The Affordable Care Act bugaboo is back. This time for real.
We are going to discuss — again — the medical impacts of the Supreme Court’s Dobbs decision reversing 50 years of abortion rights in a moment, but first….
Remember death panels? During debate over the Affordable Care Act, Republicans insisted that buried somewhere in the bill was a provision under which bureaucrats would make calculating, life-and-death decisions for older patients, maybe you. Government-mandated euthanasia of the elderly! Oooooh, be afraid!
Jon Stewart invited Betsy McCaughey onto The Daily Show in August 2009. The former New York lieutenant governor and proponent of the death panel nonsense came armed with a thick copy of the bill as a prop. Oooooh, thick, scary!
When Stewart urged McCaughey to flip to and read the death panel section in the bill, she could not.
In a twitter thread last night, Stewart did the same with Sen. Ted Cruz (R-Texas).
Senate Republicans on Friday gleefully killed the veterans’ health PACT Act they’d recently supported over a supposed “$400B blank check,” a “budgetary trick” Democrats somehow slipped into the bill. Anyway, that’s their talking point and they are sticking to it rather than admit Republican no votes are over their picque at being outmaneuvered by Democrats on an unrelated bill. Republicans got played and took it out on veterans.
Stewart insisted Cruz point to the provision in legislation he’d voted against after voting for it on June 16. Show everyone, Ted, Stewart chided, “where in the Pact Act is this 400 billion dollars blank check or unrelated spending that was added/snuck in…OR show section 805 c of the actual bill that explicitly states what the Toxic Exposure Fund can be used for.”
Crickets.
Actively dying
Now, about those horrendous, mythical death panels. Dobbs made them real.
Mark Joseph Stern explains at Slate:
When Elizabeth Weller’s water broke during the 18th week of her pregnancy, the prognosis was bleak: With almost no amniotic fluid left, the fetus could not survive. If Weller did not terminate immediately, she would be at risk of a potentially lethal uterine infection. She requested an abortion, but the hospital’s ethics committee refused. The committee feared that if doctors terminated Weller’s pregnancy before she was actively dying, they would face liability under Texas’ six-week abortion ban. So the committee forced her to wait until she had a high fever and “foul” discharge—symptoms of a serious infection in her uterus—to terminate.
Weller’s story, documented by Carrie Feibel in a wrenching NPR report, reflects a growing crisis in a post–Roe v. Wade America. Many states have banned or severely restricted abortion since the Supreme Court overturned Roeon June 24, enacting laws with extremely vague and narrow exceptions for the life of the mother. Health care providers have legitimate concerns that they will face civil and criminal liability if they terminate a pregnancy under any circumstances. They worry that judges, juries, and prosecutors will disagree that the patient had a true medical emergency. And so the decision shifts from the patient to the hospital, which frequently places these delicate considerations in the hands of ethics committees.
These committees reveal little about their work to the public, and their membership is usually kept secret; as a rule, they do not talk to the press. They have long functioned in the background, a mostly obscure feature of hospital administration. Now that’s all changed: In our post-Roe nation, the ethics committee may decide whether pregnant patients live or die.
Get it wrong in the eyes of a prosecutor and a Texas doctor could face up to life in prison under S.B. 8, the bill now being copied in other states.
Ethics committees are not new, Stern explains. But their involvement in abortion decisions is “a throwback to the 1960s and early 1970s” when America was great before (WAGB, I suppose).
The fundamental problem facing these committees is that the current crop of abortion bans were written with the most cramped and ambiguous health exceptions imaginable. Many of these laws allow termination only in the case of a genuine medical emergency—a term that is not defined, but suggests the patient’s life must be in imminent peril.
Just when is that?
Hospitals are thus left to interpret draconian laws that ban abortion except when necessary to “save the life” or “prevent the death” of a pregnant woman. But when is a patient sufficiently close to death to justify termination? When her pregnancy has a 10 percent chance of killing her? 50 percent? 90? That, increasingly, is a question for the hospital ethics committee.
For example:
As Stat’s Olivia Goldhill has reported, at least one patient with an ectopic pregnancy has been denied care under Missouri’s law. When she arrived at the hospital, her fallopian tubes could have burst at any moment, causing internal bleeding and possible death. Yet she still had to wait for the ethics committee to decide whether an abortion was legally permissible. The panel took half a day to decide that the patient was, indeed, in enough danger to terminate.
Death panels, then. They are not found in Dobbs itself. Nor are they in state abortion ban laws that kicked in after Dobbs either. But here they are anyway.
And from Republicans? Crickets.
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