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End-of-life decisions: Are you a sovereign individual or a ‘socially sustainable’ drone?

“An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.”
— America’s Affordable Health Choices Act of 2009, H.R. 3200, Page 425

Too many of us are painfully familiar with the little plastic hospital wristband with the initials DNR — which stands for do no resuscitate.

It is a symbol of the power of modern medicine over death. It is a symbol of the weakness of modern medicine’s ability to sustain a life worth living.

It also raises serious questions about the role of the dominance of the individual vs. the dominance of society. It is a question as old as philosophy. To John Locke, to whom our founders looked for guidance, the individual is sovereign and governments should exist only so long as they further the rights of the individual.

But in this time of bailouts, in which individual errors are ameliorated for the sake of the social order, when some get cash for clunkers for the sake of the air we all breath, when we contemplate end-of-life counseling as a part of legislation that spreads the cost of health care and shares the risk among the many — when does the individual give way to the good of society as a whole?

When there are only so many transplant livers to go around, who gets one? The aging alcoholic ballplayer? The hard-living rock star? The old drunk or the young punk?

On the other hand, a 55-year-old physician with Lou Gehrig’s disease wrote in Thursday’s R-J about his fear of being placed interminably on a feeding tube, like Terri Schiavo, whose comatose body became a federal case. Who gets to choose? Congress or family or self? And for what reasons? To save money? To select the life most valuable to society as a whole?

“I may well be ready to die before my family and friends are ready to say goodbye,” the doctor wrote. Isn’t that his decision?

This is not merely an academic exercise.

An editorial in Investor’s Business Daily this past week noted that one of Obama’s top medical advisers is bioethicist Ezekiel Emanuel, brother of White House Chief of Staff Rahm Emanuel. This past June in the Journal of the American Medical Association, Ezekial Emanuel wrote that “the progression in end-of-life care mentality from ‘do everything’ to more palliative care shows that change in physician norms and practices is possible."

He sees a move in this new social order toward "socially sustainable, cost-effective care."

So what will you decide for you and yours? Will you have a choice? Are you a sovereign individual or a drone in the social ant hill? Will you lie down and die? Or fight?

Sometimes the sublime of John Locke is best illustrated by the ridiculous of Michael York:


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