Several more objections, clarifications, and additional bits of evidence following the much-bruited -- and to me somewhat anticlimactic -- Betsy McCaughey-Jon Stewart smackdown two days ago. (Previous reactions here.)
On the origins of Betsy McCaughey's argumentative style:
A reader suggests they have one obvious source:
The reader explains:
Cleese's character is armed with all that one could ask for: keen wit, boundless vocabulary, perfect presence of mind, and all the facts on his side. And yet, even he can be played to a draw by a liar who maintains a sufficiently unshakable facade of conviction.
On the details of why "death panels" are so preposterous
A reader in Maine writes:
Another absurdity in the argument of Betsy McCaughey is her claim that there is something wrong with doctors having to follow a patient's wishes as expressed in a living will. There are two major problems here: 1) People can always change their living will, just as they can change their will at any point. The later living will supercedes the later one. So if a person makes a living will when healthy and sees things differently when ill, the sick person can express different wishes in the new living will. 2) Why shouldn't doctors have to respect people's wishes on end-of-life care? I have heard countless stories of living wills being ignored. The provision on living wills is effectively an implementation provision, providing for accountability and for the wishes of the patient to be respected.
Further on the Living Will point:
Reader Zach writes:
I'm surprised you didn't mention this. McCaughy's twisted logic is basically that after you draft a living will it will be enforced ruthlessly by doctors seeking to up their quality rating even if you personally object. Backing her up is an anecdote about her apparently hearing a woman telling her to hurry up and help as a doctor suffocated her with a pillow or something. Her point is that, by rewarding adherence, we're making doctors stick with the patient's initial stated intent. However, if you're conscious you can amend, annul, or otherwise do whatever you want with your will, living or otherwise, at any time you want. If you're conscious enough to tell someone not to pull the plug, you haven't triggered your living will yet.
Measuring "adherence" is simply measuring whether care providers do what you asked them to do. If you change your mind, they have to do that. In no way is it rewarding locking people into DNR orders and rewarding doctors for not allowing them to change their mind. I was disappointed that Stewart didn't point this out; that's probably because McCaughy decided to change which pages of the bill she was concerned about since her previous logic was utter bullshit as well and she reckoned that Stewart had prepped for that.
I said more or less the same thing here - http://alchemytoday.com/2009/08/21/betsy-mccaugheys-big-lie/. McCaughy's starburst-generation strategy for winning televised arguments in lieu of employing facts is eerily reminiscent of someone else. [And I think he doesn't mean the parrot but instead another hazy-on-facts political figure who barely one year ago was winking at the crowd.]
And finally, On Charles Krauthammer's contribution to the discussion:
From your recent post: "Charles Krauthammer in the Washington Post today, contends that the very act of reimbursing doctors for a discussion about living wills and end-of-life care will have a subtle bias in favor of an euthanasia-like outcome."
I don't really understand CK's "logic" on this. In the fee-for-service world of Medicare, why would a physician show a bias in favor of a euthanasia-like outcome? Dead patients = no services = no fees for the doc. I'm not suggesting doctors are driven only by $$$. But if you buy CK's presumption that doctors are going to start pushing end of life counseling because they are finally getting paid for it, wouldn't the profit-driven response be to urge your patients to pursue additional treatment to prolong their lives? Does not compute.
We want to hear what you think about this article. Submit a letter to the editor or write to firstname.lastname@example.org.