09.08.09

Bring On the Death Panels!

As Obama readies his health-care speech tonight, Sarah Palin is on the offensive again, railing against "death panels." Eric Pape on tens of millions of people who think that's a good thing.

In “Old Europe,” the wild accusations that President Barack Obama is pushing “death panels” that will unplug your granny sound surreal, while the idea that there is a link between offering some form of universal health care and the Nazis’ “final solution” is simply incomprehensible. People on this aging continent understand that there are inherent limits to what universal medical care can provide, just as there are limits to how long they might want to endure horrifically debilitating or terminal illnesses.

In other words, the debate here is not about whether there are end-of-life decisions to be made—even in the U.S., after all, insurance companies make life-or-death rulings every day, albeit with a stronger financial motive than public health-care systems. The questions in Europe revolve around how such painful decisions can be made most fairly and, increasingly, whether it can be done in accordance with the wishes of those being cared for.

No one is comfortable making such an excruciating call, which is why both public programs and private insurance companies strive to depersonalize the end-of-life process.

But it’s rarely easy. Take the cases of Gareth Anderson, 19, and Gary Reinbach, 22, both of whom were diagnosed with advanced cirrhosis of the liver a few months ago. In both cases, the U.K.’s National Health Service refused a liver transplant. Reinbach died in July, and Anderson is reportedly on a countdown.

Eric Alterman: The Speech of his Life—AgainSome Americans would hear the parents recount how they pleaded with the British system to save their young sons and conclude that the universal health-care program in the U.K. is Sarah Palin’s worst nightmare. But there were no rowdy protests at public gatherings in England, or posters of Prime Minister Gordon Brown with a Hitler moustache.

Why not? Because the British (along with most people in the European Union) believe their medical system does a pretty good job—and without anxiety-inspiring concepts such as “pre-existing conditions” or “co-pays.” Beyond that, livers are a scarce commodity because few people agree to donate organs in the U.K., the U.S. or elsewhere. (More than 8,000 people in the U.K. await organ transplants—some 259 for livers—and more than 400 reportedly died while on waiting lists last year.)

That’s the context in which health-care bureaucrats rejected Anderson and Reinbach in favor of candidates deemed to have better prospects. Neither one could fulfill or overcome a crucial liver transplant rule for alcoholics: Be sober for half a year before being admitted to the hospital. Such guidelines target chronic lifelong alcoholics such as soccer legend George Best, who fell off the wagon 12 months after his liver transplant and died two years later. (Best famously said, "I spent a lot of money on booze, birds, and fast cars. The rest I squandered.") The guidelines are less suited to a new generation of young drinkers who are destroying their livers with unprecedented speed that prevents them from living long enough to “prove” their sobriety. (Reinbach’s father says his boy was drinking several bottles of vodka per day before he was diagnosed.)

Meanwhile, a case like Anderson’s, according to National Health Service transplant officials, “highlights the dilemma doctors face because of the shortage of donated organs,” leaving health staff with grueling decisions about “who is going to take best care of this precious gift." (It certainly didn’t help that Gareth left the hospital last week—dressed in slippers, a medical gown and with intravenous drip needles in both arms—for a nearby pub, where he asked for a beer or a vodka. He had to settle for a Coke.)

Such messages are brutal for the families of those who are rejected. But even the grieving father of Gary Reinbach acknowledged in a radio interview with the BBC in July that he understood that somebody would always be left out—even if he did everything in his power to make sure it wasn’t his boy.

Which brings us back to Sarah Palin, who has galvanized passions in the U.S. in part by putting herself in the shoes of parents who, obviously, advocate as passionately as they can. Some key issues are missing from the “death panels” debate that she stirred up. The truth is that even when a patient doesn’t seem entirely dedicated to saving himself or herself, no one is comfortable making such an excruciating call, which is why both public programs and private insurance companies strive to depersonalize the process; medical officials do it largely through ethical, moral, or practical rules, while insurance companies tend to let cost concerns dictate the regulations.

Another element largely overlooked in the U.S debate is whether Granny might in certain cases want someone to pull the plug. Terminally or chronically ill people in Catholic Spain and Italy, as well as France, have made impassioned pleas in recent years—in courtrooms, on television, and in books—for state assistance that will let them die with dignity and a minimum of suffering. Many have been rejected—and then committed suicide on their own or with the help of loved ones, who, in some cases, faced prosecution.

Increasingly, though, countries such as Belgium, the Netherlands, and especially Switzerland, which have more favorable assisted-suicide or euthanasia laws, are seeing a rise in “death tourism.” In Switzerland, for example, people who assist in a suicide can only face charges if they stand to profit from the death, so clinic staff are made up of volunteers. The result: Thousands of people have taken their lives in Switzerland in this way in the last dozen years, which, in a strange sense, is actually a testament to the excellent universal medical care of the Europeans who travel there to die. Elderly or terminally ill people often fear that state-of-the-art medical technologies at home, along with restrictive laws, will be used to keep them alive longer than they dreamed—or wanted.

Among the more than 100 British citizens who have checked in to the Dignitas clinic in Switzerland are Sir Edward Downes, a legendary 85-year-old British orchestra conductor, and his 74-year-old wife, Joan, a former ballet dancer, who was in the terminal stage of liver cancer. Sir Edward had lost his eyesight and most of his ability to hear the music that drove his remarkable professional career. He didn’t want to live without the love of his life. In July, with their adult children standing next to them, they drank a cocktail of barbiturates and sank into the deepest sleep. "After 54 happy years together, they decided to end their own lives rather than continue to struggle with serious health problems,” their children said later in a statement. They died holding hands.

The complex issues surrounding end-of-life care will always be painful, because, well, death is painful in so many ways. But the debate in Europe, at least, avoids the sort of fraught, cynical polemics that are tainting America’s search for practical solutions.

Eric Pape has reported on Europe and the Mediterranean region for Newsweek Magazine since 2003. He is co-author of the graphic novel, Shake Girl , which was inspired by one of his articles. He is based in Paris.