Sarah Palin's Death Panels are Back...

The Wall Street Journal published an op-ed today by Sarah Palin on the report released by the National Commission on Fiscal Responsibility.  And once again, she has invoked the notion of government-sponsored “death panels.” 

She writes that the findings of the Commission:

“[…] implicitly endorses the use of "death panel"-like rationing by way of the new Independent Payments Advisory Board—making bureaucrats, not medical professionals, the ultimate arbiters of what types of treatment will (and especially will not) be reimbursed under Medicare.”

The controversy over these alleged “death panels” raged during the summer of 2009 as our nation fought to come to a consensus on healthcare reform.  

At the center of the controversy was the following statement made by Ms. Palin on her Facebook page:

“The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

These “death panels” were actually proposed funding for consultations between physicians and patients in order to discuss issues concerning end-of-life care.  Palin’s statements were later voted the biggest lie of 2009 by the non-partisan website, Politifact.com.

So what’s the harm in categorizing end of life discussions as “death panels?”  For one, you’re putting physicians in the role of the executioner.  Conversations regarding a patient’s wishes at end-of-life, including the transition to palliative care, are an integral part of a patient’s treatment.  These conversations respect and promote patient autonomy, by allowing patients to obtain information from their physician regarding their prognosis and treatment options in order to make informed decisions concerning the course of their healthcare.  In many terminally ill patients, this includes conversations on death and dying. 

Accepting death is probably one of the most difficult, and intimate, decisions an individual will ever face.  And this week we said goodbye to a woman who did so bravely, Elizabeth Edwards.   I’m afraid that Ms. Palin’s continued reference to “death panels” undermines the difficult decision that many persons with cancer have to make – the acknowledgement that the fight is over and the preparation for what lies ahead.  At the recommendation of her physician, Elizabeth Edwards made the decision to discontinue treatment and spend the remainder of her time in this world at home surrounded by her loved ones.  Many similarly situated patients choose to continue treatment and endure the harsh side effects of aggressive cancer treatment. 

When a particular cancer treatment has not produced the desired results, the promise or possibility of a new treatment or experimental drug gives a great deal of hope to the patient.  Especially when proposed by the patient’s oncologist.  The possibility of offering additional therapy can also be therapeutic for the oncologist, who is in the role of “fighting” the disease.  But there is a point, a point that Mrs. Edwards also faced, when treatment does become futile.  And this is an objective conversation that should be had between the patient and the physician. 

In her article, Palin refers to Independent Payments Advisory Boards, which would recommend proposals to reduce Medicare spending.  I would argue that reducing healthcare spending and seeking cost-effective medicine is not evil, Ms. Palin.  Even in a perfect world – with limitless resources and talented oncologists– we simply do not have the ability to cure every patient.  And just because we have the means of continuing treatment, doesn’t mean that we should – especially when it comes at the expense of the quality of one’s life. 

It is unfortunate that Ms. Palin continues to reference death panels and demonizes the initiation of end-of-life discussion with terminally ill patients.  These discussions are an important tool for patients in making decisions regarding their healthcare, often prevent unnecessary treatment and procedures, and accelerate the transition to palliative care.

There is a great deal of trust in the relationship between the patient and his oncologist.  I think there is something to be said about the subject of palliative care being introduced by the physician, rather than initiated by the patient.  No person with cancer, especially one who is a provider of a family, wants to feel like they are giving up on their fight against cancer by electing to embrace palliative care.  And I am certain that many members of the medical community do not appreciate the association with “death panels.”

Are FBI Stings on High Risk Individuals Really Combating Terrorism?

The recent arrest of Somali-born, Oregon teenager, Mohamed Osman Mohamud, is the latest in a trend of sting operations utilized by the FBI, which seeks to target Americans who are considered to be a high risk of carrying out violent acts on American soil.  The arrest of Mohamed Osman Mohamud came after a year long investigation leading to an eventual sting operation, foiling what Mohamud perceived to be a plan to detonate a bomb at an Oregon Christmas tree lighting ceremony.  The problem is, there was no bomb in the first place.  In fact, the public was never in any immediate danger of being harmed.  Despite what senior FBI Agent Arthur Balizan describes as "a very real threat,"  Mohamud, who believed he was in contact with Al Qaeda operatives who were helping him plan an attack, was actually speaking with FBI agents the entire time and at no time was he in contact with the terror organization.

Whether people consider these sting operations entrapment , or whether they consider them just, there are a few things that need to be considered.


One, it is fair to say that these types of operations are at best not helping American-Muslim relations, and at worst are helping to destroy them.  Shortly after the arrest of Mohamud, the Mosque that he frequented was set ablaze in what local authorities are calling arson.  It is quite the snowball effect when it comes to American-Muslim relations. A possible outcome is this:  Man is caught in alleged terror plot. Targeted members of community become enraged and set fire to Mosque that most likely had nothing to do with Mohamud's radical behavior.  This in turn leads to resentment and anger from the Muslim community as well as making it just that much easier for militant groups to recruit by spinning the whole operation as propaganda for a "American War on Islam".


Second, the resources, money, and man power needed for a year long operation is not cheap.  At minimum this is hundred of thousands of dollars that are being spent on setting up a local youth who is, with the FBI's help, becoming a radicalized militant.  Not to mention the man power it takes to conduct such an operation.  Every one person working to set up a high risk individual is one less person working to combat people who actually have the means to carry out such an attack.


Lastly, while The FBI celebrates this sting operation, and arrest, as a victory, I am left only with the idea that with the hundred of thousands, if not millions of dollars being spent on setting up high risk individuals, and hundred of agents and analysts it takes to carry out such an operation. Is this money and man power well spent? Or could it possibly be spent in better places, such as stopping actual terrorist attacks like the one that almost happened in May.