Friday, December 18, 2009

President Obama and the Just War Argument

Though President Obama's decision to "surge" in Afghanistan should not have been unexpected by the American public, I was grieved to finally hear the announcement. I was surprised -- and happily -- that he enunciated a defense of the military efforts there in terms of the classic "just war" theory because it seems to me that we Americans always assume our wars to be "just" simply because they always seem to be defending "our freedoms" or "our way of life." In other words, we rarely question our nation, and we do so only on the most selfish level. Even protests against the Viet Nam war for the most part only dwelt on the issue of whether or not America had some kind of national interest at stake, so that if we did NOT have a vested national interest, then we should NOT be fighting in Viet Nam.

Such an explanation flies in the face of classic "just war" arguments. One of the primary qualifications for "just war" in those arguments is that the war CANNOT be fought for selfish purposes.

So, again, it was good to hear our President articulate a logical defense of his decision to surge. In part, it was good to hear because it may become clearer to all of us that this war and the one we are fighting in Iraq are indeed NOT "just." We are invaders in foreign countries; we are attempting to spread our empire; we are not fighting by just means. Thus our wars are not just, according to "just war" theory.

For an insightful analysis of President Obama's speech on the surge, see this short piece by Professor Stanley Hauerwas:

"Peace on earth." (unidentified angels)

Friday, December 11, 2009

Death Panels

Sarah Palin, Glenn Beck, yada yada yada -- people claiming that the proposed health care reforms include "death panels" have gotten some folks pretty upset, including some people pretty close and dear to me. They cannot understand how I could support the reform of our health care system when it includes death panels = the plan to kill of the elderly because their health care would cost the system too much.

Now, I have to admit I'm insulted that someone would think I was in favor of such a proposal, since I do love my parents and want them to live as long as possible, so long as THEY are happy with their quality of life!!!! To be honest, I want them to live longer than that, but they've talked to me over the years about not wanting to live out the end of their days hooked to machines in a hospital room. It's hard for me to talk to them about it, but they have "no heroic measures" clauses in their living will statements. I will be very hard to convince that we should "pull the plug" (even writing that makes me shudder) at any time when there is still breath in them. But they have already made some decisions, far ahead of time, about their desired quality of life. And they've forced me to think about those issues for my own life as well. And though I love my parents, my siblings and I may at some point have to make some very, very difficult decisions. But we will do that with full consideration of my parents' wishes.

That being said: it is insulting to me for someone to claim that I -- or in general people who favor the reform of the American health care system -- want to kill off our parents because we don't think their lives are worth paying to preserve. But that is how some of the hate-mongers in our country have portrayed this effort, including Sarah Palin and Glenn Beck. They are lying and they need to repent.

Is it even logical to think that the people who are promoting this reform all want to kill off their parents? I mean -- they're not teenagers! It just makes no sense to think that they want to do that. And they don't.

On the other hand, maybe they just don't know what's in there! Maybe the wicked writers of the bill have hidden the "death panel" provision somewhere in there, and since the bill is so long (so they criticize), people who are promoting it haven't even read it! They're just ignorant, and the wicked Obama-wizard wants to keep them that way so he can kill old people.

Ok -- really? The bill is out there for public viewing. But it's so nice and easy to assume Palin and Beck are right (because, after all, they're conservatives, and they are Christians!!!), and to attribute horrid, horrible motives to the "liberals," so, well, it MUST be true.

So I decided to check into it myself. Here's what I found.

The bill that was passed by the house ("America's Affordable Health Choices Act of 2009," available at has a provision in Section 1236 (pp. 438-443) for a "DEMONSTRATION PROGRAM ON USE OF PATIENT DECISIONS AIDS." This is the provision that has been construed as the attempt to establish "death panels."

A "patient decision aid" is defined as:

an educational tool (such as the Internet, a video, or a pamphlet) that helps patients (or, if appropriate, the family caregiver of the patient) understand and communicate their beliefs and preferences related to their treatment options, and to decide with their health care provider what treatments are best for them based on their treatment options, scientific evidence, circumstances, beliefs, and preferences.

So, what this program intends to do is to make sure patients fully understand their treatment options and have thought through them based on their OWN BELIEFS AND PREFERENCES. Now, having been a cancer patient over the last year, let me assure you of how important this is! I'm grateful for the treatment I received, but I admit I have been surprised a time or two during the process because I did NOT understand all the implications. I wish I had had better information, information I could understand, and had been able to think through it all better. But I was so overwhelmed by the thought of having cancer, and the treatment options were of a wide variety, and I just couldn't get my head around it -- and in part I didn't want to. I just wanted to get it over with. Thankfully my wife had her wits about her throughout the process, so I had good guidance even when I didn't have a clue what was going on. But I've wished I'd understood better, and this provision is trying to accomplish just that sort of thing.

And it wants to do so by establishing "a shared decision making demonstration program . . . under the Medicare program using patient decision aids to meet the objective of improving the understanding by Medicare beneficiaries of their medical treatment options."

The section says: "An eligible provider participating in the program shall routinely schedule Medicare beneficiaries for a counseling visit after the viewing of such a patient decision aid to answer any questions the beneficiary may have with respect to the medical care of the condition involved and to assist the beneficiary in thinking through how their preferences and concerns relate to their medical care." Death panel? Get real.

Now, I can see how the phrase "shared decision making" could spook someone. But here's how the bill defines it:

The term ‘‘shared decision making’’ means a collaborative process between patient and clinician that engages the patient in decision making, provides patients with information about trade-offs among treatment options, and facilitates the incorporation of patient preferences and values into the medical plan.
If the test program is established (i.e., if the bill is signed into law), it is ordered to create a final report within a year of its end. That report must "include an evaluation of the impact of the use of the program on health quality, utilization of health care services, and on improving the quality of life of such beneficiaries." In other words, the intent of the program is to make sure people understand their treatment options, make sure their own beliefs and wishes become part of the treatment plan (so that the doctors can't just push for their own preferred treatment), and in general to try to improve the quality of life of the patients.

It is NOT A DEATH PANEL. Its intent is not to counsel someone to end their life, or to tell someone that their life has become too expensive for the system to maintain. Anyone who tells you different either has not read the bill or is lying.

Some folks have insisted that this provision will result in the government sending out "little blue pills" (i.e., "suicide pills") with instructions to old folks that they have to take it because the government will no longer pay for their health care. People who make such outrageous claims are using scare tactics and lies to manipulate the elderly and the already "anti-liberal" into protesting against this reform effort. That's just plain wrong.