In my essay Eugenics and the Welfare State I examine the authoritarian consequences of government not being able to keep its promises to its citizens. Under the inevitable realms of austerity, government agencies charged with providing services to people become executioners of policies that are designed to deny people those same services. As austerity deepens, the denial purpose grows in importance and evolves into a well-designed, methodically executed practice.
In medical ethics, this leads to a logically stringent – and frighteningly authoritarian – argument in favor of euthanasia. In health care, bureaucrats and physicians sit down around a table and spend the better part of work weeks on developing guidelines that define the conditions and procedures that will deny a patient health care.
As a direct result of the employment of these guidelines in British health care, tax-funded, government-employed physicians and nurses starve and dehydrate babies and teenagers to death.
When a government treats its citizens with such utter cruelty, it is no longer a government that works for the better of its people. It is a government that works against its people. These are people whom the government have deemed are unfit to receive health care under the government’s health care budget.
It would have made no moral difference if the British National Health Service had rounded up these patients, put them on a train to camp and upon arrival asked them to take a shower.
Health care is not the only area where the welfare state dehumanizes people, but it is the most appalling example. After all, when advocates of government health care want a tax-funded, single-payer, entirely government-run health care system they tell us that it is for the better of all of us. We are told that we will all get the health care we need because, the argument goes, government operates entirely based on compassion.
Today we can share yet another story of what this compassion looks like in real life. The Daily Telegraph had this report back in December:
Almost half of dying patients placed on the controversial Liverpool Care Pathway are never told that life-saving treatment has been withdrawn, a national audit has found. The study suggests that in total, around 57,000 patients a year are dying in NHS hospitals without being told that efforts to keep them alive have been stopped. It also reveals that thousands of dying patients have been left to suffer in pain, with no attempt to keep them comfortable while drugs were administered.
If someone did this to bed bugs the animal rights activists would be all up in arms. This is, by the way, a very important topic for Americans to educate themselves about. As BizzyBlog points out, the debate over the terrifying practices of government-run health care in Europe is barely even known on this side of the Atlantic ocean.
The Daily Telegraph again:
Jeremy Hunt, the Health Secretary, last night described the disclosures from records held by 178 NHS hospitals as “totally unacceptable”. He said the failure to consult patients would now be examined by an independent inquiry, which will also look at payments made to hospitals for meeting targets to place people on the pathway.
This is an important little note. The government-run, tax-funded NHS has payment standards that do three things:
- Discourage physicians from sending patients to specialists, as specialists cost more money than General Practitioners (a.k.a., Gatekeeper Practitioners);
- Demand the use of QALY, an instrument for evaluating the economic worthiness of a person’s life; and
- Encourage hospitals to put patients on medical death row when treatment is considered fiscally futile.
All these payment instruments are put in place by the British government to cap the costs of operating the National Health Service. Cost containment has infiltrated the practice of medicine to such a degree where the final word on a person’s health, even life, is fiscal, not medical.
Back to the Daily Telegraph, which explains that 130,000 British patients are put on the so called “pathway” each year – in other words, the medical death row:
The new disclosures demonstrate just how routinely hospitals are placing patients on the pathway without informing them that steps which could hasten their death have been taken. The national audit found: • In 44 per cent of cases when conscious patients were placed on the pathway, there was no record that the decision had been discussed with them. • For 22 per cent of patients on the pathway, there was no evidence that comfort and safety had been maintained while medication was administered. • One in three families of the dying never received a leaflet they should have been given to explain the process.
One need not spend much time elaborating on the individual suffering in these cases. Every conscientious person can paint that picture for himself. What we should note, though, is how quickly and conveniently these practices, once implemented, set root in our society. Consider these reactions, reported by the Daily Telegraph, from medical professionals:
Other doctors, nurses and charities for the dying have come to the defence of the approach, which they say is intended to help ensure that people can die in dignity and comfort, instead of enduring invasive and painful treatment.
First of all, we have very good reasons to ask who makes the decision on the “invasiveness” and “pain” that these patients experience. Is it the patient himself? His or her spouse? Parents? Children? Or is it the medical bureaucracy that is charged with keeping costs down because government, in its immense economic wisdom, has raised taxes to a point where it has run out of other people’s money?
Secondly, there is nothing dignified about being starved and dehydrated to death. Yet that is precisely what the British NHS does when it puts patients on the “pathway”, i.e., on medical death row.
