“Healthcare Nationalized and “the complete lives system”—WHAT IS YOUR AGE!


A very RELEVANT source: “Earlier this year, Dr. Emanuel wrote an article that advocated what he called ‘the complete lives system’ as a method for rationing health care. You can read it here.”

The chart above is from an article in “Lancet” entitled “Principles for allocation of scarce medical interventions.” NOTE: One of the three authors is Ezekiel J. Emanuel who according to my last two posts is an advisor to President Barack Hussein Obama. And according to my last post is a brother to his Chief of Staff—Rahm Emanuel. The article contains spellings that are “English” rather than “American.” I did not change the spellings. The article contains footnotes throughout. I included the footnotes in the body of the article but do not provide the actual source material information so footnoted.

The article promotes what they identify as “the complete lives system”—“We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.” (I wonder what the ages of the authors are and will they submit to their own recommendations!—my addition) I quote some of the material but certainly not all. The article, itself in full, is accessible through the links given in the two previous posts. Note two things:

1) the core argument is that medical services out of necessity MUST be rationed although the term is never used, that I could find.

2) If Doctor Emanuel is an active advisor of President Barrack Hussein Obama, he no doubt is pushing the adoption of this proposal in ANY approved “Nationalized Healthcare” system—in practice even if not written into the law.

By the article’s own statement, “the complete lives system” is what the authors recommend.

“Principles for allocation of scarce medical interventions

Govind Persad, Alan Wertheimer, Ezekiel J Emanuel

Department of Bioethics, The Clinical Center, National Institutes of Health, Bethesda, Maryland, USA (G. Persad BS, A. Wertheimer PhD, E. J. Emanuel MD) Correspondence to: Ezekiel J. Emanuel, Department of Bioethics, The Clinical Center, National Institutes of Health, Bethesda, MD. 20892-1156, USA, eemanuel@nih.gov

Source:

Lancet 2009; 373: (pages—my addition) 423–31
http://www.thelancet.com/ Vol 373 January 31, 2009

Section of Lancet: Department of Ethics

Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.

In health care, as elsewhere, scarcity is the mother of allocation.1 Although the extent is debated,2,3 the scarcity of many specific interventions—including beds in intensive care units,4 organs, and vaccines during pandemic influenza5—is widely acknowledged. For some interventions, demand exceeds supply. For others, an increased supply would necessitate redirection of important resources, and allocation decisions would still be necessary.6 (How about that! Here they actually consider supply and demand principles. I wonder why the Congress and the President are ignoring the same supply and demand principles as they advocate more coverage, more complete coverage, and at an “affordable” cost. Could it be because those three occurrences are impossible at the same time under supply and demand principles without RATIONING?—my addition)

Allocation of scarce medical interventions is a perennial challenge. During the 1940s, an expert committee allocated—without public input—then-novel penicillin to American soldiers before civilians, using expected efficacy and speed of return to duty as criteria.7 During the 1960s, committees in Seattle allocated scarce dialysis machines using prognosis, current health, social worth, and dependants as criteria.7 How can scarce medical interventions be allocated justly? This paper identifies and evaluates eight simple principles that have been suggested.8–12 Although some are better than others, no single principle allocates interventions justly. Rather, morally relevant simple principles must be combined into multiprinciple allocation systems. We evaluate three existing systems and then recommend a new one: the complete lives system.

Simple allocation principles

Eight simple ethical principles for allocation can be classified into four categories, according to their core ethical values: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness (table 1). We do not regard ability to pay as a plausible option for the scarce life-saving interventions we discuss. (Do you think that all those rich entertainers and other rich individuals who supported Barack Hussein Obama realize this? Of course, they can always go to Europe!—my addition)

Some people wrongly suggest that allocation can be based purely on scientific or clinical facts, often using the term ‘medical need’.13,14 There are no value-free medical criteria for allocation.15,16 Although biomedical facts determine a person’s post-transplant prognosis or the dose of vaccine that would confer immunity, responding to these facts requires ethical, value-based judgments.

