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Ezekiel Emanuel on Euthanasia

Given that old academic writings by Ezekiel Emanuel are entering Betsy McCaughey's Nonsensatronic 3000 and emerging as coded arguments for euthanasia (or, more evocatively, "death panels"), it's probably worth seeing what the former bioethicist and current OMB adviser has actually said about euthanasia. Luckily, it's easy to find. In 1997, Emanuel wrote a long article on the subject for the Atlantic. The subtitle stated his opinion pretty clearly: "America should think again before pressing ahead with the legalization of physician-assisted suicide and voluntary euthanasia." Nor was his conclusion particularly opaque. "The proper policy, in my view, should be to affirm the status of physician-assisted suicide and euthanasia as illegal."

The italics are his, not mine. And the article, incidentally, is worth reading in full. I've always been a strong supporter of a right to die, but Emanuel's piece left me a lot less sure of that position than I used to be.

By Ezra Klein  |  August 11, 2009; 9:02 AM ET
Categories:  Health Reform  
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Next: It Is Democracy, Not Health-Care Reform, That Is Sick


Here is an AP factcheck on the "death panels":

Posted by: Castorp1 | August 11, 2009 9:08 AM | Report abuse

It's well understood that much care is expended in the last few months of life.

This care -- often futile -- absolutely, positively accounts for some of the "inefficiency" that reformers would like to eliminate.

When that care goes away, and you are given the pill rather than the pacemaker (Obama said it, and you guys cannot take it back), the "efficiency" that has been gained is a euphemism for "rationing." Rationing care away from end-of-life patients is not euthanasia, but it is still rationing.

Posted by: whoisjohngaltcom | August 11, 2009 9:29 AM | Report abuse

Thoughtful reading.

With yet another myth out of the way, how about considering some specifics of S.391.

Section 102(b)(3) [p.16] gives quite a bit [perhaps too much] latitude to each State to determine penalties for those who do not wish to be HAPI-plan members. Section 123(f) [p.39] eliminates a bankruptcy option, making even catastrophic medical bills permanent debts. Section 111(e) [p.27] is an industry-popular, but dangerous, preemption clause. And Section 111(b)(3)(A) [p.23] will be controversial.

Posted by: rmgregory | August 11, 2009 9:53 AM | Report abuse

Until the MSM calls the forces of obstructionism what they are, bold false liars, introducing facts, truth, and reality into the discussion, no matter how well intentioned, will have limited utility in the national discourse.

Posted by: newjersey_lawyer | August 11, 2009 10:29 AM | Report abuse

This is not about health care. This is about Obama's desperate attempt to spend money as fast as he can get away with it to prop up our debt-backed Ponzi dollar before it implodes. Congress must appropriate money for the Fed to create it. The government has a negative cash flow problem with all its obligations to retirees, disabled, vets, welfare, government employees, and on and on, and the president and Congress's salaries and pension plans might suffer if he can't manufacture money under any pretext.

The whole health care scam amounts to the president and Congress practicing medicine, because they control the funding for every health care decision. If they want to practice medicine, they need to write the prescriptions, do the surgeries, and take the personal risks. I hope these lawyers have enough in personal assets to cover the medical practice lawsuits they will justifiably bring on themselves if they pursue this suicidal route.

Posted by: kcottomd | August 11, 2009 11:40 AM | Report abuse

You disingenuously neglected to mention a far more recent article (January 2009) coauthored by Emanuel: Principles for Allocation of Scarce Medical Interventions, available at
This, of course, is the one that has people talking about death panels. Who is to determine when interventions are "scarce" and who should be granted them? The government in a government-run health plan. Palin is right--under Zeke's guidelines, Trig would be expendable, and so would your 66-year-old mother or wife.

Posted by: sopra07 | August 11, 2009 12:13 PM | Report abuse

Thanks for the link, I just read Emanuel's 1997 piece.

It seems evenhanded, except for the fact that he only once and very briefly mentions the fact that American doctors are already allowed to end the lifes of patients by stopping life-sustaining technologies. And he doesn't mention terminal sedation at all.

Finally, he compares the actual practice of euthanasia in the Netherlands with US law, not with US practice. Does he really think that euthanasia occurs only where it is legal?

Posted by: wp200 | August 11, 2009 12:30 PM | Report abuse

"under Zeke's guidelines, Trig would be expendable, and so would your 66-year-old mother or wife."

He speaks the truth; I found the bill language:
42 USC 102121, OBAMACARE:
a) Baby Trig is hereby dead
b) So is your 66 year-old wife-mother
c) Insurance and fake birth certificates for all liberal fascists

But really, your comment makes absolutely no freaking sense on its face.

First, would such a thing get someone elected again? Then it's not going to be in the bill. It'd be a little tough for Obama to run on a death panel platform in 2012. Second, you're scared of this "government-run" health plan. Besides those fears being wrong, no one is forcing anyone into the government run plan -- you get to keep your plan! Third, several other countries have such plans -- are bloodthirsty Canadian bureaucrats sentencing their citizens to death? Nope. Fourth, things are *already* scarce. Right now, it's allocated based on income, meaning those who can't afford insurance often face the free market's death panel. That's wrong, which is why there's an option that a) gives them insurance and b) cuts down on everyone's costs through competition.

Posted by: Chris_ | August 11, 2009 12:37 PM | Report abuse

sopra07 -

Emanuel's article you quote (2009 Lancet) has nothing to do with euthanasia. It deals, as its title suggests, with the allocation of scarce medical interventions.

