"All the way to heaven is heaven." -- St. Teresa of Avila

 

David Brooks's latest column is wrong on so many levels I hardly know where to begin. I suppose, at the beginning.

 

So without further ado ...

The core belief that social conservatives bring to cases like Terri Schiavo's is that the value of each individual life is intrinsic. The value of a life doesn't depend upon what a person can physically do, experience or achieve. The life of a comatose person or a fetus has the same dignity and worth as the life of a fully functioning adult.

First, I had rather he said a "PVS [persistent vegetative state] patient" because the comatose can recover, and I understand that many comatose people really are aware of what's going on around them; they just can't respond. In other words, they are sentient. I have an enormous respect for sentience.

Social conservatives go on to say that if we make distinctions about the value of different lives, if we downgrade those who are physically alive but mentally incapacitated, if we say that some people can be more easily moved toward death than others, then the strong will prey upon the helpless, and the dignity of all our lives will be diminished.

Like I said, I have an enormous respect for sentience. Terri Schiavo is not mentally "incapacitated"; she is no longer sentient. Way different. There are many people with diminished mental capacity as a result of birth anomaly, disease, or accidents, yet they are sentient, and a compassionate society gives these people every opportunity for the best life they can have. 

 

Many conservatives, I've noticed, stubbornly refuse to see this distinction, so strong is their desire to present slippery-slope arguments. But to me it's quite clear.

 

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Also, there are many ways to look at "individual life." If you don't mind indulging me for a moment, I'm going to present, very briefly, the Buddhist perspective. Please note I'm not trying to convert anybody, and if this really doesn't interest you, feel free to skip down to the other set of asterisks below.  

 

From a Buddhist perspective, an individual is to life what a wave is to ocean. The individual is a phenomenon of life, as a wave is a phenomenon of ocean. Although the wave is a distinct phenomenon, at no time is it separate from ocean. When it begins, nothing is gained; when it ends, nothing is lost. Thus, life itself, beingness itself, neither begins nor ends. It just ceaselessly manifests in myriad forms. Because life is infinitely wonderful and precious, all phenomena of life are wonderful and precious and worthy of respect.

 

The Buddha taught that an individual happens when five "aggregates" come together. These are the physical body, the senses, conception, volition, and consciousness. There are whole libraries of sutras and commentaries on sutras explaining all this; it's very complex. For purposes of this discussion, however, I will only point out that all of these aggregates, although they depend on physical form, are also all processes. As the guy who wrote this page explains,

Matter is organized into a physical organism and animated by consciousness. These two combine to form the body-mind substrate of the personality. The other three aggregates are forms of activity that arises in the interactions between the body and mind.

So, in Buddhism, an individual is not a thing, or an object, but a process, continually becoming, continually reaffirming itself, until the process has run its course. And since, from this perspective, the process that was Terri Schiavo has ceased, there is no moral reason to prevent the physical form from being reclaimed by the ocean of beingness. In fact, I suspect some sects of Buddhism would discourage keeping the body animated when it is no longer sustaining the process of personhood.

 

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The rest of this post gets easier, I promise. Brooks continues,

The core belief that social liberals bring to cases like Ms. Schiavo's is that the quality of life is a fundamental human value. They don't emphasize the bright line between life and death; they describe a continuum between a fully lived life and a life that, by the sort of incapacity Terri Schiavo has suffered, is mere existence.

On one end of that continuum are those fortunate enough to be able to live fully - to decide and act, to experience the world and be free. On the other end are those who, tragically, can do none of these things, and who are merely existing.

I hate it when someone who doesn't understand what I think tries to explain what I think. I suppose I'm as much of a "social liberal" as anybody, but Brooks doesn't explain my POV at all. Although quality of life is important, that doesn't mean I think the life of someone with diminished capacity or a poor quality of life has less value. (And, anyway, it's all the same life.) My POV is that Terri Schiavo no longer exists. I suspect most "social liberals," including non-Buddhist ones, see the situation this way.

 

Brooks continues,

Social liberals warn against vitalism, the elevation of physical existence over other values.

I honestly don't know what he's talking about there.

They say it is up to each individual or family to draw their own line to define when life passes to mere existence.

