Category Archive 'Ezekiel Emanuel'

24 Sep 2014

Ezekiel Emanuel Defined the Appropriate Human Lifespan in The Atlantic

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HopeIDieBeforeIGetOld
It’s too late already for some of us.

Damon Linker read Ezekiel J. Emanuel’s Atlantic essay, Why I Hope to Die at 75, and it reminds him of certain last century lines of thought no longer held in great esteem.

Ezekiel J. Emanuel, 57, [Rahm Emanuel’s older brother –JDZ] wants to die 18 years from now. We know this because he’s told us — in the title of an essay that’s received an enormous amount of attention since it appeared on the website of The Atlantic last Wednesday.

“Why I Hope to Die at 75” is one of those essays that will spark a nationwide conversation and debate. But that doesn’t mean it’s smart. On the contrary, given the author’s prominence in the world of health-care policy — he played a major role in designing ObamaCare, contributes frequent health-care-related op-eds to The New York Times, directs the Clinical Bioethics Department at the National Institutes of Health, and heads the Department of Medical Ethics and Health Policy at the University of Pennsylvania — what’s most noteworthy about the essay is its stunning combination of wisdom and insight with moral idiocy. …

Reading Emanuel’s essay, I began to despair — not just about the moral outlook it expresses, but about whether its readers will even recognize how monstrous it is. Emanuel has taken the ethic of meritocratic striving that currently dominates elite culture in the United States and transformed it into a comprehensive vision of the human good. Viewed in its light, the only life worth living is one in which you endlessly, relentlessly strive to look as smart and clever as possible in the eyes of other smart and clever people. The ultimate goal of such a life is to be considered the smartest and cleverest person of all. Once old age or any other misfortune gets in the way of continually striving for that goal, one might as well cease to exist.

But what about everyone else? This includes the millions upon millions of Americans who don’t help to write major pieces of legislation, don’t pen op-eds for leading newspapers, don’t run departments at the NIH, and don’t head institutes at Ivy League universities. … The Emanuel brothers have clawed their way to the very top of the American elite. … Doesn’t a middle manager toiling away in an anonymous office on the outskirts of Des Moines — let alone a burger flipper earning the minimum wage at a McDonald’s down the road — possess far less intelligence, talent, and ambition? Isn’t he comparatively disabled? And if so, shouldn’t he hope to die right now rather than waiting for 75?

This isn’t just an academic question. Emanuel and his striving siblings have an adopted sister named Shoshana who suffers from cerebral palsy. The clear implication of Emanuel’s argument is that her life — like that of someone who endures a steep decline in old age — is not worth living. …

Though he would no doubt blanch at the suggestion, Ezekiel Emanuel has written an essay that in its implications clearly amounts to a defense of eugenics. Yet Emanuel’s position differs in one important respect from the version of eugenics that rose to prominence in the Western world in the early decades of the 20th century. Whereas eugenics was originally motivated by public-spirited ends — by the desire to purify the race for the sake of overall human flourishing — Emanuel’s version is provoked by a more personal concern: Extraordinarily creative, intelligent, ambitious, and successful individuals want to be seen and remembered as exemplars of “vitality,” and not as “burdens” slowly succumbing to the “agonies of decline.”

This is eugenics induced by narcissism.

I think myself that it is unquestionably narcissism, narcissism combined with hubristic confidence in the calculative power of human reason and the complete absence of common sense.

Ezekiel Emanuel, who’s got a degree from Oxford in Biochemistry, nonetheless manages to overlook the extreme variability of human heredity and fate and is perfectly prepared to sit in his office, fingertips pressed together, and prescribe the appropriate human lifespan for everyone. Ezekiel Emanuel obviously never met Melvin Poe, who was riding his horse and hunting hounds until very recently at age 94, and who celebrated his birthday last year by putting his horse over a fence.

Human health and lifespan, like human talent and ambition, varies over a quite extreme range. But one thing obviously doesn’t vary: We’re all ready to die 18 years from today. We are just not ready today. 18 years in the future is always a very long time. I feel perfectly sure however that, if the Atlantic checks back with Ezekiel Emanuel come 2032, the editors will find that he has changed his tune dramatically.

16 Aug 2009

Dowd: “Palin Strafing Rahm Emanuel’s Brother Zeke”

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Big one, must be a full Harvard professor.

Leftists characteristically avoid openly advocating their goals. They don’t call themselves Marxists or socialists. These days they even avoid the label of liberal, and prefer to speak of themselves as “progressives.” Their reliance on deception, their preference for seeking power not via an open fight, but rather by a gradual process of subversion, have made traditionally the favored zoological metaphors for leftists, not major predators like wolves, but small and sneaky vermin like rats or roaches. Winston Churchill once even described Lenin (being transported to Russia from Switzerland in a sealed train by Germany) as resembling a plague bacillus.

This morning, however, Maureen Dowd is a bit more denunciatory than usual, accusing Sarah Palin of turning back country Alaska major predator control tactics on Rahm Emanuel’s brother, medical ethicist Dr. Ezekiel Emanuel.

At the moment, what she wants to do is tap into her visceral talent for aerial-shooting her favorite human prey: cerebral Ivy League Democrats.

Just as she was able to stir up the mob against Barack Obama on the trail, now she is fanning the flames against another Harvard smarty-pants — Dr. Zeke Emanuel, a White House health care adviser and the older brother of Rahmbo.

She took a forum, Facebook, more commonly used by kids hooking up and cyberstalking, and with one catchy phrase, several footnotes and a zesty disregard for facts, managed to hijack the health care debate from Mr. Obama.

