One of the central tenets of totalitarianism is that government knowingly kills or harms people in the name of a higher ideological purpose. In Cambodia, the Pol Pot regime killed more than 1.3 million people in order to impose its communist ideal on the people. In Mao’s China people were sent to labor camps to work for and learn to appreciate Communism. During its fight against South Africa’s racist Apartheid regime, the ANC sent black South Africans to “education camps” to teach them that the ideology of the ANC was the only way forward.

In Communist East Germany people were locked in by barb wire, concrete walls and guards with a standing order to kill anyone who tried to escape the ideological paradise. The Soviet government locked up critics in mental institutions. Cubans are still forced to starve on government-imposed food rations because the government thinks that its way of feeding the population is better than what the people could come up with on their own.

There is a continuum from the most outrageous forms of oppression – Cambodia, China, The Soviet Gulag camps – to its more “lenient forms” – travel restrictions, food rationing. Everywhere within this continuum government rank themselves and their interest above the individual citizen’s needs and, in some cases, very right to exist.

Nazi Germany took this form of totalitarianism into the industrial age. Not only did the subjugate the individual, but they also tried to engineer the very people of their country. If individuals did not fit the master-race plan that the Nazis had devised, they were discarded. An entire people, the Jews, were put on a track to extermination. Others, such as the Gypsies, were deemed equally unworthy of the perfect society that the Nazi regime wanted to engineer.

But their obsession with population hygiene did not stop there. They took eugenics to an even higher level. Under a policy principle labeled lebensunwertens leben, life unworthy of living, the Nazis set out to clean the German population of individuals whose lives were considered a burden to society.  In general, this horrifying cleaning policy targeted people with disabilities that would make it difficult or impossible for them to hold a productive job.

People who during their lifetime could be expected to cost society more than they contributed.

Fortunately, we have risen above such despicable ethics. We do not discard individuals who can be expected to be a net cost to society.

Right?

Wrong. Eugenics – the “science” of “improving” population health – is back. Quietly but relentlessly, the modern, enlightened, compassionate welfare state is incorporating eugenics into their mode of operation. People who would never even dream of associating themselves with totalitarian ideologies as Nazism, become willing executors of the principle of ending lives unworthy of living – one of the main public policy principles of that same totalitarian ideology.

Eugenics is advancing in the modern welfare state as an instrument of cost containment. It is being used in health care primarily as a sorting instrument among patients in need of scarce medical resources. Disguised as advanced science, hidden behind an inconspicuous acronym called QALY, the contemporary version of the “science” of population health does its best not to tarnish the falsely compassionate reputation of the welfare state.

Support for eugenics spans from medical ethicists to pediatricians paid by taxpayers to save the lives of babies.

The academic discipline of medical ethics is providing ethical cover for physicians who kill children whose lives, the doctors say, are unworthy of living. Or, in the modern iteration, too costly to live. The argument is of course not that straightforward, but comes instead in a slightly convoluted form. In March of 2012 two professors and “medical ethicists” argued in the Journal of Medical Ethics that the lives of some disabled children would simply cost government too much money, and therefore it is logical to let mothers of those babies kill them. According to these two professors of medical ethics, the route to legalized infanticide – and institutionalized eugenics – starts with convincing the mothers of those babies that their children suffer from “burdensome” medical conditions. By explaining this to the mother, a representative of the medical bureaucracy should apparently try to convince the mother that her baby will be a lifelong burden to taxpayers. The implied conclusion is that she will do herself and society a service by killing her own child.

Back in March I explained the consequences of this argument:

By arguing that it is OK for government to encourage or even demand infanticide when its costs for caring for an “abnormal” child is too high, our two “ethical” eugenicists also imply that it is morally permissible for government to invade the womb of every pregnant woman to determine whether or not the baby she is carrying should be aborted. After all, if the ethical standards that allow for infanticide are the same as those that allow abortion, then there is nothing in the way of government-enforced abortions to keep the government’s health care costs down.

In July I reported on a related practice. Danish parents frivolously abort children with medical “abnormalities”; the trend of aborting these babies, I noted…

is not driven by the advancements in medicine – it is driven by advancements in the need to contain costs in socialized medicine. With those needs come a social and cultural climate that is harsher, stingier and more unforgiving toward abnormalities that:
a) increase the individual citizen’s need for medical care throughout her life span, and
b) decrease her ability to work and be a taxpayer.

When a tax-funded single-payer health care system pays for this type of abortions, it puts its approval stamp on a practice where the weak and disabled are sorted out and only the physically fit remain. But more importantly, by allowing this practice within the institutions of a single-payer health care system, government opens for habitual encouragement of disability abortions. The story from Denmark, which also covers similar cases in Britain, indicates that women are subjected to precisely this kind of “encouragement”.

The trend of killing babies to save money for a government-run health care system stretches beyond abortions. The aforementioned medical ethicists made a long and intricate case not for abortions – which they support – but for infanticide. They claim that there is no difference between aborting a disabled baby to save taxpayers money on future health care and killing that baby after it has been born.

