She’s Right

It pains me to have to admit
that anything
HHS Secretary Kathleen Sebelius has to say is correct, but in the gut-wrenching
case of Sarah
Murnaghan she is absolutely right---“Someone lives and someone dies.”

Notwithstanding the
inelegance of her statement, that is the painful and sad reality of the

Before getting into the
particulars of Miss Murnaghan’s case, I ask that you place yourself at the
entrance to a
triage location
during a mass casualty situation.  You might
see, for example, the first victim being carried in and hear the triage coordinator
say, “This one won’t survive, so put the litter down over there and administer
morphine until he dies.’

Then the next one comes in
and the coordinator might say, “This one does not have life-threatening injuries,
so put the litter down over at that other place, administer morphine, and we’ll
get to her when we can.”

And then one comes in and
you might hear, “We can save this one, so get cracking.”

That’s how it works.  Serious people spent a lot of time developing
rigorous protocols in
order to:

…sort incoming patients
according to the level of severity of condition. The whole concept of triage is
based on managing limited resources in health institutions, including space and
manpower….[to assure that the] focus [is] on those who [require] immediate care.

That is, the protocols
demand that resources are to be deployed to save the ones who can be saved no
matter the agony of the loved ones of the other victims to whom care may not be
able to be administered.

The protocols may well be arbitrary,
but so long as they are not also capricious they must be followed until they
are properly modified.

Long ago I worked as a
social welfare counselor, overseas and stateside.  On one occasion I was arguing too hard

to present my client’s case
to authorities, and a very senior colleague gave me a piece of advice that has
served me well: “You must deal with your clients as trauma surgeons and ladies
of the night deal with theirs---‘This isn’t happening to me.’”

That, too, may be
inelegantly put, but it is also right: Professionals must be totally
dispassionate in dealing with clients---no personal involvement with clients or
clients’ problems, no trying to “do good,” and no side-stepping of established
protocols.  When that is done, the
outcomes, most of the times, will be the right ones.

Serious arguments can be
made that the “rules are rules” position is flawed, and, at times, and,
particularly in the case of children, that position must be

Nevertheless, this
situation brings up an age old debate: Should a person who is under a law act
beside the letter of the law? In other words, is there ever a case where a
person is allowed to act contrary to what the law states? St. Thomas Aquinas
tackled this topic in his “Treatise on Law.” He believed that law should be
designed for the common good of man. However, Aquinas makes this provision in
his treatise, that “if a case arise wherein the observance of that law would be
hurtful to the general welfare, it should not be observed.”

With that in mind, let’s
look at the case of Sarah Murnaghan.

Teams of professionals from
numerous disciplines developed
protocols, over time and with much thought, for lung transplants in order
to assure, as best as they could determine, who should get transplants and in
what order those transplants should be given so that the scarce resources are
not wasted on patients who will not

...selecting an organ
recipient comes down to priorities....[and] factors [to] determine where you
land on the waitlist, including: blood type, immune system, who's the sickest
and who has the greatest need....Who's going to do best? Who will survive with
the greatest chance of living and living long? And then beyond that, you're
starting to look at things like geography [to find out how far the organ needs
to travel]....The under-12 rule evolved...from the medical complications that
come with putting an adult organ in a child.

Unquestionably, the intrusion
of politicians and jurists in the process is

Lung transplants are the
most difficult organ transplants, and children fare worse than adults, which is
one reason for the policy, said Dr. Arthur Caplan, a bioethicist at New York
University’s Langone Medical Center. He called it troubling, and perhaps
precedent-setting, for a judge to overrule that medical judgment. He also
predicted a run to the courthouse by patients who don’t like their place on the
waiting list.

Whenever established
protocols are overruled, certain unfortunate consequences ensue.  

Mona Charen makes a
powerful case against such intervention
here at NRO:

The people calling upon
Sebelius to intervene and grant a waiver from the usual rules regarding
children and transplants are the ones urging the politicization of medical care
— at least in this case. They would be the ones responsible for setting a
terrible precedent. The lesson would be this: If you can muster public pressure
through social media, the press, and politicians, your loved one can get an
advantage over others waiting for a lung or kidney or liver. Photogenic
patients or those with media-savvy or even politically well-connected relatives
would go to the head of the line. That is exactly what conservatives ought to

Ace of Spades forcefully wrote about the girl’s case at Breitbart a few days ago

With ObamaCare coming,
and bureaucrats patrolling for whether it's cost-justified to save your life or
give you that new hip, our health care will increasingly consist of politicking
-- going to our government to plead for special favor, enlisting the media and,
for the well-heeled, even PR companies. 
Our nation is no longer one of rights or ownership.  It is now one
in which we merely plead to the courtiers of government for favors, or to keep
something we have in our possession

And read this for the
Left’s argument against such intervention:

…decisions about
life-saving care [should be] where it belongs--with patients and their doctors.

Concurring opinions can be
here, here, here, and here.

To compassionately place
one person, be that person a sympathetic little girl or somebody’s buddy or
relative, at the head of a line on which that person does not belong according
to the protocols governing placement on that line means that every other person
appropriately on that line gets bumped down, and one of those persons might die
because that compassionately-placed person had been given, inappropriately, a
chance to live.

Assuredly, rejecting the
letter of the “rules are rules” position may or may not be the right thing to
do in any given situation, but when it is done, it is always done subjectively and
often it is done capriciously.

Those who think the protocols
are wrong or out of date should make their crusade one to reevaluate and
change, if necessary, the protocols, but they should not allow themselves to
get all weepy and up in arms because protocols that are in place are being
properly, if arbitrarily, followed.

I certainly have a great
deal of compassion for little Sarah Murnaghan and her family, but I also have
compassion for everybody else on both the pediatric and adult waiting lists and
their families.

Imagine that your father
has been bumped down by Miss Murnaghan and then that he dies whilst finally
finding himself at the head of that line. 
He was there and then at the head of the line, and not in recovery,
since he had not been the recipient of the previous transplant because of his having
been bumped down earlier by Miss Murnaghan.

My guess is that you’d be
really ticked---a liberal might not be ticked, but you sure as hell would be
really ticked!

And while I’m at it, and
while I hate disagreeing with things that Sarah Palin has to say, I have advice
to give to her---sit back, take a deep breath, and think it through---
Death Panels are on the way because there are not enough resources available
in order to give complete healthcare to everyone needing complete healthcare.

With a hat-tip to Powerline’s Steven Hayward, let me paraphrase Sir Winston Churchill: Unlike the widow’s cruse, these resources cannot miraculously replenish themselves.

And it’s only going to get
worse because every advance in healthcare means that more people will live
because of their having had the benefits of those advances---and each of us will
need more healthcare for longer periods of time.

And the pool of providers
of resources for that healthcare grows proportionately smaller every day.

And Mrs. Palin shouldn’t be
surprised when we eventually get to the point (as
the UK already
has) of Death Panel decisions being made not just on chances-of-life vs. death criteria but also on quality-of-
life vs. death criteria.

Admin · 559 views · 0 comments
Categories: First category
22 Jul 2013. 06:10:55 pm

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