Well, no, we think that it's up to medical science to determine when a life process has finished, or when the body is no longer sustaining the person we loved, or when the individual is no longer sentient, however you want to perceive it.

The central weakness of the liberal case is that it is morally thin. Once you say that it is up to individuals or families to draw their own lines separating life from existence, and reasonable people will differ, then you are taking a fundamental issue out of the realm of morality and into the realm of relativism and mere taste.

No, what we've saying is that, once the body is no longer sentient, it is up to families to decide if they want to maintain the body, or let it go. And it should be up to the families, because they're the ones who have to live with the consequences.

 

There is a story in today's Los Angeles Times about two mothers whose children were in a persistent vegetative state. One mother chose to bring her daughter home to care for, and the other mother chose to let her son go. My position is that these mothers had to work out for themselves what they could or could not live with; what they could or could not handle. Each mother did what she felt in her gut she should do, and so IMO both decisions were the correct decisions.

 

If some "moralistic" do-gooder had forced the first mother to let her daughter die, and the second mother to take her son home to care for him, those would have been the wrong decisions.

 

Families in these circumstances have to consider how they're going to cope with the consequences of the decision. Some families may not have the emotional or physical resources to maintain the loved one's body, and others might find some purpose or comfort in caring for the body. Some may perceive the person is really gone, but those who do not may need more time to process what's happened to their loved one. So, the right decision may not always be the same decision. There are a lot of variables to consider. That's why it's important for families to make these decisions, not the government.

 

People like Brooks who whine about "relativism" want morality to be something written in a rule book. I think that rule-book morality is what you fall back on when you don't understand morality.

You are saying, as liberals do say, that society should be neutral and allow people to make their own choices. You are saying, as liberals do say, that we should be tolerant and nonjudgmental toward people who make different choices.

Yep, as long as people don't break the law or scare the horses.

What begins as an appealing notion - that life and death are joined by a continuum - becomes vapid mush, because we are all invited to punt when it comes time to do the hard job of standing up for common principles, arguing right and wrong, and judging those who make bad decisions.

This makes me nuts. It's the rule-book moralists like Brooks who are not doing the hard work that compassion often demands. "Common principles" can cause suffering. There used to be a "common principle" that slavery was moral, for example. True morality demands that we close the rule books and set aside what we want, and instead look at the situation as-it-is and respond with selfless compassion.

If "principle" causes people to act in ways that are not honest and compassionate, then principle can hang.

The down side of honesty and compassion is it takes hard inner work to avoid the temptations of desire and ego. Nobody said morality was easy.

And what's this about "judging people who make bad decisions"? In how many different ways did Jesus teach his followers not to do that? The poor man-who-maybe-was-God practically stood on his head, waving a flag and whistling Dixie, to draw attention to the teaching do not judge one another.  See Matthew chapter 5, for example. But here's Brooks, thinking it's up to him to pass judgment on the rest of humanity.

If I ever meet Brooks, I will explain he is relieved of this duty.

There are laws, and courts, and courts must judge, but this isn't the work of morality. It's the work of civilization; it's something we humans need so we can stand to live with each other. But civilization doesn't depend on whether the family next door chooses to pull a feeding tube, or not.

You end up exactly where many liberals ended up this week, trying to shift arguments away from morality and on to process.

I've written before from time to time that process deserves respect. I've often noticed that conservatives these days seem to have no respect for process, only for the result. But the result is the process. This is something you have to learn for yourself through experience; I don't think I can explain it. But whenever you hear people say that the process doesn't matter, as long as we get to our result, expect the result to be bleeped up. And truthfully, in the grand scheme of things, there are no results. Everything is always in flux. It's all process. If you read the Buddhist section, you saw the argument that individual humans are processes.

 

And to me, morality is a process. It's a continual challenge of understanding who you are, how you relate to the rest of creation, how your actions impact others, how your actions come back and bite you, how to find the will to put aside what you want and instead do what is compassionate.

 

Though you may be following the Bill Bennet Golden Rule Book of Morality to the letter, if you have no understanding of these things -- of process, of beingness, of action and reaction, of the temptations of ego -- you will still screw up the morality thing.