Basically, it's about who gets the kidney. The people who do not get the kidney aren't murdered, they simply have to stay on dialysis.

Emanuel states that it might be reasonable to give a slight preference for young people over old people because young people can benefit longer, and to use a weigthed lottery with slightly worse odds for old people. How would you decide who gets the kidney?

Posted by: wp200 | August 11, 2009 12:55 PM | Report abuse

That's the irony of this.

Emmanuel made his bones arguing against euthanasia. I remember being very pissed off about the stuff he wrote when this was a hot topic and I was supporting a person's right to die.

It just shows, again, how crazy this "debate" has become. The lunatics are running the asylum.

Posted by: theorajones1 | August 11, 2009 1:06 PM | Report abuse

We're knocking around a straw man here. The references to "death panels" refer to those deciding who gets lifesaving or life-extending treatments. Euthanasia is something the PATIENT requests, yes? If not, then it's murder.

I don't know how I found myself on this page. Clearly it's an echo chamber of doting Obama fans. But do read the 2009 article, would you? It is far more germane to the health plan that our betters are trying to ram through without our discussion or dissention.

Posted by: sopra07 | August 11, 2009 2:01 PM | Report abuse

Speaking of euthanasia, this clip from the Daily Show is a must-watch:

Posted by: PeterH1 | August 11, 2009 3:49 PM | Report abuse

sopra07 - Instead of ducking with you talk about straw men, how about answering the question: How would you decide who gets the kidney?

Posted by: wp200 | August 11, 2009 4:10 PM | Report abuse

"The people who do not get the kidney aren't murdered, they simply have to stay on dialysis."

Bull. When it's a heart or a liver, they don't stay on dialysis: They die. It's not murder, but it is choosing who lives and who dies.

Posted by: whoisjohngaltcom | August 11, 2009 4:19 PM | Report abuse

whoisjohngaltcom -

How would you decide who gets the kidney/heart/liver?

Posted by: wp200 | August 11, 2009 4:30 PM | Report abuse

From Ezekiel Emanuel's 1997 article: "Broad legalization of physician-assisted suicide and euthanasia would have the paradoxical effect of making patients seem to be responsible for their own suffering. Rather than being seen primarily as the victims of pain and suffering caused by disease, patients would be seen as having the power to end their suffering by agreeing to an injection or taking some pills; refusing would mean that living through the pain was the patient's decision, the patient's responsibility. Placing the blame on the patient would reduce the motivation of caregivers to provide the extra care that might be required, and would ease guilt if the care fell short. Such an easy, thoughtless shift of responsibility is probably what makes most hospice workers so deeply opposed to physician-assisted suicide and euthanasia."

Thanks for including the link to this article. As a newly minted physician, my mind has been changed, specifically, after I read the above quote.

Posted by: goadri | August 11, 2009 4:49 PM | Report abuse

goadri - "Broad legalization of physician-assisted suicide and euthanasia would have the paradoxical effect of making patients seem to be responsible for their own suffering."

If it had done so in the Netherlands, I'm sure Emanuel would have mentioned it.

It seems to me a bit much to deny all patients mastery over their own bodies because of the hypothetical argument that some patients will somehow be blamed for their own suffering.

BTW, I'm a doctor in the Netherlands, and I can assure you that we do not hold patients responsible for their own suffering.

Posted by: wp200 | August 11, 2009 5:05 PM | Report abuse

"How would you decide who gets the kidney/heart/liver?"

I don't know. I have ideas. Certainly not through politicians or political appointees.

My point was that the decision is very much a life and death decision, in contrast to your initial assertion that non-recipients simply remain on dialysis.

Posted by: whoisjohngaltcom | August 11, 2009 5:10 PM | Report abuse

I use kidney because that's the example Emanuel uses. Kidneys and deciding who's first to get flu vaccinations in case of a pandemic (i.e. nurses, lab technicians).

Anyway, Emanual doesn't propose letting politicians decide, he proposes to set up an algorithm to follow.

And yes, life and death decisions do get made like this. I have watched a women die of sarcoidosis of the lungs because she had become inelegible for a lung transplant: a medical student did a thorough physical on her during work-up for the transplant and found a concurrent rectal tumor. Tumors and immunosuppresives don't mix.

Still, the lungs she didn't get did save someone else.

Posted by: wp200 | August 11, 2009 5:59 PM | Report abuse

"Anyway, Emanual doesn't propose letting politicians decide, he proposes to set up an algorithm to follow."

And then, when an old lady, like that woman's 105-year-old mother mentioned at Obama's first televised meeting, needs a pacemaker, the algorithm determines that she can't have it. She gets a pain pill instead.

That's a fine algorithm.

Posted by: whoisjohngaltcom | August 11, 2009 6:18 PM | Report abuse

John Galt,

Emmanuel's article deals with the provisions of extremely scarce medical commodities, like organs or vaccines. You may not like Emmanuel's criteria for allocating these commodities (such as prioritzing the lives of younger citizens over older ones), but we must come up with *some* system for determining how to distribute them. Unless you can find a way of making organs magically grow on trees...

In any case, it is irrelevant to the Obama proposals McCaughey attacks, like an Indepedent Medicare Advisory Commission (IMAC).

Posted by: PeterH1 | August 11, 2009 6:41 PM | Report abuse

Hi Peter,

Perhaps you could frame the argument in terms of the 105-year-old lady who got the pacemaker at her doctor's discretion, after hearing about which Obama explained the need for some people to "take the pill."

Where in this proposal are the provisions for people like her?

Posted by: whoisjohngaltcom | August 11, 2009 7:26 PM | Report abuse

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