This time it's personal

Harold Pollack gives Sarah Palin more respect than she deserves by actually responding rationally to her claim that Barack Obama wants to murder her baby.

Of course we will face the same dilemmas over end of life care and how much is too much no matter whether we have a national health service, single payer national health care, the mixed up mess we have now, or the system Sarah Palin wants in which only rich people have any health insurance at all. What is unfortunate is that the problem of allocating health care resources is barely addressed in the current legislative proposals, not that it is addressed on the basis of eugenics. The issues have nothing to do with whether any individual's "productive potential" as Palin seems to think.

As long-time readers know, my father died early this year after a very long, slow, increasingly tortuous battle with dementia. My mother had to battle equally hard with the nursing home staff and the Medicare fraudsters they brought in to pretend to be physicians. Among other atrocities, against her specific instructions and contrary to a Black Box warning, they twice gave my father antipsychotics in order to knock him out so they wouldn't have to bother to look after him. She found him slumped in his chair and drooling both times.

Anyway, she had to come up with instructions as we knew the end was approaching and she didn't have anybody to talk with about it except me. Her own primary care physician was useless for that sort of thing. Fortunately, she happens to have a son who is a medical sociologist and who works in an academic medical center, which meant I could consult with my M.D. colleagues specifically about my father's as well as draw on my own training and extensive acquaintance with the relevant literature.

It turns out that the specific instructions she needed to give wouldn't be obvious to most lay people. No feeding tube we can probably all think of, but we wouldn't know whether we could be comfortable giving that instruction if we didn't know the science about what happens to people with advanced dementia when they stop eating. It's okay, really: they aren't hungry and if they don't drink, it's because they aren't thirsty. She also had to know, specifically, to request no intravenous antibiotics and no hospitalization. These were the right choices for my father, my mother, and all of us in the family, and they allowed my father to die peacefully when the time came.

Now if Sarah Palin or anybody else wants to make different choices, they may do so. She can have the feeding tube and respirator and the central line pumping in antibiotics while her cerebral cortex turns to dust if she thinks that will bring her closer to God. What she should not be allowed to do, however, is demand treatments that just don't work, for Trig or anybody else, and that the rest of us pay for them. But that's much too complicated for her to understand.