In a medical emergency, the triage system is a priority system to treat the most life-threatening and severe injuries first. It rations limited health resources to the most urgent cases, divided into three categories: Those who are likely to live, regardless of receiving care, those likely to die, regardless of care, and those for whom immediate care might make a positive difference in outcome. From a practical viewpoint, it is understandable for attending doctors and medical personnel to use the triage system to make such serious calls in a mass casualty situation. Time is of the essence, and patients must be prioritized for treatment according to the limited resources at hand.
However, when the triage method is used on a national scale to determine allocation of limited health care availability for its citizens, it changes from a doctor making a first-hand professional decision in the best interests of the patients in his personal care, to an impersonal government making legal guidelines to patients unseen. It becomes Abandon Ship! writ large, where the executive officer on an overcrowded lifeboat must decide who stays and who goes, else they all perish en masse.
Dr. Ezekiel Emanuel is brother of Rahm Emanuel, the White House Chief of Staff. He was called to be President Obama adviser on the health care bill. Dr. Emanuel recently authored Principles for allocation of scarce medical interventions in the 2009 issue of the Lancet, a magazine concerned with bioethics issues. In the article, Dr. Emanuel offers guidelines on how (and most importantly, "to whom") limited health resources should be allocated on a national scale. His solution is to redefine medical ethics to justify serving only some of the nations sick at the expense of others.
A sample of Dr. Emanuel’s political triage philosophy:
"Although not always recognized as such, youngest-first allocation directs resources to those who have had less of something supremely valuable — life-years….
….Strict youngest-first allocation directs scarce resources predominantly to infants. This approach seems incorrect. The death of a 20-year-old young woman is intuitively worse than that of a 2-month-old girl, even though the baby has had less life. The 20-year-old has a much more developed personality than the infant, and has drawn upon the investment of others to begin as-yet-unfulfilled projects. Youngest-first allocation also ignores prognosis, and categorically excludes older people. Thus, youngest-first allocation seems insufficient on its own, but it could be combined with prognosis and lottery principles in a multiprinciple allocation system.
Save the most lives
One maximizing strategy involves saving the most individual lives, and it has motivated policies on allocation of influenza vaccine and responses to bioterrorism. Since each life is valuable, this principle seems to need no special justification. It also avoids comparing individual lives. Other things being equal, we should always save five lives rather than one.
However, other things are rarely equal. Some lives have been shorter than others; 20-year-olds have lived less than 70-year-olds. Similarly, some lives can be extended longer than others. How to weigh these other relevant considerations against saving more lives — whether to save one 20-year-old, who might live another 60 years if saved, or three 70-year-olds who could only live for 10 years each — is unclear. Although insufficient on its own, saving more lives should be part of a multiprinciple allocation system."
Principles for allocation of scarce medical interventions, Dr. Ezekiel Emanuel, Lancet 2009; Pages 373: 423—31. Department of Bioethics, The Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
This is only a small sample of the good doctor’s rubric to determine who receives what quality of health-rationed care. He claims to do so from a dispassionate objectivity, i.e., without a suffering patient in front of him to bias his decision. Please take the time to read his article in its entirely — it is the makings of a progressive-era eugenics manifesto.
To justify such Darwin-inspired selection of the fittest for national health care; Dr. Ezekiel Emanuel wrote an earlier treatise in the 1996 Hastings Center report to redefine what constitutes "good" in terms of State-issued health care:
“Thus, it seems there is a growing agreement between liberals, communitarians, and others that many political matters, including matters of justice and specifically, the just allocation of health care resources — can be addressed only by invoking a particular conception of the good. We may go even further. Without overstating it (and without fully defending it) not only is there a consensus about the need for a conception of the good, there may even be a consensus about the particular conception of the good that should inform policies on these nonconstitutional political issues.”
Advocating a consensus to declare what is "Good" in terms of health care is nothing more than moral relativism to cloak the harshness of the selection process with a velvet curtain. For those who do not have health coverage, any health coverage will seem "good" by his definition, even if only free band-aids and aspirin are handed out. Dr. Emanuel’s audacity to state that such redefinition of "good" health care on a national level need not be considered a constitutional or political issue shows his contempt for the representative system of our government and its citizens — obviously, we are not smart enough like him and his colleagues to be allowed to take part in the discussion, even though its our tax dollars and lives are at stake! It is nothing more than the elitist wordplay that Orwell predicted would used to redefine the meanings of words for political consumption for the proles. I can hardly wait to hear what level of medical care Dr. Emanuel defines as "double-plus good"!
Dr. Emanuel’s proposal for national heath care distribution is nothing more than a kinder and gentler process of Josef Mengeles’ method motioning his hand either to the right to direct Jews into work camp, or left to the gas chambers. If David Duke had been selected to advise president LBJ on civil rights legislation in 1965, one would rightfully question the objectively of such an advisor to such a issue. But in the rush to the government trough for heath care coverage, many citizens have taken no thought of what they are being served, until too late they find that the only health care treatment they are being administered is the "final solution."
Ron Shirtz [send him mail] is a transplanted Californian teaching Graphic Communications in Northern (Not “Upstate”) New York. His hobbies include arranging deck chairs on sinking ships, tilting at windmills, and being fashionably late.