A story from from the British newspaper Daily Mail reveals that their argument for infanticide has been thoroughly put to work in the British National Health Service:

Sick children are being discharged from NHS hospitals to die at home or in hospices on controversial ‘death pathways’. Until now, end of life regime the Liverpool Care Pathway was thought to have involved only elderly and terminally-ill adults. But the Mail can reveal the practice of withdrawing food and fluid by tube is being used on young patients as well as severely disabled newborn babies.

How “severely disabled”?

One doctor has admitted starving and dehydrating ten babies to death in the neonatal unit of one hospital alone. Writing in a leading medical journal, the physician revealed the process can take an average of ten days during which a baby becomes ‘smaller and shrunken’.

Ten days. For ten days the hospital staff – and parents – watch a small, innocent child slowly die. And why? Because government has taken a monopoly on providing health care and determines that the baby will cost the health care system too much money over its life span. A fiscal version of lebensunwertens leben. A life too costly to live.

Back to the Daily Mail story (emphasis added):

Medical critics of the LCP … say it is a form of euthanasia, used to clear hospital beds and save the NHS money. The use of end of life care methods on disabled newborn babies was revealed in the doctors’ bible, the British Medical Journal. Earlier this month, an un-named doctor wrote of the agony of watching the protracted deaths of babies. The doctor described one case of a baby born with ‘a lengthy list of unexpected congenital anomalies’, whose parents agreed to put it on the pathway. The doctor wrote: ‘They wish for their child to die quickly once the feeding and fluids are stopped. They wish for pneumonia. They wish for no suffering. They wish for no visible changes to their precious baby.Their wishes, however, are not consistent with my experience. Survival is often much longer than most physicians think; reflecting on my previous patients, the median time from withdrawal of hydration to death was ten days.

The ethical war on fiscally burdensome citizens is being extended beyond the walls of government-run hospitals and offices of professors of medical ethics. The European Union has decided that it can no longer afford to pay for assistance to disabled citizens. This decision comes after the EU has spent two decades expanding its funding of that same type of assistance. The Eurocrats have been exhibited the assertiveness of someone who thinks his checkbook will live forever. As a result, the EU has crowded out private solutions to the problems faced by citizens with disabilities. Now that government can no longer afford to meet its spending commitments, it deems the disabled too costly to care for.

Their lives are too costly to live.

Perhaps there is a cynical logic in the fact that babies are being killed within the borders of the EU, just so government won’t have to pay for their health care and disability assistance in the future.

The Daily Mail again:

‘Parents and care teams are unprepared for the sometimes severe changes that they will witness in the child’s physical appearance as severe dehydration ensues. The use of end of life care methods on disabled newborn babies was revealed in the doctors’ bible, the British Medical Journal ‘I know, as they cannot, the unique horror of witnessing a child become smaller and shrunken, as the only route out of a life that has become excruciating to the patient or to the parents who love their baby.’

When Obamacare brings this practice to America, the parents will probably be offered a painkiller.

There’s more. The Daily Mail explains that the sentencing of a baby to die by starvation and dehydration…

involves the discharge to home or to a hospice of children who are given a document detailing their ‘end of life’ care.  One seen by the Mail, called ‘Liverpool Pathway for the Dying Child’ is issued by the Royal Liverpool Children’s NHS Trust in conjunction with the flagship children’s hospital Alder Hey. It includes tick boxes, filled out by hospital doctors, on medicines, nutrients and fluids to be stopped.

And that’s what the term “end of life care” means. No care at all.

Parents have to agree to their child going on the death pathway, often being told by doctors it is in the child’s ‘best interests’ because their survival is ‘futile’. Bernadette Lloyd, a hospice paediatric nurse, has written to the Cabinet Office and the Department of Health to criticise the use of death pathways for children. ‘‘I have also seen children die in terrible thirst because fluids are withdrawn from them until they die’ She said: ‘The parents feel coerced, at a very traumatic time, into agreeing that this is correct for their child whom they are told by doctors has only has a few days to live.

These recommendations to parents do not come out of thin air. And they are not based on medical evaluations. They are based on one of the most cynical instruments ever developed by the economics profession. More on that in a moment. We are not done with the horror stories from the Daily Mail article.

It is very difficult to predict death. I have seen a “reasonable” number of children recover after being taken off the pathway.  ‘I have also seen children die in terrible thirst because fluids are withdrawn from them until they die. ‘I witnessed a 14 year-old boy with cancer die with his tongue stuck to the roof of his mouth when doctors refused to give him liquids by tube. His death was agonising for him, and for us nurses to watch. This is euthanasia by the backdoor.’