 

And lo, Brooks provides an example:

If you surveyed the avalanche of TV and print commentary that descended upon us this week, you found social conservatives would start the discussion with a moral argument about the sanctity of life, and then social liberals would immediately start talking about jurisdictions, legalisms, politics and procedures. They were more comfortable talking about at what level the decision should be taken than what the decision should be.

Then, if social conservatives tried to push their moral claims, you'd find liberals accusing them of turning this country into a theocracy - which is an effort to cast all moral arguments beyond the realm of polite conversation.

He's so eager to make his argument about principles he forgets to be honest. Oopsie-doodle! This is the danger of denying the process of morality and relying on a static rule book instead. In order to maintain the integrity of his principles, he has to be dishonest -- in his column and with himself -- about the views of others.

 

Nobody says that people can't debate "moral arguments" in "polite conversation." What we're saying is that this is a nation of law, not a nation ruled by a mob, or subject to some popular consensus of what is or isn't "moral."

 

Many actions I consider immoral are not illegal, nor would I make them so. True morality cannot exist where all behavior is coerced. And once in a while someone does something illegal that is very moral. Rosa Parks comes to mind.

 

The point is that, as a nation of law, and not a theocracy, our laws must have a practical and secular purpose, such as maintaining traffic flow, respecting property rights, upholding contracts, and prohibiting murder -- not because murder is "immoral," but because civilization can't exist where people live in fear of each other.

 

I suspect Brooks knows this; he just lacks the moral courage to admit it.

Once moral argument is abandoned, there are no ethical checks, no universal standards, and everything is left to the convenience and sentiments of the individual survivors.

Since when were there "universal standards"? Ideas about what is and is not moral shift throughout space and time. What's upsetting Brooks is that there are people in the world who do not share his ideas of what is or isn't proper. And because he is a limited person, he must find some excuse to denigrate people who see things differently. Hard, heartbreaking choices are dismissed by Brooks as mere "convenience" and "sentiments."

 

This is, IMO, immoral.

 

Also: For another POV on why Brooks is being dishonest, see Armando at Daily Kos. And I agree with Armando that Matt Yglesias's post on "absolutism," although interesting, doesn't break through to the fundamental dishonesty of Brooks's position. But Matt is very young (compared to me, anyway) so I'm inclined to forgive him. See also Billmon on moral relativism and David Brooks.

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There is a difference between bad coverage and willfully irresponsible coverage, and another line between willfully irresponsible coverage and dangerously irresponsible coverage. In the last three days, those lines have been crossed. Repeatedly. And it has been absolutely, definitively intentional. ...

 

... Now, there are times when the news media is simply sloppy; there are times when journalists simply get stories wrong, and there are times when, as in the trials of Michael Jackson, Kobe, O.J., Martha Stewart, etc., the news channels are simply swept away by their natural tendency towards low-cost voyeurism. But this isn't one of those times. This isn't petty irresponsibility or sloppiness, to be chalked up to the dwindling resources of corporate newsrooms.

This is a decision on the part of producers to willfully bend the lines in a manner that promotes sensationalism and potential violence, by intentionally tossing known-false information into a wire-taut public conflict to enhance the "ratings value".

I felt the same way last year about the swifties. Of course, there's an unholy alliance between cable news and the VRWC anyway, but I also believe the cable news whores saw the swiftie controversy as a ratings booster, and they exploited it. The cable newsies may be whores, but they're not stupid, and deep down most of the cable news show hosts must have known the swifties were full of it. And I believe that exploitation swayed a presidential election. We can rightfully gripe at Kerry for not responding sooner and more forcefully, but if the news business weren't such a freak show, he wouldn't have had to.

As I keyboard, basic news coverage seems to be breaking down. By now you've probably heard about the Miami Herald's report that Governor Bush sent state law enforcement agents to take custody of Terri Schiavo, but they were stopped by local police from doing so.  Here's the story as reported by Knight Ridder. Putting aside that this farce was almost certainly staged -- Jeb needs to appease the Fetus People, but he also needs the Schiavo controversy to go away and never come back -- Dr. Atrios says there appears to be a blackout of the story on CNN. I don't see anything about it on the web sites of MSNBC, the New York Times, or the Washington Post either, which makes me wonder if there's some question about the story's veracity. Or, maybe (dare I hope?) they're ignoring it because they know it was staged.