Third, if a government agency – the NHS in this case – can spend hundreds of millions of dollars on developing, maintaining and evaluating standards aimed at killing patients for budgetary reasons, what other services of the welfare state can government subject to similar practices?
This last question is very important. While a single-payer health care system is the crown jewel of the welfare state, it is but one of many components that build the full-blown, wet socialist dream that I left when I emigrated from Sweden. Another major part is the general income security system, designed to provide income security for working citizens. Government covers your salary when you are on sick leave, when you are home with a baby, when you have to take care of an elderly relative, and for other similar purposes.
This system, where put in place, comes with significant payroll taxes. These taxes, in turn, eat in to people’s salaries to the extent that very few people have the ability to shore up money enough to cover their own income losses. In Sweden where this general income security system has been in place for almost half a century now, the high taxes have depressed private earnings to a point where less than seven percent of the employed has enough money in the bank to cover a year’s worth of regular sick leave without having to go into debt. The only thing that keeps them afloat is the small check they get from the government-run income security system – after government has taxed them for those very same checks.
As this income security system was hit by austerity back in the ’90s, the compensation standards were gradually eroded. Furthermore, the requirements for receiving sick leave compensation were raised dramatically. In my book Remaking America: Welcome to the Dark Side of the Welfare State I report cases where people with cancer are driven back to work because of the harsh, austere standards that government has imposed on compensation. I tell the story of a woman who was driven to suicide by the income-security bureaucracy.
There is nothing dignified in first taking people’s money and promising them services and entitlements, and then denying people those same services and entitlements. There is certainly nothing dignified in rationing health care and other entitlements under the pretense that government is still taking care of people. If government is going to default on its promises – which it will inevitably do under the welfare state – then the advocates of that big government should at least have the honesty to admit that they will have to select those whom government can afford to take care of.
And discard the rest of us.
Speaking of discarding people, the Daily Telegraph gives examples of the so called dignity provided by the National Health Service:
In a hard-hitting speech last week Mr Hunt expressed concern about the culture of the NHS, warning that too many patients were forced to experience “coldness, resentment, indifference” and “even contempt”. He warned that in the worst institutions a “normalisation of cruelty” had been fostered. The family of Arthur Oszek, 86, say they did not find out he had been put on the Liverpool Care Pathway last year until he was left begging for a drink, having been taken off his drip. After almost a day of discussion with medical staff, treatment was resumed, but it was too late, and Mr Oszek died within 24 hours last August. Ann Murdoch, Mr Oszek’s stepdaughter, said: “We asked the doctors why he was taken off his drip and we were told he was on the Liverpool Care Pathway. We did not even know what it was.” “There is no way that should have happened without asking us. We kicked up a fuss and demanded he be put back on his medication and eventually they agreed about 20 hours later.”
And they are not the only ones to find out the hard way what it means to have a relative who is placed on medical death row:
Patricia Greenwood, 82, was put on the pathway in August, after being admitted to Blackpool Victoria Hospital with heart problems, and then suffering a fall. Doctors told her family that they had taken her off feeding tubes because she was not expected to last more than a couple of days. After her son, Terry, 57, defied the hospital’s orders and gave her sips of water through a straw, Mrs Greenwood, a former pub landlady, rallied, and doctors agreed to put her back on a drip. She is now back at home and has made plans for a world cruise.
It remains to be seen if Mrs. Greenwood’s son will be prosecuted for endangering the finances of the British government.
The welfare state is sold to us as a humane, compassionate package that will make the lives of all of us so much better. In reality, it is nothing but the same old authoritarian government that we have seen far too many examples of around the world. The only discernible difference is that the transformation of a free society into socialism takes one more generation under the welfare state. Since the welfare state is first and foremost a fiscal project, it does not come with restrictions on people’s freedom of speech. Government convinces people of the alleged virtues of socialism not by pointing a gun at their forehead, but by luring them into believing they no longer have to work to feed themselves and their family.
Europe started building its full-scale welfare states after World War II. They began suffering from fiscal problems already in the ’70s, but the ailment did not accelerate until the ’90s. For each recession the burden of the welfare state has grown heavier, and Europe has been brought closer and closer to the inevitable point where the welfare state collapses.
That point has come. Europe will not get out of its current economic crisis unless it does away with its welfare state. Since that is very unlikely to happen, the only way forward for Europe is into the chasm of industrial poverty, where the entire continent becomes an economic wasteland of despair, depression and – yes – complete lack of dignity.
Britain’s medical death row is one small step in that direction.