McCaughey: Emanuel believes reform must include “redefining” the Hippocratic Oath

From McCaughey's August 27 Journal column:

Dr. Emanuel says that health reform will not be pain free, and that the usual recommendations for cutting medical spending (often urged by the president) are mere window dressing. As he wrote in the Feb. 27, 2008, issue of the Journal of the American Medical Association (JAMA): “Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely 'lipstick' cost control, more for show and public relations than for true change.”

True reform, he argues, must include redefining doctors' ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the “overuse” of medical care: “Medical school education and post graduate education emphasize thoroughness,” he writes. “This culture is further reinforced by a unique understanding of professional obligations, specifically the Hippocratic Oath's admonition to 'use my power to help the sick to the best of my ability and judgment' as an imperative to do everything for the patient regardless of cost or effect on others.” [Wall Street Journal, 8/27/09]

Emanuel did not “blame” the oath for the “overuse” of medical care. Rather, as Media Matters noted, he argued in his June 18 JAMA piece, co-authored by Victor R. Fuchs, that the culture of health care “overuse” has led physicians to interpret the Hippocratic Oath “as an imperative to do everything for the patient regardless of cost or effect on others.”

McCaughey previously said Emanuel wanted to “eliminate” the Hippocratic Oath

From the May 11 edition of Fox Business' Cavuto:

McCAUGHEY: He said you hear all of these vague promises of savings from health information technology, from eliminating waste, from preventive care. He calls that “merely lipstick cost control” -- more for show and PR than for real.

He said if you want to save money in health care, we're going to have to push doctors to eliminate the Hippocratic Oath and give more attention to costs when they're treating a patient. Don't be focused so much on the welfare of your own patient; think about where else the money could be spent -- maybe for prenatal care for the lady down the hall.

McCaughey has a history of backtracking her attacks on Democrats' health care proposals when confronted

CLAIM: Provisions in the economic recovery act would permit the government to dictate treatment.

• Discussing the health care information technology provisions on CNN's Lou Dobbs Tonight, McCaughey asserted, “It promises several things. It promises that whatever the system is, it's going to eliminate inefficient care, excessive care, duplicative care. It's going to eliminate disparities of care between one person and another.” Responding to host Lou Dobbs' claim, "[T]he issue is, in whose opinion is it duplication?" McCaughey asserted, “Whatever the federal government deems unnecessary care. Take a look at page 442. And worse yet -- and now I'm speaking really to the physicians -- this bill gives the secretary of Health and Human Services the power to determine which doctors are, quote, 'meaningful users of this new system' -- it's against the rules not to be -- and empowers the secretary to use quote, 'increasingly stringent measures to enforce compliance.' ” [2/10/09]

• On Fox News' Glenn Beck, McCaughey said the provisions “explain why every doctor in the United States and every patient will be required to use these records. It says that it will achieve elimination of waste, more cost-effective medicine, that it will eliminate disparities between what one patient gets and another” and that "[t]he secretary of Health and Human Services is empowered to determine which medical providers, doctors, and hospitals are, quote, 'meaningful users of this system,' and therefore, in compliance. And, the HHS secretary is also authorized to use 'increasingly stringent measures' -- that's the language in the bill -- 'to enforce compliance.' " [2/10/09]

McCaughey backtrack: Legislation is vague enough to allow it to happen in the future. Indeed, CNN senior medical correspondent Elizabeth Cohen reported during the February 11 edition of CNN Newsroom, “I had a PDF of the bill up on my computer. I said, 'Show me where in the bill it says that this bill is going to have the government telling your doctor what to do.' And she directed me to language -- it didn't actually say that. But she said that it was vague enough that it would allow for that to happen in the future.” Cohen added, “Now when we asked the folks who wrote this bill, 'Hey, is this bill going to allow the government to tell doctors what to do?” they used words like, 'preposterous' and 'completely and wildly untrue.' "

CLAIM: The House health care reform bill would “absolutely require” end-of-life counseling.