Nah, that can't be it.

But yesterday, I remember clearly, there were stories about somebody trying to steal a gun to kill Michael Schiavo, and somebody else putting a bounty on Michael Schiavo, but today those stories have nearly evaporated.

I'm starting to feel a tad nervous.

Billmon has a long rant up about blogging and life and the universe and everything, in which he says,

What I finally had to confront was the fact that truth alone is impotent in the face of modern propaganda techniques – as developed, field tested, refined and deployed by Madison Avenue, the Pentagon, the think tanks, the marketing departments of major corporations, the communications departments of major research universities, etc. To paraphrase Hannah Arendt, the peculiar vulnerability of historical truth (which means political truth) is that it isn’t inherently more plausible than outright lies, since the facts could always have been otherwise. And in a world where the airwaves are overloaded 24/7 with the mindless babbling of complete idiots, it isn’t very hard to make inconvenient facts disappear, or create new pseudofacts that reinforce whatever bias or cultural affinity you want to cultivate – particularly if the audience is already disposed to prefer your reassuring lies to discomforting truths told by strangers.

He's right, but if he's right, how can republican government survive?

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It seemed as if the campaign had never ended. There was John Kerry standing on a chair in a blue neighborhood of Atlanta, in the Democrat-friendly tavern Manuel's, speaking to 100 folks, many of them wearing Kerry-Edwards T shirts. ... 

 

"It's been a long time since the Democratic Party gave somebody a second chance," says Grossman. "That's a big challenge to overcome." But it might not be the biggest. Kerry may find that there is little he or any other contender can do to get his party's nomination if Hillary Clinton decides to run. The New York Senator holds a commanding lead in every poll of Democratic voters, and some major party fund raisers are saying they expect her to have a huge financial advantage over her opponents. "She'll crush them all," says a lobbyist who plans to raise funds for 2008 candidates.

As she slices up the traditional Democratic base, Clinton is also reaching out to the middle, seeking common ground on contentious issues from war to abortion. It is an early, but impressive show of political gamesmanship. And it is all happening while the rest of the Democratic pack of presidential possibilities train their arrows mainly at President Bush and Republicans in Congress.

Clinton's reaching out to women in Kerry's home state for her 2006 Senate race is smart politics for 2008. It points out how difficult it would be for both to run for president.

For liberal women, the lure of backing a female presidential candidate is powerful, one that would be difficult for Kerry or any male Democrat to neutralize. Moreover, if Clinton does run for the Democratic nomination, Kerry would also be fighting off another US senator from the Northeast.

Meanwhile, Delaware Senator Joseph Biden, who is also contemplating a presidential run, is also taking shots at Kerry, most recently in a New Yorker article, where he used the ''w'' word -- ''weak'' -- in connection with Kerry. Shoving Kerry out of the '08 contest makes it easier for Biden, who doesn't need another veteran male senator in the race, especially one who begins with the national constituency Kerry built as the last Democratic presidential nominee....

...Some conservative commentators are beginning to speculate that Clinton will not seek reelection to the US Senate in 2006. The theory, advanced by John Podhoretz in the New York Post, suggests that Clinton would not want to take votes in the Senate that could be used against her as a presidential candidate, which happened to Kerry during his presidential quest.

But at the moment, Clinton is concentrating on the base that lifted Kerry up, while letting others talk about the obstacles that blocked his path to the White House. Slice.

Makes me want to crawl into a corner and cry.

The Dems are not getting it. We don't want a candidate who moves right to find "common ground" with the wingnuts. We don't want a candidate who has ever provided butt cover for Bush. We don't want a candidate who voted for that abomination of a bankruptcy bill (Biden).

Dems are preparing to package Hillary into their idea of a marketable political product. Everything from her speeches to her hair style will be focused-grouped to death, and eventually she'll be made over into whatever some Beltway "consultants" decide is what people want, and off she'll march to the 2008 nomination. And then they'll wonder why sales are off.

