Real Life Death Panels

As the United States debates how to overhaul its health-care system, arguments have become increasingly outlandish — perhaps none more so than former vice-presidential nominee Sarah Palin’s assertion that the Obama administration plans to implement state-sponsored “death panels” to determine whether the elderly and infirm deserve life-saving medical treatment. Writing in Wednesday’s Wall Street Journal, Palin doubled down on her claims, saying that though “establishment voices” dismissed them, they nonetheless “rang true for many Americans.”

Of course, the U.S. government has no plans to “pull the plug on grandma“; the claims were false and the provision that sparked the rumors – a measure providing for free advice on how individuals can create living wills to inform their doctors and families what kind of end-of-life care they want — was removed from prospective legislation, just in case. But Foreign Policy took a close look around the world, in places where something akin to death panels is alive and well.

ASSISTED SUICIDE PROGRAMS

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Death panel factor (out of 100): 30  

The details: Voluntary euthanasia is today legal only in Switzerland, Luxembourg, Belgium, the Netherlands, and the U.S. state of Oregon. Physician-assisted suicide is offered to foreign citizens only in Switzerland — largely through one organization, Dignitas, that has helped hundreds of people who are not Swiss residents end their lives since 1998. Recently, British conductor Sir Edward Downes and his wife travelled to Zurich in July with Dignitas to “die peacefully, and under circumstances of their own choosing.”

Countries like the Netherlands and Switzerland do not have “death panels” to determine eligibility. In the Dutch case, for instance the courts and medical societies delineated careful guidelines, which if followed correctly guarantee a physician will not be prosecuted for murder. These include ascertaining the patient is of sound mind and experiencing “unbearable suffering,” as well as having a second, independent doctor confirm it. In all countries, the doctor must report the death to the coroner or police.

TEXAS “FUTILE CARE” LAW

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Death panel factor (out of 100): 25

The details: In 1999, as governor of Texas, former U.S. President George W. Bush signed legislation giving medical professionals an unprecedented level of autonomous power and creating perhaps the country’s only example of a “death panel” in action.

The Advance Directives Act, known also as the Texas Futile Care Law, mostly functions in the way Palin’s so-called death panels would: It gives patients the right to dictate the kind of end-of-life care they would like to receive. But the law contains a provision allowing a hospital committee to arbitrate disputes between families and physicians. The boards can end life support for patients if the care is determined to be “futile.” Under the current law, the hospital need only inform the patient’s family two days before the committee meets to make its decision; the family has 10 days to transfer its loved one to another facility. The Texas legislature is currently considering legislation to extend the time frame.

Advance directives were encouraged by, among others, Palin herself. When still governor of Alaska, she issued a statement on Healthcare Decisions Day encouraging an “increase [in] the number of Alaska’s citizens with advance directives.”

EXTRAORDINARY TREATMENT PANELS

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Death panel factor (out of 100): 15

The details: Though nothing at all like the living-will counseling erroneously portrayed in the United States, the British National Health Service (NHS) does have a panel appeal process that is sometimes accused of giving people an “early death sentence.”

As mentioned briefly in FP’s debunking of global healthcare myths, the British National Institute for Health and Clinical Excellence (NICE) sets standards for the NHS by evaluating medications and approving those found to be cost-effective. Many cancer drugs which cost exorbitant amounts and afford only a few months of life, at best, do not garner approval.

There is, however, an extensive appeals process by which patients and their doctors can request these treatments. The patient’s doctor submits a request to a local trust, and a panel comprised of at least one doctor reviews it. While some exceptions are granted, most are not.

The patient is left with the choice of paying out-of-pocket or foregoing the treatment (as in the United States, if an insurer refuses a claim). Numerous patients’ rights groups support the sick and their families through the process of requesting approval for the expensive medications. A note of cynicism, however: Significant funding for some of these advocacy groups comes from the same drug companies producing the expensive treatments.

CAPITAL PUNISHMENT ARBITERS

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Death panel factor (out of 100): 100

The details: So, what about literal death panels? Fifty-eight countries still use the death penalty today, and they have a broad range of trial, appeals, and execution processes. The United States and Japan are the only OECD countries that still execute criminals for the crimes of murder and treason. (Other countries have not outlawed it outright, but no longer apply it.) Both have extensive review and appeals processes, and take years between conviction and execution. And, in both, the country’s Supreme Court is essentially the highest-ranking “death panel,” the last recourse for those looking to overturn their verdicts or commute their sentences.

In China — the world leader in executions, at an estimated 5,000 in 2008 (the country does not release official statistics) — death penalty decisions are made by committee. In 2007, judicial leaders decided the country should execute fewer people and apply the laws more evenly. That initiated a requirement that all capital cases be reviewed by the Supreme People’s Court, which now commutes around 15 percent of death sentences. The number of executions has halved since then. But the country has still come under harsh criticism for its quick turnaround between trial, verdict, and death.

Iran and Saudi Arabia — also criticized for frequent use of the death penalty, even upon minors — have appeals processes, but execute a high proportion of their prisoners. These two countries along with China, the United States, and Pakistan performed 93 percent of known executions around the world in 2008.