Friday, May 4, 2012
The term “death panel” famously dates to the summer of 2009, when former Alaska Governor Sarah Palin used that term to refer to a provision in proposed health reform legislation (H.R. 3200, section 1233) that would have paid physicians (more than current reimbursement allows) to provide voluntary advance care planning (VACP) to Medicare beneficiaries. The characterization of VACP as “death panels” was later (correctly) denounced by PolitiFact, among others, as the “lie of the year.”
Still, the term has been employed somewhat more accurately (even if pejoratively) in other contexts. For example, the UK’s National Institute for Health and Clinical Excellence (NICE) makes healthcare coverage decisions that effectively impact who will live and who will die. And here in the United States, many charge that the Medicare IPAB will soon move (though currently statutorily barred) from merely insisting on cost effective treatment to outright denying expensive treatment. While usage of the term “death panels” is generally mere calumny, it is sometimes befitting.
I write this post to commemorate the 50th anniversary (1962 – 2012) of a genuine and infamous American “death panel”: the Admissions and Policy Committee of the Seattle Artificial Kidney Center at Seattle’s Swedish Hospital. In 1962, Swedish housed the only dialysis clinic in the country. But, even locally, there were more needy patients than Swedish could accommodate. The Seattle Committee’s job, as a famous Life Magazine article title described it, was to “decide who lives, who dies.” Consequently, it became known as the “God Committee” or “God Squad.” Over the following decade, other committees in other cities also decided who would, and who would not, get access to life-saving dialysis.
The dialysis committees disappeared after Congress expanded access in 1972, by authorizing the End Stage Renal Disease Program under Medicare. There was no longer a shortage of machines and facilities. But many other conditions of healthcare scarcity persist. For example, today, we have organ transplantation committees and hospital futility committees. There are all sorts of “death panels” in the United States. We need them. By acknowledging both their existence and their importance, we can better rationally, openly, and fairly grapple with the tragic choices that our society must make.