I'm hoping the Blogosphere has a major impact on the 2006 mid-terms. Then the Washington powers that be would be given notice that they have to haul their heads out of their butts and pay attention to us.

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Recommended: "All You Need to Know About the Schiavo Case" by Motherlode at No More Apples. "The Radical Right Tries Out Some New Fashions" at Steve Gilliard's News Blog.

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Native Americans across the country -- including tribal leaders, academics and rank-and-file tribe members -- voiced anger and frustration Thursday that President Bush has responded to the second-deadliest school shooting in U.S. history with silence.

Three days after 16-year-old Jeff Weise killed nine members of his Red Lake tribe before taking his own life, grief-stricken American Indians complained that the White House has offered little in the way of sympathy for the tribe situated in the uppermost region of Minnesota.

 "From all over the world we are getting letters of condolence, the Red Cross has come, but the so-called Great White Father in Washington hasn't said or done a thing," said Clyde Bellecourt, a Chippewa Indian who is the founder and national director of the American Indian Movement here. "When people's children are murdered and others are in the hospital hanging on to life, he should be the first one to offer his condolences. . . . If this was a white community, I don't think he'd have any problem doing that."  

This, of course, is just part of a pattern. After September 11 The Brat had to hide out on Air Force One for several hours before he could pull himself together (or sober up?) and act like a president.  More than a year ago he had to be coaxed into addressing the nation after a particularly bloody day in Iraq (not as bloody as the days have been since, of course). And do you remember The Blackout of August 2003? I wrote at the time

It took him four hours to bring himself to speak to the nation after the Blackout began, and then he could do so only on tape. (Drunk or stupid? We report -- you decide.) After this week's bombing that killed at least 20 UN workers, Bush's keepers managed to get him off the golf course, into a suit and tie, and in front of cameras a bit faster. The keepers are learning, it seems.

Of course, he would have been a lot quicker if he'd been able to wear a quasi-military costume and prance around in front of a few thousand screaming groupies.

So if it's any consolation to Mr. Bellecourt, Bush doesn't give a shit about white people, either. That is, unless they're donors or present an opportunity to pander to donors.

The reaction to Bush's silence was particularly bitter given his high-profile, late-night intervention on behalf of Terri Schiavo, the brain-damaged Florida woman caught in a legal battle over whether her feeding tube should be reinserted.

"The fact that Bush preempted his vacation to say something about Ms. Schiavo and here you have 10 native people gunned down and he can't take time to speak is very telling," said David Wilkins, interim chairman of the Department of American Indian Studies at the University of Minnesota and a member of the North Carolina-based Lumbee tribe.  ...

 Even more alarming than Bush's silence, he said, is the president's proposal to cut $100 million from several Indian programs next year.

Bill Clinton addressed the nation within a few hours after Columbine. But the White House says Bush will say something about Red Lake in tomorrow's radio address. I'm sure the speechwriters are hard at work right now, making sure the President's words are sufficiently sincere.

Joan Smith writes in the Seattle Post-Intelligencer:

In Bush's America, where the political class has embarked on a mission to resuscitate the brain-dead, no one seems to have either the will or the power to intervene in the everyday existence of young people whose lives are going horribly awry. Whole sections of U.S. society grow up with guns and violent death, if not the internecine rivalries of gang culture, making the right-to-life debate currently being conducted in Congress and the Florida courts seem like a surreal joke.

I don't think this is an accident. Politicians enjoy occupying the high moral ground and it is easier to emote about the pain of Schiavo's parents, Bob and Mary Schindler, than to address the disfiguring inequalities of the richest nation on Earth -- especially when you are personally implicated, as the current president is, in making those inequalities worse.

But we knew that.

Also note: Wampum is accepting donations on behalf of the Red Lake Memorial Fund.

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Very basically, there are two kinds of conservatives on today's American Right: social  conservatives and political conservatives. And although they have been fellow travelers and Bush supporters for some time, they really are two very different groups with very different philosophies.

 

Social conservatives want to use government to enforce their vision of morality and "normalcy." They want government to ban gay marriage, abortions, most divorce, and the teaching of evolution. They want government to indoctrinate conservative Christianity through prayers in public school classrooms and various "faith-based" programs.

