i haven’t put a great deal of energy into keeping abreast of the current health care dialogue, but i am sort of fascinated about this outcry over ‘death boards’ that conservatives fear will happen under a more equitable system. common people, sitting in judgment over who lives and who dies? hadn’t i heard of this before? a quick flip through the vast electronic bookshelf yielded the november 9, 1962 issue of life: they decide who lives, who dies documented the six anonymous individuals tasked by the seattle artifical kidney center with reviewing the records of those stricken with kidney disease to decide who would get the most utility out of the experimental dialysis treatment, then suffering from very limited availability. the candidates were medically qualified by the hospital before being passed to the board, who reviewed their occupation, education, community service, family situation, religion, and standing amongst their peers, among other factors. a very few were rubber-stamped for the experimental treatment, which had a very high success rate.
the outcry the attention brought was significant, generating a documentary on nbc a few years later, and a seminal 1968 article in the ucla law review by david sanders and jesse dukeminier; its sensationalist quote was that this was, “the bourgeoisie sparing the bourgeoisie, …measuring persons in accordance with its own middle-class suburban value system”; but the real thrust was this:
“if a project is experimental, the use of broad discretion in selecting candidates who can demonstrate the validity of the project is not objectionable. once a procedure proves its merit and passes from the experimental to the standard, however, … justice requires that selection be made by a fairer method than the unbridled consciences, the built-in biases, and the fantasies of omnipotence of a secret committee.” (this excerpted in 1974’s fascinating the courage to fail by renee fox and judith swazey, which includes transcriptions of some of the review board’s meetings.) bioethics was born.*
since then, the field has exploded, yielding think tanks and presidential commissions – george w. bush appointed a council on bioethics in 2001 to help him understand such issues (though it was disbanded by barack obama, who seems to prefer a group with policy experience rather than a strict philosophical function). there are academic as well as practical bioethicists, and the major religions engage with the issues and have contributed extensive literature within their own frames. bioethics is as serious and well-regarded as any philosophical study.
under our quasi-capitalist health care system, there has been great need to discuss the right way to make decisions on the availability of care. there exist forty years of high-quality scholarship and real-world examples that inform our current thinking, and yet, some politicians and talking heads are speaking as if an issue has just come to light. health care reform will not suddenly create ‘death boards’ who use the rudimentary tools of the past to choose who lives and who dies; it will simply allow us more opportunities to use the advanced tools we’ve developed, and to hone our thinking about bioethics. we will make mistakes, certainly, but – and here i think is my strongest argument for liberalism over conservatism – as in all things, this is the best we can do. and just because our inability to act perfectly, our admission that we lack true mastery over the universe is frightening doesn’t mean we shouldn’t do it.
—
* yes, really. the first printed appearance of the word was, i believe, 1970: dr. van rensselaer potter’s book bioethics: bridge to the future.
on bioethics
i haven’t put a great deal of energy into keeping abreast of the current health care dialogue, but i am sort of fascinated about this outcry over ‘death boards’ that conservatives fear will happen under a more equitable system. common people, sitting in judgment over who lives and who dies? hadn’t i heard of this before? a quick flip through the vast electronic bookshelf yielded the november 9, 1962 issue of life: they decide who lives, who dies documented the six anonymous individuals tasked by the seattle artifical kidney center with reviewing the records of those stricken with kidney disease to decide who would get the most utility out of the experimental dialysis treatment, then suffering from very limited availability. the candidates were medically qualified by the hospital before being passed to the board, who reviewed their occupation, education, community service, family situation, religion, and standing amongst their peers, among other factors. a very few were rubber-stamped for the experimental treatment, which had a very high success rate.
the outcry the attention brought was significant, generating a documentary on nbc a few years later, and a seminal 1968 article in the ucla law review by david sanders and jesse dukeminier; its sensationalist quote was that this was, “the bourgeoisie sparing the bourgeoisie, …measuring persons in accordance with its own middle-class suburban value system”; but the real thrust was this:
“if a project is experimental, the use of broad discretion in selecting candidates who can demonstrate the validity of the project is not objectionable. once a procedure proves its merit and passes from the experimental to the standard, however, … justice requires that selection be made by a fairer method than the unbridled consciences, the built-in biases, and the fantasies of omnipotence of a secret committee.” (this excerpted in 1974’s fascinating the courage to fail by renee fox and judith swazey, which includes transcriptions of some of the review board’s meetings.) bioethics was born.*
since then, the field has exploded, yielding think tanks and presidential commissions – george w. bush appointed a council on bioethics in 2001 to help him understand such issues (though it was disbanded by barack obama, who seems to prefer a group with policy experience rather than a strict philosophical function). there are academic as well as practical bioethicists, and the major religions engage with the issues and have contributed extensive literature within their own frames. bioethics is as serious and well-regarded as any philosophical study.
under our quasi-capitalist health care system, there has been great need to discuss the right way to make decisions on the availability of care. there exist forty years of high-quality scholarship and real-world examples that inform our current thinking, and yet, some politicians and talking heads are speaking as if an issue has just come to light. health care reform will not suddenly create ‘death boards’ who use the rudimentary tools of the past to choose who lives and who dies; it will simply allow us more opportunities to use the advanced tools we’ve developed, and to hone our thinking about bioethics. we will make mistakes, certainly, but – and here i think is my strongest argument for liberalism over conservatism – as in all things, this is the best we can do. and just because our inability to act perfectly, our admission that we lack true mastery over the universe is frightening doesn’t mean we shouldn’t do it.
—
* yes, really. the first printed appearance of the word was, i believe, 1970: dr. van rensselaer potter’s book bioethics: bridge to the future.