By Hal Scherz
Thursday, June 20, 2013
The case of Sarah Murnaghan, a 10 year old girl in
Philadelphia with end stage lung disease due to cystic fibrosis, has captured
the attention of the American public since it was picked up by the mainstream
media. This unfortunate child would have certainly died without a lung
transplant, and apparently, the only one standing in her way was Kathleen
Sebelius, the Secretary of Health and Human Services, whose signature would
have cleared the way for Sarah to be placed near the top of the transplant
list, because of the severity of her disease. A federal court intervened, and
Sarah received her lungs, but this case is instructive in illustrating the
problems inherent when medicine and politics are intertwined.
Issues such as these are commonplace in the medical
arena. Doctors are routinely confronted with situations which pose medical,
moral, and legal challenges, as they decide how best to care for their
patients. Should parents who are Jehovah’s Witnesses be permitted to withhold a
life-saving blood transfusion from their child? Do parents have the right to
have a baby for the purpose of donating stem cells to another child who would
die without such a transplant?
These medical dilemmas can be gut-wrenching, complex, and
multi-faceted, often without a clear cut solution. Consequently, most medical institutions have
bioethics committees to help resolve these difficult problems, because medical
decisions cannot always be based on a “one size fits all” algorithm. These
decisions must recognize that each individual and often each medical situation
is unique.
In the case of transplantation of solid organs, another
problem arises- that of scarcity of resources. When one patient receives an
organ, it means that another who might be just as ill and equally deserving of
such an organ will be denied. Because there are not enough organs to satisfy
the needs of all who need them, there are protocols that have been developed to
help determine the most equitable way to make the best use of a valuable
commodity. These protocols have been developed by transplant surgeons and other
specialists at UNOS (United Network for Organ Sharing ) based upon the best
available medical information at the time that they are created.
There can be problems with this approach. The first is
that medical innovation is rapid in this field, so that by the time that
protocols become official policy, they are often outdated. In the case of
Sarah, techniques have been developed such that pediatric thoracic surgeons can
now successfully use adult lungs in children. Whether this procedure is
indicated in her case should be a private determination involving her parents
and her physicians. Possible deviations from guidelines should be reviewed by medical
experts already invested in this process, not politicians, bureaucrats or
judges. Often, when medical policy
becomes the purview of bureaucrats, there is little room for deviation, no
mechanism to evaluate individual cases, and no way to make exceptions.
Ironically, the Affordable Care Act (ACA, Obamacare) has
given Secretary Sebelius incredible and unprecedented latitude regarding
virtually all aspects of American health care decision making. The ACA left the
regulatory scope of the law including the powers granted to the Secretary
intentionally vague, potentially allowing her office unlimited oversight into
every aspect of healthcare.
An equally frightening reality involves Secretary
Sebelius’ new partner in the execution of Obamacare - the Internal Revenue
Service (IRS). The recent revelations regarding their lack of impartiality in
applying tax policies to political opponents of the Obama administration are
unforgivable. But now, the IRS will be intimately involved in healthcare, in
ways that we currently do not fully understand. At the very least, they will
determine based upon your tax records, the level of federal subsidies an
applicant will receive to assist with the purchase of health insurance inside
of the new state exchanges. The IRS will also determine the penalty should
someone choose not to purchase insurance.
Given their track record, all Americans should be worried
about the potential for abuse by some “rogue” agents who could theoretically
target groups of Americans and delay applications or interfere with medical
care if their political views vary from those of the President.
The Sarah Murnaghan case should not be used to make a
scapegoat of Kathleen Sebelius. Neither she, nor her office should have been
involved in this case at all. That the ACA vests such broad sweeping power in
the hands of one non-physician federal bureaucrat should be lost on no one, and
should give pause to all who supported this massive law. The further we take
medical decisions away from patients and their doctors, the greater the
potential for abuse and for possible politicization. We cannot have bureaucrats
and regulations coming between us and our medical care. The recent scandals
involving government agencies that have become too large and unaccountable should
be a wake-up call for all Americans. It is precisely why we need less
government in healthcare, not more.
No comments:
Post a Comment