Obamacare may be weakened, but its chief designer, Ezekiel Emanuel, still wants to decide whether your life is worth living.
NBC News and MSNBC recently announced that Ezekiel Emanuel, the chief Obamacare architect and brother of President Obama chief of staff Rahm Emanuel, has been hired as a “medical contributor.” Presumptive Democrat presidential nominee Joe Biden has also tapped Emanuel as a health care advisor.
According to Yahoo News, he will co-host a four-part special on Lawrence O’Donnell’s “The Last Word” that will “examine the public health crisis from a variety of perspectives, including the governmental response, the strain on hospitals, the latest research into treatments and how the disease works, and the heroes — nurses, doctors and medical personnel — who are fighting COVID-19 on the front lines.” Emanuel recently told MSNBC the United States has “no choice” but to remain in lockdown for the next 18 months to fight the virus.
Now seems a good time to remember that Emanuel believes people — particularly the aged — who aren’t contributing materially to society should get out of the way for the benefit of the strong. It’s an argument that seems especially ironic at this time, given that President Trump is getting pounded by the left daily for purportedly putting the health of the economy over the well-being of the vulnerable.
Writing for The Atlantic back in 2014, Emanuel outlined the reasons he hopes to die at the age of 75. He wasn’t outright advocating euthanasia or assisted suicide, but stating his intention, when he reaches 75, to eschew any medical treatments designed to prolong his life — not only aggressive measures such as chemotherapy, but also treatments as basic as antibiotics.
His argument was a purely utilitarian one: by the time someone has reached 75, he is on the downhill slope — in mental acuity, creativity, physical strength, productivity, and ability to contribute materially to society. Rather than prolong a life that Emanuel deems of lesser quality and worth than it was at 20, 40, or 60, he plans to accelerate the arrival of death and, theoretically, compress the period of suffering that precedes death. He doesn’t want his children to go through a lengthy time of watching him decline and die, only to be left “with memories framed not by … vivacity but by … frailty.”
Shortly after Emanuel’s article was published, I wrote a response, “Why I Want to Live Long and Burden My Children,” arguing against his utilitarian view. The title was not ironic. I described the challenge of caring for my elderly mother in my home, noting that, while she wasn’t able to contribute in ways the world generally values, the “burden” of her presence was a blessing to my family in other ways, teaching us about humility, service, sacrifice, and the inherent value of life apart from its so-called usefulness.
Fast-forward five years. In January, Emanuel wrote a new article for The Atlantic in which he recounted the weeks leading up to and including his father’s recent death. After a fall, Emanuel’s 92-year-old father was diagnosed with an incurable brain tumor. Rather than seek treatment, the family decided to take him home to die in peace.
Emanuel uses the occasion of his father’s death to demonstrate the health system’s predisposition toward continuing pointless treatments rather than providing quality end-of-life care. He concludes, “A terminal diagnosis is inherently traumatic for patients and their families. My father’s experience at home before his death needs to become the standard of care. And not just for patients with pushy sons who have medical training and know how to speak with physicians, disconnect cardiac monitors, and firmly refuse the interventions that our health-care system is so predisposed to offer.”
It’s a worthwhile point. Like many, I can relate to Emanuel’s experience with his father. In 1994, my own father died of lung cancer, metastasized to his brain and liver. He previously had a leg amputated due to peripheral artery disease and was in a weakened state from that as well as from radiation for the cancer.
Once the cancer spread, the oncologist told my mom that the next step, chemotherapy, would be extremely hard on my father, with little chance of measurably extending his life. He said that, if the patient were his own father, he would not recommend it. My father, with my mother’s support, turned down further treatment.
My mother’s own end-of-life story is similar to that of Emanuel’s father. She died four years ago, after a fall followed by a hospitalization, complications, and, finally, hospice care. When it became clear that she was too tired to fight, we took her home to die in her own bed, surrounded by people who loved her.
So I am not arguing for doing anything and everything to prolong life when it’s clear that death is imminent. I am a Christian who believes that there comes a time to shift the focus from extending earthly life to preparing for the passage into eternal life.
But those looking to Emanuel for end-of-life guidance would do well to remember that he is an atheist who has not changed his view about how to approach questions of life, death, and patient care since he served as the primary designer of Obamacare. A review of his most recent interviews and writings on the topic reveals that he still holds to a utilitarian approach based on productivity and “quality” rather than one that has a high regard for all life, regardless of whether it is valued by others. In fact, he objects asmuch to the healthy senior citizen living it up in a Florida retirement community as to the one waiting to die in a nursing home because, in his view, neither is contributing meaningfully to society.
“Look at what most 82-year-olds are doing, even the ones who are mentally and physically functional,” he says. “The New York Times had this big story about the Fountain of Youth that was published just after my article. They went to some place in Arizona where they reported on this woman riding a motorcycle and this guy scuba diving, all in their 90s. Basically, those people are having fun. They’re not doing anything that is contributing new ideas, new contributions, or mentoring younger people. They are enjoying themselves. Which is great. But not if it is all of your life.”
The problem with judging the value of a life based on its “quality” or usefulness is determining who gets to decide. The child in the womb, the patient in a vegetative state, and the elderly person with dementia are not able to speak for themselves. They are weak and at the mercy of others who, however well-intentioned, cannot entirely ignore their own agendas.
Even those who are able to speak for themselves — whether healthy, disabled, or terminally ill — may be influenced by all manner of arguments based on quality, usefulness, or convenience because such arguments have been so pounded into our societal consciousness. But when we buy into them even a little bit, we unlock a door that is all too easy to throw wide open.
If we allow the child who is likely to have a low “quality” of life to be aborted at 3- or 6- or 9-months’ gestation, what is the problem with killing her, on that basis, right after birth — or even later? If an older person, whether ill or healthy, is no longer contributing what Emanuel deems to be “meaningful work,” why should the health care system help him keep going?
Then there’s that little issue of cost. Emanuel notes in his most recent article that it was much cheaper to take his father home than to continue pursuing treatment.
In a 2019 article for National Review, Wesley J. Smith cites a Journal of the American Medical Association editorial about the inevitability of health-care rationing. He notes that while the force of Obamacare has been “blunted,” the “overarching” plan of rationing is still in place, and voices like the New England Journal of Medicine continue to tout “quality of life” as one basis on which to do so.
I agree with Emanuel on one point: no matter what we do and how we try to escape death, it will come for each of us, and at some point, we have to come to terms with and prepare for it. But none of us is in a position to decide what makes a life worth living. To do so is the epitome of human arrogance. As Lutheran pastor Christopher Esget preached in a sermon before this year’s March for Life in Washington, D.C., “God makes, and we are made. He makes life, and we leave alive.”
Emanuel is now 13 years from the age that he said, in 2014, he wants to die. No doubt he considers that he is still contributing sufficiently to the universe to merit continued dependence on that universe’s resources. I wish he granted the same right of self-evaluation to everyone else, particularly as he positions himself as a voice of authority during a pandemic.
I also wish he understood that the God who created him, and who loves him whether he acknowledges it or not, has a much different gauge of his life’s value than its usefulness in this world.