 

But political conservatives lean toward libertarianism and don't like Big Gubmint, period. They've been Bush supporters because they like his tax cut plans -- they tend to be "starve the beast" proponents -- and they support the war in Iraq. They are mixed on whether they approve of gay marriage -- some do, possibly most do not. But they do not like people messing with the Constitution and are opposed to a gay marriage amendment. And they don't want America turned into a theocracy.

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(CBS/AP) Congressional leaders have insisted their only motivation in getting involved in the Terri Schiavo case was saving a life. But Americans aren’t buying that argument, a CBS News poll finds.

An overwhelming 82 percent of the public believes the Congress and President should stay out of the matter.

Just 13 percent of those polled think Congress intervened in the case out of concern for Schiavo, while 74 percent think it was all about politics. Of those polled, 66 percent said the tube should not be inserted compared to 27 percent who want it restored. The issue has generated strong feelings, with 78 percent of those polled -- wheter for either side of the issue -- saying they have strong feelings.

Public approval of Congress has suffered as a result; at 34 percent, it is the lowest it has been since 1997, dropping from 41 percent last month. Now at 43 percent, President Bush’s approval rating is also lower than it was a month ago.

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To see the Left (LA Times) react to Congress giving the Federal Courts jurisdiction over Terri's case, was just amazing. They are hysterical with the notion that a coup d'etat had come to pass. Afterall, what business does Congress have in overseeing the almighty Courts.

I would wonder how anyone who had read the Constitution, Federalist Papers, etc. could call what Congress did a "coup d'etat." Well, the Left hasn't read that stuff and has managed to convince many that the Courts have always been all powerful and nothing in the Constitution restrains that power.

I think the writer skipped Article 3. The Freep are a little shaky on the literacy thing.

The Left knows that its agenda can't be passed through the legislative process. Thus, the Courts are now in charge. Selecting willy nilly what is and is not the law. Who is and is not a citizen.

He's still pissed off about Dred Scott? That's actually kind of sweet.

Who is and is not entitled to seek redress in courts. Constitution?!!? What the hell is that. It is nothing more than a word to the Left and to too many Americans.

Yeah, who the hell do those judges think they are, ruling on laws and stuff? Bleepin' hell in a handbasket ...

Rude Pundit says conservatives are drowning in their own bile, but I think if that were possible the Freep would have done it by now.

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Moreover, the law allows for (even if in the Hudson and and Nikolouzos cases it did not actually involve) the termination of life-sustaining treatment for patients with "irreversible" conditions (i.e., conditions from which they will not recover and which leave them unable to care for themselves) even if their higher brain functions are completely normal. Indeed, the law contemplates that a fully competent patient may be served by his health-care provider with a 10-day notice to find another provider or have his plug pulled; it even provides that the patient has the right to attend the committee meeting at which his fate is to be decided. (Sec. 166.046) And the law provides no substantive guidance other than the provider's decision that the requested life-sustaining care would be "inappropriate."

So, if I read the Texas law correctly, it would allow for Terri Schiavo's feedling tube to be disconnected if her health care provider so decided, and if her family couldn't find another provider willing to take the case, even if her higher brain functions were entirely normal (rather than, as appears to be the case, entirely absent), even if she were awake and asking to be allowed to live.

As it happens, the real-world consequences of single-payer healthcare -- also known as socialized medicine or national health insurance -- are well-documented. Single-payer care exists in Canada, New Zealand, Great Britain, and much of Western Europe. And wherever it has been tried, writes John C. Goodman, president of the National Center for Policy Analysis, ''rationing by waiting is pervasive, putting patients at risk and keeping them in pain.''

 

... countries with nationalized systems invariably limit healthcare to control costs. The result, of course, is ever-lengthening wait lists.

The cost of providing health care for U.S. citizens who have no insurance will total $125 billion this year, with taxpayers and private entities footing most of the bill, a report issued on Monday said.

... "Leaving 44 million Americans uninsured exacts a substantial price on society as well as individuals, while covering the uninsured would improve their health care without generating large increases in overall health spending," said Diane Rowland, executive director, Kaiser Commission on Medicaid and the Uninsured.

