August 14, 2009

Socialized Medicine’s Logic of Killing the Elderly

Sultan Knish

It's hard not to notice that many of the most vocal ObamaCare protesters are senior citizens. And senior citizens remain the largest challenge for ObamaCare. Not in political terms, but in terms of resource management. Senior citizens are likelier to require medical care than younger workers, and contribute little or nothing to the system. From the perspective of socialized medicine it becomes all too easy to contemplate "cutting the waste" by reducing the care given to senior citizens, the disabled, infants with birth defects, the mentally retarded and anyone else who fails the system's "Productivity in Practice or Potential" test.

Most people have not considered the fundamental change that comes in the transition to socialized medicine. But it is part of a larger social transition, one that moves the cost and decision making process from families and religious organizations, into the bowels of a "big picture" government planning system.

Let's stop for a moment to ask why we don't simply euthanize the elderly or anyone who, in the words of White House Health Care advisor Ezekiel Emanuel, is "irreversibly prevented from being or becoming participating citizens." The answer would seem obvious to most of us, but the question is a vitally important one.

The key phrase here is "Citizens." Since the state is doing the planning and deciding who gets medical care and who doesn't, it is the state's perspective that defines socialized medicine. Once health care is shoved into one giant system chock full of resource shortages that can't be met, the resources will have to be allocated one way or another. From the state's perspective, it makes a certain utilitarian sense to give life to productive citizens, while denying it to non-productive citizens.

The reason we don't do things like this is that for us morality is individual, not collective. We don't think in terms of a system, we think in terms of individual people. And from a utilitarian standpoint, we exist on a familial level. The care we give to our children is a return on the care that we ourselves were given by parents. And the care we give to our elderly parents is meant to be returned by our children. If we were to begin sticking the elderly on ice floes, we know in the back of our minds that our children are likely to do the same to us. Or as one bumper sticker witticism goes, "Be nice to your children, they'll choose your nursing home."

The family as the basis of society however has crumbled in favor of the state. As people increasingly turn over the care of their children and their parents to the state, the social investment becomes not in the family, but in the state. As the moral power of the family is transferred to the social service bureaucracies of the state, the investment that people have in their children and their elders diminishes, their investment in the social services bureaucracy grows. Birth rates drop, inheritance levels drop and the elderly begin dropping too as each generation tries to game the system in order to maximize the resources available to it at a given time.

Euthanasia of the elderly, the disabled and infants is morally wrong on an individual level, but when one begins playing with hundreds of millions of lives, morality quickly becomes hazy. That is the danger of playing god: When you sit on a high enough throne looking down at all the ant people with their ant problems, individuals cease to matter, only the welfare of the system does. That is why large centralized systems quickly become oppressive, because they become detached from the wishes and wills of individuals. At the system level, only the system itself matters.

When individuals gain the power of live and death over hundreds of millions, individual welfare gives way to the welfare of the state. Once the state has been defined as the sole source of life for everyone living under it, the state then gains the right to sacrifice the lives of any number of individuals for its own self-preservation. With ObamaCare, with socialized medicine, the state becomes the unquestioned source of life for those living under it. The individual becomes nothing more than a cog within a machine, a tiny spinning wheel marked "Citizen 5435534" whose destiny will be decided based on how well he functions within the system.

That leaves out anyone whose life does not contribute to the system, or as Dr. Ezekiel Emanuel put it, those "who are irreversibly prevented from being or becoming participating citizens," thereby failing the Productivity in Practice or Potential test. Such people draw more from the system while giving back very little. The Nazis considered them to be "Life Unworthy of Life." The modern formulation designates them as suffering a "Poor Quality of Life," which is a fancy way of saying that people like Dr. Zeke have decided that their lives aren't worth living. A problem that can be decided in an oven or a needle, or if those aren't painful enough, by starving them to death in public view.

This is not a theoretical discussion. Hospital staff already quietly kills patients they decide are just taking up space. I know an elderly woman who spent the better part of several months staying in her husband's room because the hospital staff kept "accidentally" unplugging him. Eventually they got their way. But while such tactics have to be covert at the present, a "Gentleman's Agreement" cloaked in the sanctity of the white robe and the moist needle, under socialized medicine they will begin coming out of the closet more and more, as medical resource shortages turn what was once a crime into government policy.

Imagine that instead of ObamaCare, we were discussing ObamaFood, as the government decided that it would end hunger in America permanently by confiscating everyone's food and placing it in a big pile and then giving everyone an equal amount of food. The plan seems noble enough, but when all the food is gathered together, it turns out there isn't enough for everyone. The government will have to ration the food. Some must get less. And some perhaps none at all.

