cost and effect on others,” is the basis upon which government health care, as I experienced it in the United Kingdom, functions. It is the only way it can function as the traditional view of the Hippocratic Oath is not doable in such a system.

We already saw an example of this in Secretary Sebalius’ refusal to allow a heart transplant to be given to a young child. It was only through the intervention of the Court that this precious life was spared.

During my sojourn in the U.K. nearly three decades ago, I was treated to the harsh reality of national health care. Our local health board in Manchester needed to supply our hospitals with six additional dialysis machines to meet the needs of the growing patient load which required this service to maintain their very lives. Unfortunately, their budget granted them by the Federal government was far less than required. The were left to review their needs – forced to make adjustments. One adjustment that was decided upon was not to purchase any additional dialysis machines as in the eyes of the Board there were many more pressing issues that needed attention.

Letters were sent to those designated “unworthy” of future dialysis treatment. Those on the dole, the elderly, and others determined as Dr. Emmanuel would put it, based upon their “cost and effect on others,” were singled out for a letter. The letter simply told the recipient that he/she need not come to Hospital any longer as dialysis would no longer be available. It was a “death notice” issued by a “death panel.”

Our Jewish tradition requires that a Bikur Cholim, a committee be set up in every Jewish community to maintain medical care for all – Rabbi, farmer, philanthropist, worker, the poor and the beggar alike. The community and the individuals residing in that community would have to prioritize spending. Those responsible to collect communal funds from the individual would establish the sum to be given and even could force, if necessary, the payment of that sum by the individual through the Bet Din – religious court. I do not believe they would view as a priority in one’s budget, season tickets at Wrigley Field, for example, as superseding ones obligation to provide for the healthcare of society.

I cannot and will not believe that Americans want their doctors or hospitals to be guided in their provision of medical care by a lay body who effectively, in line with Dr. Emanuel’s ethics, determines what medical care, if any, an individual will receive, not only by the need of the patient but by the impact such care will have upon society as a whole. As in my example from the U.K., they would essentially determine the ill person’s value to society. Does he work, is he productive, does his life have a meaningful impact on others, his probable years of life he might live, a new Unesaneh Tokef, this time in the hands of humanity – “Who shall live and who shall die.”

Many times, when confronted by the mourner with the painful question of why their loved one died, I have responded that, in theory, the issue of life and death can remains in G‑D’s hand or we could demand to play a role in determining who shall live and who shall die to insure our sense of fairness is in play. For me, I opt for the present situation, accepting that at times the G‑dly decision will be one I cannot fathom and may even disagree with, rather than have to sit on the celestial “death panel.”

Don’t you agree with me? The path our society is now on with regard to health care is morally wrong, un-Jewish. It needs to be changed. Considering the "quality” of another’s life begins the slippery slope toward euthanasia and worse. That the Jew was considered, evaluated, to be a non-human race of vermin, was the “justification” for their slaughter by the Nazis. We need to learn from history rather than embarking upon a path, G‑d forbid, toward reliving history.