The nation would have to spend an extra $48 billion to cover the so-called newly uninsured, the report said. But that would only increase health care spending's share of gross domestic product by 0.4 percent.

Partly because they lack insurance, an additional 18,000 adults die each year, the report estimated, citing figures from a branch of the National Academy of Sciences.

People who have no health insurance typically get less preventive care, are diagnosed with more advanced diseases, and "tend to receive less therapeutic care and have higher mortality rates," the report said.

The upside is, of course, that the working poor are not clogging up waiting lists, and Jeff Jacoby gets to see his doctor more quickly than he would if he were Canadian. 

It may be that, if you do have health insurance, you get better treatment in the U.S. than you would in a single-payer country. But if that's so, those poor people sure are messing up our national stats. According to this report (PDF file) from the University of Maine,  our health care system doesn't rank all that highly among those other other nations. As ranked by the World Health Organization (see Table One), the Unites States may be first in responsiveness, but it is thirty-seventh in overall performance. 

And (as I've ranted about in the past) our infant mortality rate compared to other industrialized nations is a disgrace. And don't get me started on medical bankruptcy.

But back to health care rationing and terminal illness. Right now people in their last year of life -- about 1 percent of the population -- use 30 percent of our nation's health care expenditures. We need to make some hard choices here, and let's hope those choices aren't made for us by the marketplace. Otherwise, someday we'll be putting our elderly poor adrift on ice floes while the bodies of long-insentient wealthy are maintained for years on end.

Mr. Kleiman links to a thoughtful post at Lean Left about "futile care." It used to be the case that medical facilities provided aggressive care even for the terminally ill until the patient was dead. Then we developed the notion that, maybe, some people would not want aggressive care, and so patients could refuse treatment or leave living wills. But now --

Some patients, or their families, wanted aggressive treatment up to the very end - which, in some cases, could be a very long time. Where the patient had at least minimal brain function, this made sense: though patients have the right to refuse treatment under those conditions, they also have the right to request it if they feel such a life would still be valuable or meaninful to them. (This raises severe problems when the patient’s ability to use up caregiving services exceeds their ability to pay for them, and the patient is receiving minimal benefit from them, but in practice most hospitals and nursing homes have tried not to refuse care in those circumstances because it leads to bad publicity. They suck up the cost and write it off.)

However, there is another conflict that sometimes arises: that in which a patient or patient’s family demands aggressive or intensive treatment that cannot benefit the patient in any significant degree. ...This may be a demand for an expensive treatment they’ve heard of that isn’t really appropriate for the patient, or a demand for an experimental treatment that shows no promise of working, or a demand for continued treatment for a patient who has no conscious experience at all.... In these cases, distraught or unrealistic family may demand continued treatment even when it is known that the treatment they are requesting cannot help the patient, or even, as in the case of higher-brain death, when no treatment can produce any difference in outcome.

In a perfect world I would still prefer to honor the wishes of the family rather than have laws written to say who gets treatment and who doesn't. But in a flawed world of finite resources I tend to agree with Matt Yglesias that the Texas futile care law has merits. But let's be clear that this law should be applied only in circumstances in which the patient is no longer sentient. Deal?

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It was, famously, H.L. Mencken who defined Puritanism as “the haunting fear that someone, somewhere, may be happy.” The Puritans still exist, of course, but as Dobson showed in January, they’ve broadened their sights to include that someone, somewhere, who might disagree with them. [Keith Olbermann, Bloggerman]

I just got my new "silencing speech on campus" issue of The Nation, focusing on the current attempt to purge liberals from academia. Here's a bit from an article by Russell Jacoby called "The New PC: Crybaby Conservatives."

Today's accusations against subversive professors differ from those of the past in several respects. In a sign of the times, the test for disloyalty has shifted far toward the center. Once an unreliable professor meant an anarchist or communist; now it includes Democrats. Soon it will be anyone to the left of Attila the Hun. Second, the charges do not (so far) come from government committees investigating un-American activities but from conservative commentators and their student minions. A series of groups such as Campus Watch, Academic Bias and Students for Academic Freedom enlist students to monitor and publicize professorial conduct. Third, the new charges are advanced not against but in the name of academic freedom or a variant of it; and, in the final twist, the new conservative critics seem driven by an ethos that they have adopted from liberalism: affirmative action and a sense of victimhood, which they officially detest.

