Bioethicists fight myths over rationing, end-of-life care

In the battle over health system reform, debate has centered on issues such as expanding insurance coverage, containing costs and setting up a government-run plan to compete with private health insurers.

But as Congress recessed in August, critics of Democratic reform plans targeted a provision in the House legislation that would reimburse physicians for counseling patients about their end-of-life care options. Sarah Palin, the 2008 Republican vice presidential candidate, falsely said the measure called for "death panels" that could deny care to patients who are elderly or disabled.

It was such rhetoric about the central terrain of medical ethics and patient autonomy that led a new group, the Assn. of Bioethics Program Directors, to speak up. The group, which represents the directors of 60 bioethics programs with two or more full-time staffers at medical schools in the U.S. and Canada, issued a statement seeking to dispel what it called "three myths about the ethics of health care reform" (link).

Myth No. 1, the group said, is that reform would mean that patients would surrender control of their health care decisions. Myth No. 2 is that reform would control costs by depriving patients of useful but costly interventions. As myth No. 3, the group listed the notion that "health care reform will deny older Americans medical treatments at the end of life."

That last one "was the most pernicious myth because it got traction because it was based on a made-up claim," said Jeffrey Kahn, PhD, MPH, the group's president and director of the University of Minnesota Center for Bioethics.

"It's wrong in so many ways," Kahn added. "We wanted to poke a hole in that. A lot of what the field of bioethics has worked on in the last 30 years are exactly those issues -- helping people make better decisions at the end of life. And here comes a provision exactly for that purpose, and it was being twisted around as a claim for government-funded death panels. That hit very close to home for us."

The group was formed partly so that bioethicists could speak out more forcefully on matters of public concern, Kahn said.

"This seemed like an area about which we have a stake and something to say," Kahn said. "Whether people think it's important that we speak is up to them to decide. ... I don't imagine it will be the last time."