Sarahcuda knows, from her brush with Barry on the campaign trail, that he is vulnerable on matters that demand a visceral and muscular response rather than a logical and book-learned one. Mr. Obama was charming and informed at his town hall in Montana on Friday, but he’s going to need some sustained passion, a clear plan and a narrative as gripping as Palin’s I-see-dead-people scenario.

She has successfully caricatured the White House health care effort, making it sound like the plot of the 1976 sci-fi movie “Logan’s Run,” about a post-apocalyptic society with limited resources where you can live only until age 30, when you must take part in an extermination ceremony called “Carousel” or flee the city.

Painting the Giacometti-esque Emanuel as a creepy Dr. Death, Palin attacked him on her Facebook page a week ago, complaining that his “Orwellian thinking” could lead to a “death panel” with bureaucrats deciding whether to pull the plug on less hardy Americans.

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When democrats go ballistic like this, and pull out all the stops on denial, you can tell that someone has struck a nerve. For several days now, democrats everywhere have been screaming in pain over this one. Even my liberal classmates have been faithfully repeating the Gospel According to Talking Points Memo and Daily Kos: “Palin is lying about ‘Death Panels.'”

Was Palin lying? Let’s see.

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Sarah Palin’s Facebook entry said:

The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

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Palin was repeating a point made in a House speech, Monday, July 27, 2009 (5:18 video), by Rep. Michelle Bachmann (R-6th district Minn.)

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Much of Michelle Bachmann’s speech consisted of her reading a July 24th column from the New York Post by Betsey McCaughey. McCaughey quoted Dr. Emanuel repeatedly:

Emanuel bluntly admits that the cuts (produced by democrat so-called health care reform) will not be pain-free. “Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely ‘lipstick’ cost control, more for show and public relations than for true change,” he wrote last year (Health Affairs Feb. 27, 2008).

Savings, he writes, will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, “as an imperative to do everything for the patient regardless of the cost or effects on others” (Journal of the American Medical Association, June 18, 2008). …

Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else.

Many doctors are horrified by this notion; they’ll tell you that a doctor’s job is to achieve social justice one patient at a time.

Emanuel, however, believes that “communitarianism” should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those “who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia” (Hastings Center Report, Nov.-Dec. ’96).

Translation: Don’t give much care to a grandmother with Parkinson’s or a child with cerebral palsy.

He explicitly defends discrimination against older patients: “Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years” (Lancet, Jan. 31).

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Cornell Law Professor William A. Jacobson observes that the argument Sarah Palin quoted from Rep. Bachman certainly is important and central to the debate of proposed health care reform.

The article in which Dr. Emanuel puts forth his approach is “Principles for Allocation of Scarce Medical Interventions,” published on January 31, 2009. A full copy is embedded below. Read it, particularly the section beginning at page 6 of the embed (page 428 in the original) at which Dr. Emanuel sets forth the principles of “The Complete Lives System.”

While Emanuel does not use the term “death panel,” Palin put that term in quotation marks to signify the concept of medical decisions based on the perceived societal worth of an individual, not literally a “death panel.” And in so doing, Palin was true to Dr. Emanuel’s concept of a system which

    considers prognosis, since its aim is to achieve complete lives. A young person with a poor prognosis has had a few life-years but lacks the potential to live a complete life. Considering prognosis forestalls the concern the disproportionately large amounts of resources will be directed to young people with poor prognoses. When the worst-off can benefit only slightly while better-off people could benefit greatly, allocating to the better-off is often justifiable….
    When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.

Put together the concepts of prognosis and age, and Dr. Emanuel’s proposal reasonably could be construed as advocating the withholding of some level of medical treatment (probably not basic care, but likely expensive advanced care) to a baby born with Down Syndrome. You may not like this implication, but it is Dr. Emanuel’s implication not Palin’s.

The next question is, whether Dr. Emanuel’s proposal bears any connection to current Democratic proposals. There is no single Democratic proposal at this point, only a series of proposals and concepts. To that extent, Palin’s comments properly are viewed as a warning shot not to move to Dr. Emanuel’s concept of health care rationing based on societal worth, rather than a critique of a specific bill ready for vote.

Certainly, no Democrat is proposing a “death panel,” or withholding care to the young or infirm. To say such a thing would be political suicide.

But one interesting concept which is central to the concepts being discussed is the creation of a panel of “experts” to make the politically unpopular decisions on allocating health care resources. In a letter to the Senate, Barack Obama expressed support for such a commission:

    I am committed to working with the Congress to fully offset the cost of health care reform by reducing Medicare and Medicaid spending by another $200 to $300 billion over the next 10 years, and by enacting appropriate proposals to generate additional revenues. These savings will come not only by adopting new technologies and addressing the vastly different costs of care, but from going after the key drivers of skyrocketing health care costs, including unmanaged chronic diseases, duplicated tests, and unnecessary hospital readmissions.

    To identify and achieve additional savings, I am also open to your ideas about giving special consideration to the recommendations of the Medicare Payment Advisory Commission (MedPAC), a commission created by a Republican Congress. Under this approach, MedPAC’s recommendations on cost reductions would be adopted unless opposed by a joint resolution of the Congress. This is similar to a process that has been used effectively by a commission charged with closing military bases, and could be a valuable tool to help achieve health care reform in a fiscally responsible way.

Will such a commission decide to curtail allocation of resources to those who are not deemed capable of “complete lives” based on prognosis and age, as proposed by Dr. Emanuel? There is no way to tell at this point since we do not have a final Democratic proposal, or know who would be appointed to such a commission.

Ezekiel Emanuel’s paper: Principles for Allocation of Scarce Medical Interventions


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