Ezekiel Emanuel – Health Care Reform — Deadly Doctor or Euthanasia Opponent

While President Obama uses his array of staff to help figure out how to ‘fix’ health care, one interesting member—Dr. Ezekiel Emanuel, the medical ethicist and oncologist who advises President Obama, and also brother of Obama’s Chief of Staff, Rahm Emanuel—has been getting a lot of attention recently. Since Dr. Emanuel began heading the mysterious Comparative Effectiveness Council, his visions and ideologies on long term care are being questioned.

The WSJ noted that long term care, and cost of caring for patients who are near death accounts for a big piece of the government's medical spending. While the end-of-life counseling provision in the House bill is expected to cost a few billion dollars over the next decade, “health policy experts say it could lower medical spending by reducing end-of-life medical care that patients don't want.”

For example, while “about 5% of Medicare beneficiaries die each year, spending during that last year of life accounts for 27.4% of total Medicare spending, according to a 2001 study published in Health Affairs. In addition, “the Urban Institute, a nonpartisan research center, found that the government could save $90.8 billion over 10 years by better managing end-of-life care.”

There are many challenges with end-of-life care however, and “changing Medicare's incentives around end-of-life care would involve a more substantial overhaul of the way doctors are paid.”   

It seems that the insurance industry is "supportive of the concept" of advanced-care planning according to Robert Zirkelbach, a spokesman for trade group America's Health Insurance Plans.

The health-care bill that recently passed the House “does not contain any provisions that would deny treatment to the elderly, infirm or disabled.” The Bill does provide reimbursement to doctors who engage in voluntary discussions of so-called living wills with patients.

The provision “would require Medicare to pay physicians to counsel patients once every five years.” In these voluntary sessions, doctors would discuss “end-of-life decisions, living wills, hospice care or establishing a proxy to make their health decisions when they are unable to.   Unfortunately for the politicians there are long term suspicions and rightfully so, that the government will incentivize physicians to convince patients to make decisions based on fear, vs. medical and ethical realities.

This debate is likely to remain heated however, because the Senate Finance Committee “decided to exclude such a measure, Senate aides said this week,” and Emanuel’s coverage is adding fuel to the fire.

Time Magazine noted that opponents of health care reform are calling him a "deadly doctor," who, according to an opinion column in the New York Post, wants to limit medical care for "a grandmother with Parkinson's or a child with cerebral palsy." Dr. Emanuel defended himself by noting that he has spent his “career opposing euthanasia and working to increase the quality of care for dying patients.”

Based on Dr. Emanuel’s statements, Betsy McCaughey, the conservative scholar and former lieutenant governor of New York who wrote the NY Post attack on Emanuel, believes "there is a lack of transparency" for health care reform.

In her Post she quotes Emanuel on age discrimination for health-care distribution, and cost-effectiveness considerations.  He wrote in a Lancet  editorial Principles for allocation of scarce medical interventions published in January  "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" .  The paper though was a review of four different alternatives in decision making.

Her discredit of presidential appointees and Emanuel specifically reflect the suspicion that many patients have with government funded end of life counseling.

For decades, Emanuel has studied the ethics of medical care, been published in journals, and has received multiple awards for his work to improve end-of-life care.    

The WSJ also noted some of Emanuel’s statements from 1996, discussing which medical services should be guaranteed. On the issue of euthanasia, Emanuel published an article just before the Supreme Court heard oral arguments in a case over euthanasia and assisted suicide.

He noted that advocates were showing a “biased perspective by suggesting that most patients seeking euthanasia are in great pain.” Instead, Emanuel cited his own research that showed “psychological factors such as depression and anxiety were far more often the motivating factors for patients seeking euthanasia or physician-assisted suicide.” As a result, euthanasia would be merely an escape.

While critics will continue to look closely at Emanuel’s quotes, his scholarly work and achievements must not be forgotten.

I believe that Dr. Emanuel wants the best outcome for all Americans and patients.  Though we may tactically disagree on some issues he is a thoughtful physician who is very concerned for patients at the end of their lives.