Except I never heard that the ethos of Affirmative Action was "winner takes all." And it isn't just academia. From a post at Alas, a Blog:

I run into variations on this “we conservatives are entitled to not be criticized” argument again and again. Although there were a handful of legitimate complaints having to do with overzelous “hate speech” laws, the majority of the complaints about “PC thought police” a few years back, consisted of conservatives saying it made them uncomfortable to be criticized when other students found their views misogynistic, heterocentrist or racist.

Did no one ever tell them that it’s not “thought police” when someone is criticized or made uncomfortable?

Amp at Alas provides examples, but I'm sure we've all seen this. Truly, the righties will not rest until they have sniffed out and eliminated every thought that dares stray from their orthodoxy.

Update: Kevin Drum, February 13:

Conservatives tend to thrive on a sense of besiegement, a belief that they're surrounded on all sides by enemies seen and unseen who must be destroyed. The politics of personal destruction, brought to a fever pitch during Bill Clinton's presidency, is tremendously helpful to their cause — and always has been.

OK, I Lied Department: Don't miss Dan Froomkin's comments on Schiavo. Especially this photo.  

"There are an estimated 4,000 deaths each day where there's a conscious decision to limit treatment in some way," said Dr. Ron Cranford, professor of neurology at the University of Minnesota in Minneapolis.

"We have an estimated 14,000 to 35,000 adults and kids in a persistent vegetative state every year," he said. "It's a routine thing to discontinue treatment. These decisions are made behind the scenes."

Other estimates place the number of adult patients in PVS in the United States between 15,000 and 25,000. The annual cost of caring for these patients is estimated to be as high as $7 billion.

Cranford is among the neurologists who personally examined Terri Schiavo — in 2002 he confirmed the Florida woman was in PVS. "There's no doubt — not a shred of doubt," he said. Schiavo's feeding tube was removed Friday after a years-long legal battle between her husband and her parents.

Dr. Stephen S. Lefrak, professor of medicine at Washington University School of Medicine and chair of the ethics committee at Barnes-Jewish Hospital in St. Louis, confirmed that ending the care of a patient — also known as "terminal wean" — is a decision made daily in most hospitals.

Schiavo resides at a nonprofit hospice that has assumed part of the cost of her care. Medicaid pays for the rest. According to this AP story, keeping her alive costs about $80,000 per year, and at least $350,000 of the malpractice settlement awarded to Schiavo and her husband in 1992 has been spent on her care. Florida Medicaid normally offers hospice coverage for those with a life expectancy of no more than six months, but Schiavo has received assistance from the state for the last two years. [Slate]

Texas was the leader in making such drastic changes. It knocked nearly 200,000 people off the rolls last year. That state's physicians are now fighting a government plan to move more Medicaid patients into managed care. The proposal would turn over case management duties currently handled by doctors to HMOs.

The plan would offer the state more budget certainty, but it also would mean that the state is spending 11% to 15% in administrative costs that could be available for patient care, said John Holcomb, MD, chair of the Texas Medical Assn.'s ad hoc Committee on Medicaid.

At the end of last year, Tennessee Gov. Phil Bredesen put into motion a retraction of the TennCare program that would drop more than 300,000 enrollees. That has been held up by legal challenges by patient advocacy groups in the state.

Now Mississippi is facing a $268 million deficit that is threatening to shut down the program altogether. And West Virginia is more than $100 million short in state funding just a few months away from its new fiscal year -- a fact that will precipitate some "painful" cuts, according to state officials. [American Medical News, March 21, 2005]

It is truly touching that the compassionate Republicans are so dedicated to ensuring that the vulnerable in our society receive the medical treatment they need. Golly gee, the Moose forgot that this crew just attempted to cut Medicaid benefits for the poor. At least the Catholic Church is consistent in its support for life.

I'm puzzled. I thought the President and GOPers didn't like activist judges and were for smaller government. It seems here they're moving this case to ensure activist judges handle it and are taking powers away from state courts and handing it over to the federal government. Do conservative principles matter, or are they only to be affirmed during election time?