There will of course be lifestyle penalizations. ObamaCare puts the government in a position of judging every single individual's lifestyle and punishing "sin" by withdrawing medical resources. Do you drink more than the prescribed limit? Do you smoke? Do you drive, a notoriously accident prone activity, instead of taking public transportation? Are you above the government's weight limit? ObamaCare puts the government in the godlike position of judging everyone and creating a health care "Water Empire" to discourage behaviors it dislikes.

But such measures will be unpopular, and will make the public more willing to shove those who consume "more than their fair share" overboard.

Euthanizing the elderly will begin by defining "End of Life" down, more and more. DNR's will move from voluntary to mandatory. The quality of the care will drop. Wards will be grim and awful places, poorly maintained by staff that sees the elderly as disposable. Depression in the elderly will be enabled, instead of treated. Wanting to die will be seen as a rational response, rather than a suicidal one. Decreasing medical procedures will be available to the elderly, and will instead be supplemented with empty group therapy sessions. Dying will be treated as a public good, a final chance to give back to society by ceasing to be a burden on it.

The treatment of the disabled will follow suit. Comatose patients, the severely physically disabled and mentally disabled will have their humanity degraded by being called, "Vegetables," before being euthanized, a little preview of which we got in the Terri Schiavo case. The media at the time deliberately ignored disabled protesters, focusing instead on the antics of the religious protesters, because it understood that the public would not be ready to accept the real agenda behind the case.

Screenings will help insure that defective children are never born. And if they are, hospitals will not provide any care for them. Parents attempting to provide care, rather than euthanasia, will paradoxically be charged with child abuse. Anyone who thinks this kind of legal paradox is farfetched should remember that we currently live under the legal fiction that an unborn child can be murdered by a third party and aborted as a constitutional right by the mother. Of course the individual's sovereign right over her body will itself become a legal fiction, when the supremacy of the state in medical matters gives it superior rights to everyone's body.

Of course such things will not happen overnight. Most systems don't turn monstrous over the weekend. Even Nazi Germany took nearly a decade to follow through on the logical conclusion of National Socialist philosophy regarding the Jews, going from repression to expulsion to extermination. It took nearly twice as long for the USSR to follow through on Marxism's view of the Jews, but made up for it by skipping from repression to planned extermination. The United States has strong and deep moral roots, despite a vast amount of cultural degradation, a transition to euthanasia will not happen overnight. But the logical conclusion of the system dictates it. And those who run the system have already begun to treat it as a given.

Absolute power corrupts absolutely by granting godlike power, without godlike wisdom. And any horror quickly becomes tenable in the name of the system, which itself becomes the god. For the liberal theology of social justice, the great dream has been of Government as God, to create a vast bureaucratic machine that will feed and clothe the poor, provide mandated equality to all and create the utopian kingdom of heaven on earth. And if Government is God – then those who run government become viceroys or avatars of the godhead of social justice. Or messiahs.

Socialist tyrants from Lenin to Stalin, to Hitler and Mussolini, and down to Castro and Saddam were praised for their supposed ability to make the chaotic tide of human affairs work through central planning. They made the trains run on time, provided health care, education and a social safety net to all, eliminated crime and insured public order. In short, they created the perfect state machine, a utopian system in which everything works controlled by one godlike figure at the center of it all.

Americans were not immune from that same dream, springing from mingled awe at the recent accomplishments of technology and outrage over muckraker's revelations about the way the other half lived. FDR was the embodiment of the great American socialist dream. It was a dream that failed, over and over again. American government is not a polished machine, it is a great creaky engine that leaks water and blows steam everywhere. It is incredibly inefficient and rarely gets anything done right. But despite everything liberals have not lost faith that the right man can make it all work, destroy the reactionary forces of capitalism and the family, to make way for Holy Liberal Empire in which no one will ever be oppressed, except those who deserve to be.

When you pull back the curtain on a Utopian dreamland, the horror behind it is a pure nightmare of death camps and firing squads, misery, oppression and brutality. A million awful things that those at the top did not care about, because all that mattered to them was the beautiful system they were building. A system that would be perfect – once all the imperfect people in its way were taken care of.

The elderly, the disabled, children struggling for life, dying people fighting to live are all in the way of socialized medicine, which must do horrible things in the name of the larger dream of free medical care for everyone. The problem of resource consumption makes it all too easy for the dictators of health to look down from their ivory tower and decide that these people are a drain on the system and that they must go.

FamilySecurityMatters.org Contributing Editor Sultan Knish, a blogger, columnist and freelance photographer born in Israel, maintains his own blog, Sultan Knish.

But who has the right to judge who is a productive member of society and who must be terminated for the benefit of society? Suppose a vigilante "peoples' committee" determined that members of congress were a danger to the country and must be exterminated post haste. Would the congress critters be rounded up and given lethal injections, or would there be a national lottery to award permits to eager hunters?