Montana allows assisted suicide
Last Thursday, the Montana Supreme Court found that there is no law prohibiting patients from seeking physician-assisted suicide, making it the 3rd state to allow the practice (after Oregon and Washington). The Court focused not on finding a right to assisted suicide, but on failing to find a legal prohibition against it in Montana law. Assisted dying, they argued, can be seen as an extension of patient autonomy and personal responsibility for crucial, life and death decisions.
Two judges dissented, however. Here’s Justice Jim Rice:
Until the public policy is changed by the democratic process, it should be recognized and enforced by the courts. In my view, the court’s conclusion is without support, without clear reason, and without moral force.
This is a Scalia-esque argument for judicial restraint on difficult moral questions. But sometimes rhetoric about “judicial activism” acts as a smokescreen for smuggled-in moral assumptions. When speaking of basic “rights” (and liberals are often inclined to think that the right to die is among them), it’s convenient to use the language of established public policy when it’s in your favor and protest “overreaching activism” when the perceived rights are not currently recognized. Meanwhile, actual moral argument regarding the demands and limits of autonomy when it comes to end-of-life decisions is pushed aside.
But perhaps that’s a good thing – Justice Rice would likely suggest that we ought to hash the issues out in public, through the political process, and in this way morality is not swept under the rug for the ease of legalistic maneuvering. The spectre of Roe v. Wade haunts us still!
-Colin
Can the Senate pass permanant legislation?
The Independent Medicare Advisory board is making the rounds on the blogosphere. Reactions range from the hilarious to the sober, with the former category represented by the Weekly Standard (via Yglesias).
Democrats are protecting this rationing “death panel” from future change with a procedural hurdle. Could it be because bureaucratic rationing is one important way Democrats want to “bend the cost curve” and keep health care spending down?
The policy justification for the panel is to remove cost decisions from the political process, where they will be subject to strong lobbyist pressure. If costs are ever really going to go down on a per-procedure basis, such an independent voice is likely necessary. Controversially, there are provisions included that make it procedurally difficult or impossible to amend or repeal this provision.
But Megan McArdle at the Atlantic has an important process-oriented objection.
But process matters. What if your select commission runs amok? Or what if 80-90% of Americans simply hate it and don’t want it? It is neither practically nor ethically desirable to appoint a dictator. Nor is any man so wise that he should be able to enshrine his preference into unchangeable law for all time.
Luckily, a friend who has covered senate procedure in other contexts assures me that this probably will not work: as a law, it’s unconstitutional, and Senate rule changes require a 2/3rds majority that they are not going to get.
Although I doubt that Reid’s objective is a diabolical means of making his agenda permanent, I do think there are real dangers with senate rule changes like this; permanent legislation would remove all democratic accountability from the commission as well as hamstringing ability to redress unforeseen policy concerns. The risks run more towards slippery slope as opposed to present dangers of the provision at hand, but they exist all the same.
Indeed, the objections seem so obvious it’s really surprising that the language was included in the bill, critical as it may be. Maybe there is something to be said for the conspiracy theories asserting that the bill’s great length hides all sorts of diabolical provisions. (Probably not.)
-John
Image courtesy Wiki Commons
Would health care save lives?
I wanted to quickly weigh in on the debate that seems to have largely ended this week in the blogosphere. The question at hand is whether it is appropriate or necessary to use stark language to indicate that policy debates have real-world consequences. Ezra Klein and Yglesias sparked controversy by calling attention to the near-certainty that expanding access to insurance would save lives; thus, voting against the bill is a vote that costs lives.
I think that Klein’s point is indisputably correct, but I do think Klein hopes that this revelation should really change things. Policy decisions do have costs, but they are economic in addition to human in nature. His point seems to be that the policy calculus is significantly different when the human cost is revealed, but I think that cost has always been obvious to all involved.
I think the real point, and one that Yglesias makes more explicitly, is that progressives should be using more hyperbolic language in defense of their policy objectives, which is a political judgment (and likely a correct one).
-John
One flu over the cuckoo’s nest
Nurses say no to vaccine
On Friday, a judge directed New York state health officials to temporarily freeze a mandatory vaccination program for seasonal and swine flu. The order resulted from a lawsuit filed by three nurses who claimed the vaccination order was a violation of their civil rights.
Is it?
Death panels and democracy
Recent polling shows that nearly half of Americans believe in the “death panel” lie. The national misinformation campaign on health care reform should really be considered a success given these poll numbers. (50% also believed that the proposed health care reform would use government money to finance abortions!). It is also notoriously difficult to correct public opinion once it has been formed. Getting right to the point — given that outright lying about the facts of proposed legislation to the public is effective, is this sort of behavior endemic to democracy?
The 24 hour news cycle likely does not help, as incentives point to the need to fill airtime with talking points from both sides. Further, for outlets like CNN that are vested in appearing balanced, there is apparently a compulsion to show both sides of a story, even if one side is a lie. However, there is certainly an air of “it was better in my day” about blaming the current media.
I’ll take the stand that these sorts of political lies are likely to take hold due to two factors. The first is confirmation bias — for example, well over half of self-identified Republicans believed the death panel farce. Of course, the good news there is that the recipients of confirmation would likely have opposed health care reform to begin with, doing little to meaningfully change the political balance.
I’m afraid the second reason might be simple gullibility.
Can anyone make a compelling arguement for how political misinformation in a democracy can be controlled, or is it a permanant feature?
-John
More on healthcare and choice
The healthcare onslaught continues! Following up on yesterday’s post, here’s New York Times columnist David Leonhardt:
To be clear, the versions of reform now floating around Congress would do a lot of good. They would make it far easier for people without an employer plan to get health insurance and would make some modest attempts to nudge the health system away from its perverse fee-for-service model.
Yet they would not improve most people’s health care anytime soon. Giving people more control over their own care would. White House advisers, however, decided against that option long ago. They worried that opening up the insurance market would destabilize employer-provided insurance and make Mr. Obama’s plan vulnerable to the same criticism that undid Bill Clinton’s: that it was too radical.
Advocating for an open market approach to healthcare is not soley a conservative pursuit.
–Sam
Out with the old
In today’s New York Times, Richard Dooling presents what can only be described (though not necessarily pejoratively) as a utilitarian view of healthcare:
With so much evidence of wasteful and even harmful treatment, shouldn’t we instantly cut some of the money spent on exorbitant intensive-care medicine for dying, elderly people and redirect it to pediatricians and obstetricians offering preventive care for children and mothers?
–Sam
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