Ezra Klein Interviews Ezekiel Emanuel on 'Death Panels' and D.C. Food

Sunday, August 16, 2009

Before Ezekiel Emanuel joined his brother Rahm in the White House, he was director of the National Institute of Health's clinical bioethics programs and an oncologist specializing in breast cancer. Since he began advising President Obama's budget chief, Peter Orszag, on health care, he's become a surprisingly high-profile figure. A recent New York Post article dug through his academic papers and branded Emanuel one of Obama's "deadly doctors," accusing him of everything from wanting to refuse health care to the elderly to wanting to let the developmentally disabled perish. Reached in Italy last week, the man the New Republic called "the nicest" Emanuel brother struck back at his critics in a conversation with The Washington Post's Ezra Klein. Excerpts:

We've heard harsh accusations in the health-care debate lately, including Sarah Palin's contention that you want "death panels" and Rep. Virginia Foxx's charge that Democrats want "to put seniors in a position of being put to death by their government." So, do you want to euthanize my grandmother?

No. I've never met your grandmother. I'm sure she's a lovely lady.

Anybody else's grandmother?

No. I'm on record against legalizing euthanasia and assisted suicide for over a decade now.

The New York Post quoted a 1996 article you wrote saying that some people believe health-care resources shouldn't go to those "who are irreversibly prevented from being or becoming participating citizens." What was your point?

I was examining two different, abstract philosophical positions to see what they might offer in the context of redoing the health-care system and trying to reduce resource consumption in health care. It's as abstractly philosophical as you can get on a practical question. I qualified it in 27 different ways, saying it wasn't my view.

Before you joined the White House, you were a bioethicist. What does a bioethicist do?

Worries about some of the hardest questions society has to face. One of the quotes in the New York Post came from an article we recently published in the Lancet where the question we were confronting may be the most difficult question the health-care system faces every day. We don't have enough solid organs for transplantation; not enough kidneys, livers, hearts, lungs. When you get a liver and you have three people who need it, who should get it? We tried to come up with an ethically defensible answer. Because we have to choose.

Our system is expensive in part because we've refused to answer some of these questions, like how we deal with end-of-life care, or what minimum benefits should be guaranteed to every American. But isn't not answering those questions a sort of answer, too?

Yeah. You can't avoid these questions. Even if you don't provide an overt justification for them, you end up making decisions. Sometimes those aren't good decisions, or they're decisions you regret. We had a big controversy in the United States when there were a limited number of dialysis machines. In Seattle, they appointed what they called a "God committee" to choose who should get it, and that committee was eventually abandoned. Society ended up paying the whole bill for dialysis instead of having people make those decisions.

Many see the health-care system as aimed at preventing death, and whenever someone dies, that's a failure. So we don't build in options around death because that would be admitting the possibility of failure.

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