Sarah Palin, M.D.

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The former Alaskan governor, Sarah Palin, better explains today why she is concerned about President Obama’s support for allowing doctors to offer living will consultations to patients with government funding. It is, I believe, a must read, if only as an exercise in logic. Palin is arguing in plain terms that doctors cannot be trusted to give advice to patients, a rather stunning turn.

The issue is the context in which that information is provided and the coercive effect these consultations will have in that context. Section 1233 authorizes advanced care planning consultations for senior citizens on Medicare every five years, and more often “if there is a significant change in the health condition of the individual … or upon admission to a skilled nursing facility, a long-term care facility… or a hospice program.” During those consultations, practitioners must explain “the continuum of end-of-life services and supports available, including palliative care and hospice,” and the government benefits available to pay for such services.

Palin goes on to explain that since one of the intents of the bill is to reduce costs in the health system it is logical to assume that seniors “might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal end-of-life care.” (This situation, it can be noted, leaves wealthy people, who by contrast do not depend on Medicare to pay for their consultations with doctors, free to be manipulated by nefarious doctors with discussions about end-of-life preferences.) Let us pause a moment here to consider the import of this argument. Palin is saying that the government should not fund a service many doctors want to provide to their patients–and many patients want provided to them–because doctors might try to dupe patients into denying themselves services. She is arguing, in other words, that the government’s proper role is to restrict the range of services that doctors can provide patients. Isn’t this the opposite of the traditional conservative stance on health care–that the government should not get between the doctor-patient relationship?

Later in the same post, Palin returns to her case against Ezekial Emanuel, whom I wrote about yesterday. Here the problem really is context. Again, she misrepresents his academic work with selective quotes. The first quote, in a paper in which Emaneul discussed dementia, should be put in the context of a theoritical discussion of social ethics, which Marc Ambinder ably explains here. The second quote, in which she speaks about Emaunel’s endorsement of age preference for certain medical treatments, should be put in the context of his paper–which was narrowly focused on those few ethical dilemmas in which there is an absolute scarcity of resources, like when there is one liver for three potential patients.

As Emanuel later makes clear in the same paper, his argument about age preference should not be applied to the broader healthcare debate, which is exactly the thing Palin is accusing him of doing. “Accepting the complete lives system for health care as a whole would be premature,” Emanuel writes on page seven of the paper. “We must first reduce waste and increase spending.” (Reducing waste and increasing spending is, it turns out, exactly the strategy at the heart of the Obama health care reform effort.) Luckily, Palin provides citations for her quotes, so anyone can read for themselves exactly what Emanuel was writing about.