Ageist Health 'Reforms' Can Be Lethal

Friday, November 13, 2009

Many women are angry with the House health bill for its abortion exclusion. But the plan also singles out poor people over 50--a group dominated by women--for legal and lethal bias, says Margaret Morganroth Gullette. And that's not the only danger ahead.

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If we don't find ways to cut costs without cutting care, one top hospital administrator told me, it will be "hospice for all," meaning that seriously ill Medicare and Medicaid beneficiaries might more often be steered toward palliative care.

The Hastings Center Report published an article by Dr. Muriel Gillick describing--approvingly--how denial of coverage might be instituted through regulation.

"National Institutes of Health consensus conferences will be required to determine a new standard of care for patients with a variety of chronic conditions, such as dementia and heart failure, in the last phase of life," Gillick wrote in the article. Then, she said, Medicare and Medicaid administrators would "need to give teeth to the practice guidelines" by reimbursing only for treatment that met the new guidelines.

"Consensus conferences" could be true death panels. And they could threaten with under-treatment a disproportionate number of women, since women, on average, live longer than men and have more ailments.

Ethicists disagree with Gillick's recommendation that "the way to deal with the minority of patients who might want to try treatments that have a vanishingly small chance of working is simply not to offer such interventions. This decision should be made at the policy level."

More Humility in Life-and-Death Issues

Such decisions should be made by doctors, who can better estimate whether a treatment has a "vanishingly small chance of working" in a particular patient. A little more humility by policymakers is in order in cases of life and death.

The Hastings Center has become a magnet for duty-to-die advocates. John Hardwig notoriously argued in the Report that people after their late 70s or 80s should simply refuse treatment. Daniel Callahan, director of the center, agrees. (If many of us would off ourselves, or refuse life-extending treatment, that would cut costs considerably.)

But mainstream commentators too are obsessed with the supposed expense of

end-of-life care. Gerontologists are keeping quiet about age rating and under-treatment. Such "details" are ignored in the progressive press, out of concern for the 47 million people uninsured.

But why shouldn't women--and men--who support this know what else to be wary about and what to fight for? These may be long battles.

Health care should be available to the sick even if they are considered "old." The only relevant criteria-I quote Felicia Nimue Ackermann, an ethicist at Brown University--are a desire to stay alive, medical need and a reasonable chance that the procedure will work.

The principles for true health reform include equally shared responsibility and advocacy for the vulnerable.

Want me to guess your age? Say whether you think "hospice for all" after 80 sounds "great" or "perilous."

Margaret Morganroth Gullette's most recent books are "Aged by Culture" and "Declining to Decline." Her upcoming book is "Agewise: Fighting Ageism in America." She is a resident scholar at the Women's Studies Research Center at Brandeis University.

For more information:

"High-Cost Care Beneficiaries" report, 2005

"Our Aging Societies: Ethical, Moral, and Policy Challenges" study, 2007

Gillick, Muriel, "Is Death Optional?" May 27, 2009

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What is wrong with us that we are we not appalled enough to be slamming the Obama Administration, Congress & Senate with letters and emails and planning a march on Washington?! This is unacceptable! Women yet again take the hit and where are we collectively, waiting for someone else to fix the problem???

The photograph is excellent. This woman appears to represent all the problems we women face in later life. Do not do sports. OR Push yourself to be both sexual and sporty and musical and in every way make yourself available, thus, turning a woman into something she is not in order to keep healthy. Older people are not easily fooled, but, their choices are not as easy for them as younger folks today assume should be so. So, women depend, to help them, on a health care system that puts older people close to the bottom of their priority lists.We used to be high on that list, as we used to be respected for our age. All we are now, is not fast enough.