• On Fred Thompson's July 16 radio show, McCaughey claimed of the House tri-committee health care reform bill:

McCAUGHEY: And one of the most shocking things I found in this bill, and there were many, is on Page 425, where the Congress would make it mandatory -- absolutely require -- that every five years, people in Medicare have a required counseling session that will tell them how to end their life sooner, how to decline nutrition, how to decline being hydrated, how to go in to hospice care. And by the way, the bill expressly says that if you get sick somewhere in that five-year period -- if you get a cancer diagnosis, for example -- you have to go through that session again. All to do what's in society's best interest or your family's best interest and cut your life short. These are such sacred issues of life and death. Government should have nothing to do with this. [fredthompsonshow.com, interview archives, 07/16/09]

• Following her appearance on Thompson's show, McCaughey made a similar claim in a July 17 New York Post op-ed, writing that "[o]ne troubling provision" of the bill “compels seniors to submit to a counseling session every five years ... about alternatives for end-of-life care,” adding that the “mandate invites abuse, and seniors could easily be pushed to refuse care.”

McCaughey backtrack: Bill makes counseling mandatory “in so many words.” According to a July 28 Politico article, when asked about criticism of her claim that the bill makes counseling “mandatory” -- a falsehood that earned a “Pants on Fire” status from PolitiFact.com -- McCaughey claimed that she was right about the effect (if not the literal wording) of the legislation. McCaughey stated that "[i]n so many words" the bill would make end-of-life counseling mandatory because “although it is presented in the bill as a Medicare service, when a doctor or a nurse approaches an elderly person who is in poor health, facing a decline in health, and raises these issues, it is not offering a service. It is pressuring them.”

New York Times: McCaughey “largely quot[ed]” Emanuel's “past writings out of context this summer”

According to an August 24 New York Times article:

Few people hold a more uncomfortable place at the health care debate's intersection between nuanced policy and cable-ready political rhetoric than President Obama's special health care adviser, Dr. Ezekiel J. Emanuel.

Largely quoting his past writings out of context this summer, Betsy McCaughey, a former lieutenant governor of New York, labeled Dr. Emanuel a “deadly doctor” who believes health care should be “reserved for the nondisabled” -- a false assertion that Representative Michele Bachmann, Republican of Minnesota, repeated on the House floor.

[...]

Ms. McCaughey seemed to have evidence for her conclusion that “he explicitly defends discrimination against older patients” in a recent New York Post opinion article. She quoted from a paper he co-wrote for Lancet in January: “Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25.”

But she did not report that the paper was addressing the allocation of “very scarce resources” like kidneys or vaccines, not the system in general.

Dr. Emanuel's argument -- that young adults should take priority in vying for limited health resources because they will get more years of life from them -- is a fairly mainstream if unpleasant approach to a problem with only bad choices, ethicists and doctors of varying persuasions say.

“These kinds of dilemmas go on every day in clinical practice,” said Dr. Scott Gottlieb, a physician and scholar at the American Enterprise Institute, a conservative research group. “There's a very big leap to say his contemplations about how doctors contend with these issues extends to saying he believes government should take on these issues.”

Dr. Gottlieb opposes the administration's proposals, calling them too prescriptive, too expensive, and too open to eventual increased rationing.

In a brief interview, Ms. McCaughey said that either way, because of its Medicare cost cuts, “the president's proposal will force hospitals to operate with scarce resources.”

The administration disputes that assertion.

Ms. McCaughey, Ms. Palin and others have based accusations that Dr. Emanuel would direct treatment away from the disabled on a 1996 paper he wrote for the Hastings Center bioethics institute.

In it, Dr. Emanuel did not assert that “medical care should be reserved for the nondisabled,” as the critics have said.

The paper laid out what he called a growing consensus among competing political philosophies about how a society should allocate health care services. In clinical terms, he said that consensus held that those who “are irreversibly prevented from being or becoming participating citizens” should not be guaranteed the same level of treatment as others.

He cited as an example, “not guaranteeing health services to patients with dementia.”

Dr. Emanuel said he was simply describing a consensus held by others, not himself.