Here is how health care officials characterize this government-sanctioned euthanasia:

Alder Hey confirmed that children and babies are discharged for LCP end of life care ‘after all possible reversible causes for the patient’s condition are considered’. ‘There is a care pathway to enable a dying child to be supported by the local medical and nursing teams in the community, in line with the wishes of the child patients, where appropriate, and always their parents or carers.’

The “care” that these children are receiving is the antithesis of care. They receive nothing at all, literally. No food, no water, no medications, nothing. Some of these children may be sick enough to have a short life span, but that is completely irrelevant. This government-paid program actively sentences these children to death – and then executes them in a way that would not even be used on mass murderers. A person who has raped and killed children would get a more humane execution than these children. If someone did this to a sick dog there would be an outcry of tsunamic proportions.

At the bottom of this, of course, is the fact that the British government runs the National Health Service. Their prime purpose is not to deliver health care, but to deliver health care provided that government can afford to deliver it. In order to decide whose health care government can afford to deliver, the health care system applies something called Quality Adjusted Life Years (QALY). It is a system according to which government can assess the costs and benefits of providing care to individual patients. Here is an introduction to QALY from the Liberty Bullhorn Economic Newsletter of November 2011:

At the heart of QALY is the question: how can a tax-paid bureaucracy compare Jack’s and Jill’s need for health care? To make this comparison the QALY model converts Jack’s and Jill’s health experiences into one common denominator. This common denominator is a utility value scale. The theoretical basis for this scale is the ethical value theory of utilitarianism, with the explicit premise that government, not Jack and Jill, assign utility values to their health care experiences. A life in perfect health is considered to have a utility value of 1, while death has a utility value of 0. In between are various health conditions that span the entire continuum between 0 and 1.

It is important to understand that Jack and Jill do not get to assign utility to their own health experiences. A government bureaucracy does that job for them. If Jack and Jill disagree with the utility assignments that the bureaucracy has made, they can protest all day long if they want to. Government has the last word – in fact, the only word – on how much or how little they suffer from their health condition.

Suppose Jack and Jill want treatment at the same hospital. There is not enough resources to treat both of them, so a health care bureaucrat is assigned the duty to decide who will be admitted. He asks the question: how close to 1 or 0 are Jack’s and Jill’s health experiences? Jack and Jill both suffer from the same type of cancer. It is currently curable in both cases but if left untreated it will kill them. The bureaucrat now asks four questions to determine who will be admitted. … 1. How many more years is the patient likely going to live? 2. How many of those years will the patient be affected by his/her health condition? 3. How much less worth living will his/her life be without treatment? 4. Is the patient likely to be paying enough taxes over the course of his/her life to compensate government for the treatment costs?

Please note again that the patient is not involved in answering any of these questions. The only purpose with them is to find a difference in utility value between Jack and Jill so that the health care bureaucrat can determine who gets treatment – and who is left to starve and thirst to death in the compassionate hands of government-provided “end of life” care.

The choice is, however, not based simply on the utility calculation. There is another aspect involved as well. Suppose the health care bureaucrat finds that Jack’s utility from his remaining life years is only slightly higher than the utility that Jill will experience. At this point, the decisive variable will be – expected tax revenues. If Jill makes more money and her future expected income will produce a lot more tax revenues for government than Jack’s income, then she will get the treatment because he is more likely to pay for his treatment through taxes than Jill is.

There is another way to look at how QALY works. Suppose Jack and Jill have the same income, are the same age and suffer from the same type of cancer. Suppose Jack was in perfectly good health before the cancer but Jill suffered from a disability. The disability means that the doctors have to provide more complex, and more costly, treatment for her cancer. The cost of surgery on her is in other words significantly higher than it is to save Jack’s life.

In this case the QALY calculation will recommend that the government-run hospital admit Jack for treatment but let Jill go without it. Because she is less able to pay for the cost of her treatment – same income, more expensive surgery – government is less likely to recover the cost of surgery in her case.

A disabled person is less likely than an able-bodied person to get health care under a QALY-run government health care system. But it does not stop here. In an excellent piece for The Freeman, October 2006, Jane M Orient, executive director of the Association of American Physicians and Surgeons, explained that the QALY model actually allows health care administrators to assign negative value to live:

It ought to be obvious that there is an unbridgeable chasm between life and death. Nevertheless, the discontinuity apparently escapes those who set up relative value scales based on “quality-adjusted life-years” (QALYs). The unstated assumption is that at some point on the QALY scale, visible to experts, the value of a life becomes negative—even less than the value of death. British instructions for how to use QALY actually include a scale where life can be given a negative value.

This is why babies are left to die in British tax-paid health “care”.

The welfare state is sold to us as one big, warm compassionate embrace by a benevolent government. In reality, that embrace is a choke hold on anyone who does not fit the welfare state’s fiscal template and tight budget. While the practice of eugenics under the umbrella of the welfare state supposedly has nothing to do with racial hygiene, the actual effect is precisely that: a population clean of costly, fiscally unwanted abnormalities.

A population that fits the ideology of the welfare state.