Do you believe that “death panels” could somehow be a good thing? A recent article in Slate makes the case, arguing that state-appointed boards in Ontario provide the most “objective process” for dealing with tough end-of-life decisions.
The piece is worth a read, not only because it gives a perspective on foreign healthcare from a foreign voice (the author, Adam Goldenberg, is Canadian), but because it cuts to the core of a basic dilemma for citizens and the state. Namely, whence does political authority arise? And to what extent can it be legitimately exercised?
Although Goldenberg’s case for objectivity falters (e.g., he implies that the Hippocratic Oath somehow eliminates the incentive for doctors to kill off patients), the fundamental tensions remain helpfully clear. In Ontario, the Consent and Capacity Board is commanded to keep the patient’s best interests in mind. How separate the patient’s interests are—or ever could be—from the government’s interest is left untouched. And of course the varying degrees of personal interest left unspoken by a comatose patient will remain forever indecipherable.
There’s also the enormous matter that such a board, in Ontario at least, can actually override the wishes of a family when determined to be appropriate, based on the request of doctors.
Given this final fact, it’s hard to accept that a benignly named Consent and Capacity Board is anything but savage and malicious. But Goldenberg thinks that’s only a superficial skew. And to an extent, he’s right: our perception of the “override function” might (if we’re clear thinking and honest) be colored by the moral wrongness of actively killing someone. But there’s also the dismissal of family wishes—the thing that Americans are probably most likely to object to, given our ever-widening (and therefore increasingly meaningless) idea of “objective morals.” As far as intentional killing of innocent life goes, the judgment is final. But it seems only a short distance between valuing a family wish and valuing the wishes and best interests of the state. (This distance grows shorter by the day, the more we relinquish the nature of the family to the power of the state.)
So, for those who believe primarily that moral obligations exist toward people by virtue of their humanity, Goldenberg’s article is hardly convincing. But for those who emphasize an expedient submission of the personal to the political, his case seems hard to resist.