Friday, August 21, 2009

Charles Krauthammer Update: Still An Idiot.

When I opened the Op-Ed section of the paper this morning, I saw this headline over Krauthammer's column:

Let's Be Honest About Death Counseling

And I thought, Honest? Well this will be a refreshing change of pace!
Then the column begins:

Let's see if we can have a reasoned discussion about end-of-life counseling.

And I thought, Yes! Finally! Let's do that! Let's have a reasoned discussion.

We might start by asking Sarah Palin to leave the room.

Oh my God! Has Charles Krauthammer gained some semblance of sanity? (clouds open, angels sing)

I've got nothing against her.

Really? Nothing? Not the fact that she's a bald-faced liar? Not the fact that she is the one who injected the term "death panel" into our national political discourse? Not the fact that she stood silently smiling when attendees at her rallies shouted "kill him!" at the mention of Barack Obama? Not the fact that she fleeced the taxpayers of Alaska, abused her power for personal vendettas and then quit before her first term was up?

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I've got nothing against her. She's a remarkable political talent.

Really? You mean in the same way that William Shatner is a remarkable musical talent?

She's a remarkable political talent. But there are no "death panels" in the Democratic health-care bills, and to say that there are is to debase the debate.

Okay, back on track. Let's have our reasoned discussion now.

We also have to tell the defenders of the notorious Section 1233 of H.R. 3200 that it is not quite as benign as they pretend. To offer government reimbursement to any doctor who gives end-of-life counseling -- whether or not the patient asked for it -- is to create an incentive for such a chat.

Oh, here we go. I knew it was too good to be true.

First of all, the only reason that Section 1233 is "notorious" is because of the lies spread by dimwits like your pal Sarah. And do you really think that doctors are going to spring end-of-life counseling on patients that haven't requested it? "well, your test results look fine, Mr. Smith, have you ever considered a DNR? Ka-Ching! I spoke about end-of-life issues, pay up, Medicare!"
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What do you think such a chat would be like? Do you think the doctor will go on and on about the fantastic new million-dollar high-tech gizmo that can prolong the patient's otherwise hopeless condition for another six months? Or do you think he's going to talk about -- as the bill specifically spells out -- hospice care and palliative care and other ways of letting go of life?

Right, because doctors HATE expensive, life-prolonging procedures. They make way more money letting their patients slip unfettered into the sweet embrace of death.

No, say the defenders. It's just that we want the doctors to talk to you about putting in place a living will and other such instruments. Really?

Yes, Really.

Really? Then consider the actual efficacy of a living will. When you are old, infirm and lying in the ICU with pseudomonas pneumonia and deciding whether to (a) go through the long antibiotic treatment or (b) allow what used to be called "the old man's friend" to take you away, the doctor will ask you at that time what you want for yourself -- no matter what piece of paper you signed five years earlier.

A living will is for times when a patient CAN"T speak for himself. You can't really believe that a doctor would tell a patient " sorry, fully conscious patient, I know you say now that you want to live, but I've got a paper here that says otherwise! Nurse! To the death chamber with this man!" Idiot!

You are told constantly how very important it is to write your living will years in advance. But the relevant question is what you desire at the end -- when facing death -- not what you felt sometime in the past when you were hale and hearty and sitting in your lawyer's office barely able to contemplate a life of pain and diminishment.

Yes, and if you are able to make your wishes known at the time, they will of course be honored. Again, living wills are only brought into the picture when a patient is unable to speak or otherwise communicate his wishes. The point is to avoid ending up like Terry Schiavo, lying brain dead in the hospital for years while the family is torn apart fighting over what your final wishes may or may not have been.

My own living will, which I have always considered more a literary than a legal document, basically says: "I've had some good innings, thank you. If I have anything so much as a hangnail, pull the plug."

Then what the hell are we talking about? You have a living will, so you must understand that it is not a contract that can be enforced against your will.

I've never taken it terribly seriously because unless I'm comatose or demented, they're going to ask me at the time whether or not I want to be resuscitated if I go into cardiac arrest. The paper I signed years ago will mean nothing.

That's what I've been saying! Why am I even here? You're arguing both sides of the issue against yourself!

And if I'm totally out of it, my family will decide, with little or no reference to my living will.

Oh shit! You just keep getting stupider! Why would you bother having a living will if you expect everyone to ignore it? You obviously have strong feelings on the issue, why would you want other people deciding for you?

Why? I'll give you an example. When my father was dying, my mother and brother and I had to decide how much treatment to pursue. What was a better way to ascertain my father's wishes: What he checked off on a form one fine summer's day years before being stricken; or what we, who had known him intimately for decades, thought he would want? The answer is obvious.

Ok, let me give you an example. Terry Schiavo. (yes, again!) Her husband, who had known her intimately (hopefully more intmately than you and your brother had known your father) believed that her wishes were to not be kept artificially alive by machines. Her parents believed the opposite. It ended with the courts, the media, and a bunch of imbecilles in Congress being involved in what should have been a private family tragedy.
Hopefully, you and your brother came to the same conclusion regarding your father's wishes, but a lot of families won't. And, not for nothing, but you and your brother might have both been wrong.

Except for the demented orphan, the living will is quite beside the point. The one time it really is essential is if you think your fractious family will be only too happy to hasten your demise to get your money.

That statement is too disgusting to merit comment.

So why get Medicare to pay the doctor to do the counseling? Because we know that if this white-coated authority whose chosen vocation is curing and healing is the one opening your mind to hospice and palliative care, we've nudged you ever so slightly toward letting go.

Why would you assume that the doctor, whose vocation is, as you say, curing and healing, would be inclined towards pressuring his patients to forgo medical treatment which is, by the way, how he earns his money?

It's not an outrage. It's surely not a death panel. But it is subtle pressure applied by society through your doctor. And when you include it in a health-care reform whose major objective is to bend the cost curve downward, you have to be a fool or a knave to deny that it's intended to gently point the patient in a certain direction, toward the corner of the sickroom where stands a ghostly figure, scythe in hand, offering release.

No, you'd have to be a paranoid lunatic or a filthy liar to say that it is. Or an idiot like Charles Krauthammer.

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