When evaluating principles, we need to distinguish between those that are insufficient and those that are flawed. Insufficient principles ignore some morally relevant considerations. Conversely, flawed principles recognise morally irrelevant considerations: inherently flawed principles necessarily recognise irrelevant
considerations, whereas practically flawed principles allow irrelevant considerations to affect allocation. Principles that are individually insufficient could form part of an acceptable multiprinciple system, whereas systems that include flawed principles are untenable because they will always recognise irrelevant considerations.” (page 423)

“The complete lives system

Because none of the currently used systems satisfy all ethical requirements for just allocation, we propose an alternative: the complete lives system. This system incorporates five principles (table 2): youngest-first, prognosis, save the most lives, lottery, and instrumental value.5 As such, it prioritises younger people who have not yet lived a complete life and will be unlikely to do so without aid. Many thinkers have accepted complete lives as the appropriate focus of distributive justice: ‘individual human lives, rather than individual experiences, [are] the units over which any distributive principle should operate.’1,75,76 Although there are important differences between these thinkers, they share a core commitment to consider entire lives rather than events or episodes, which is also the defining feature of the complete lives system. (Where would Congressmen fall under this system? Is this why Congress refuses to become part of the proposed system?—my addition)

Consideration of the importance of complete lives also supports modifying the youngest-first principle by prioritising adolescents and young adults over infants (figure). Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. (Don’t be an infant or not yet born!—my addition) Similarly, adolescence brings with it a developed personality capable of forming and valuing long-term plans whose fulfilment requires a complete life.77 As the legal philosopher Ronald Dworkin argues, ‘It is terrible when an infant dies, but worse, most people think, when a three-year-old child dies and worse still when an adolescent does’;78 this argument is supported by empirical surveys.41,79 Importantly, the prioritisation of adolescents and young adults considers the social and personal investment that people are morally entitled to have received at a particular age, rather than accepting the results of an unjust status quo. Consequently, poor adolescents should be treated the same as wealthy ones, even though they may have received less investment owing to social injustice. (Except they won’t be, at least in some cases, because of prognosis!—my addition)

The complete lives system also considers prognosis, since its aim is to achieve complete lives. A young person with a poor prognosis has had few life-years but lacks the potential to live a complete life. (Who decides this? A GOVERNMENT bureaucrat!—my addition) Considering prognosis forestalls the concern that disproportionately large amounts of resources will be directed to young people with poor prognoses.42 (The lame, the sick, the “deformed,” the “mentally disabled?”—my addition) When the worst-off can benefit only slightly (Who decides this?—my addition) while better-off people could benefit greatly (Who decides this?—my addition), allocating to the better-off is often justifiable.1,30 (Often?—my addition) Some small benefits, such as a few weeks of life, might also be intrinsically insignificant when compared with large benefits.8 (Is this not playing GOD? When you bring your young child into an emergency room and nurses and doctors start discussing the child’s “complete lives system” evaluation, are you going to accept their conclusions—we can’t operate because his/her “complete lives system” evaluation is too LOW! Are you not yet scared by the present proposal before Congress?—my addition)

Saving the most lives is also included in this system because enabling more people to live complete lives is better than enabling fewer.8,44 In a public health emergency, instrumental value could also be included to enable more people to live complete lives. Lotteries could be used when making choices between roughly equal recipients (Trust your health fate to chance rather than to a bureaucrat!—my addition), and also potentially to ensure that no individual—irrespective of age or prognosis—is seen as beyond saving.34,80 (Contradictory!—my addition) Thus, the complete lives system is complete in another way: it incorporates each morally relevant simple principle. (These authors concept of ethics and morality seem to be different than mine. For example, should a convicted murderer be ranked above someone else because he is 25 years old and the other person is 75 years old? Do you think that they support or oppose the MURDER of unborn babies? How about the MURDER of unborn, “imperfect” babies such as those with Down syndrome?—my addition)

When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated (figure).78 (Notice, the curve starts very low for the very youngest, and then drops sharply between 50 and 60 years of age! And they don’t even show the curve past about 75 years old!—my addition) It therefore superficially resembles….” (page 428)

Are you scared NOW!