Leading Bioethicists Do Not Believe that the Elderly Have Equal Rights in the U.S. Medical Care System

By:

Dave Kingsley

Nursing Homes & COVID:  200,000 Fatalities in One Institutionalized Population

Last week, the U.S. officially recognized a COVID death toll of one million U.S. residents.  An estimated 200,000 or 20 percent of those deaths have occurred in nursing homes. At any given time, individuals in long-term care/skilled nursing institutions comprise approximately three-tenths of one percent of the U.S. population.  One would think that an investigation would be under way to determine how such a tragedy could occur in one institutionalized population and who is accountable.

There is no doubt that a huge proportion of these deaths were preventable.  However, due to neglect and greed of corporate providers, paid by taxpayers to care for patients in LTC/SKN facilities, and lax government regulation, COVID was allowed to sweep through institutions housing frail elderly and disabled Americans. This resulted in the largest mass fatality of an institutionalized population in the history of the United States.   

Appallingly, interest in accountability for this human rights atrocity on the part of politicians, the media, the medical professions, government agencies, or any other relevant interest group is nonexistent.  Even two commissions on nursing homes – one specifically charged with investigating COVID in LTC/SKN institutions and one under the auspices of the National Academies Science Engineering & Medicine (NASEM released a report barely a month ago) – ignored the issue of industry culpability.

The industry is culpable.  It was well-known that a novel virus was likely to make its way to the United States eventually.  For decades, scientists have been sounding alarms.  Asian countries learned from the SARS pandemic and issued guideline for protecting patients from raging viral pandemics.  Those guidelines were ignored by the U.S. nursing home industry.

Indifference to an unnecessary mass fatality event is occurring in a context of long-developing denigration of the worthiness and value of elderly and disabled Americans.  Religions and their leaders have been absent from and seemingly uninterested in the plight of institutionalized people needing nursing care. Indeed, many deplorable facilities are affiliated with major religious organizations.

And then there is the question of bioethics and decline of Enlightenment and Judeo-Christian ethics as they pertain to persons needing medical care.  Indeed, the current dominant bioethics movement supports withholding beneficial medical care from the elderly for the sake of the market economy and what they erroneously see as federal budgetary constraints.

The Elderly & Human Rights in a Neoliberal Capitalist Society

As a highly visible extremist Catholic majority on the nine member U.S. Supreme Court “legislates” on human rights for a population of 340 million citizens, a small group of America’s most prominent and powerful bioethicists are engaged behind the scenes in a chilling, ageist movement – mostly in academic journals. Few Americans are aware of the proposals for “rationing” medical care concocted by Daniel Callahan of the prestigious Hasting Center on Bioethics, celebrity physician Zeke Emmanuel, and other well-known bioethicists.[1]

The underlying philosophical/ethical, foundation of these physicians’-academicians’ rationale is a toxic, perverse, combination of utilitarianism and neoliberal economics rather than a profound and humane theoretical framework calling for reinforcement of universal human rights based on Enlightenment values and ethics.  The essence of their reasoning is that the U.S. cannot afford all the medical care needed by the U.S. population, therefore some needed care should be directed away from the elderly to young populations who are of more value to society, i.e., from the less productive to the more productive.

A review of the literature clearly exposes two unexamined and flawed premises of this horrifying philosophical/ethical position: (1) the U.S. economic system cannot absorb the cost of needed medical care for all citizens, and (2) the elderly are not as worthy as younger cohorts.  Proponents argue from these premises to the conclusion that it is OK to shorten the lives of elderly Americans for the sake of reducing costs.

Integral to their position is the concept of a “decent minimum level of medical care.”[2]  Schneiderman defines a decent level of medical care as:

“…a level of medical care that enables a person to acquire an education, seek or hold a job, or raise a family.  Or, if the person, because of impaired health, is unable to meet any of these goals, to attain a reasonable level of function within the person’s limits and respectful of the person’s dignity, as well as a reasonable level of comfort, whether it be from pain or other forms of suffering.”[3]

This statement clearly expresses an opinion contrary to humanistic ethics that grew out of the Enlightenment and formed the philosophical underpinnings of liberal democracy. The bioethicists in this movement have a perspective of human beings through the lens of bioethical utilitarianism in which their right to medical care is reduced to their worth in a radical free-market economic system.  As Schneiderman states: “Without the support of society, the individual would not prosper; in return, I argue, the individual has a duty to recognize society’s needs for productive citizenry.”[4]  He proceeds to claim that “The success of the society depends on the productivity and contributions of its individual members.”[5]

The Context of Rationing Bioethics

As prior quotes suggest, a powerful group of bioethicists are valuing humans for the purposes of medical care based on their value to the economic system.  Without operationalizing “productivity” and “contribution,” they presuppose a declining value of aging human beings because of less engagement in and usefulness to the economic sector of society. Wisdom, life experience, leadership ability, and other contributions needed by an enlightened, democratic society are not only discounted, but given no worth whatsoever. 

As Zeke Emmanuel, the most famous bioethicist in the U.S., wrote in the Atlantic, it is best to die by 75 because life is not worth living past that age and all productivity and contributions cease.[6] Dr. Emmanuel equates “living too long” with living beyond our 75th birthday.  He claims that longevity “robs us of our creativity and ability to contribute to work, society, the world.”  That it “transforms how people experience us, relate to us, and most importantly remember us.  Dr. Emmanuel believes we are, after age 75, “no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.

Culling the Herd:  Let the Old Die

At some point in U.S. history, elders were no longer seen as important to the survival of the family, community, and nation.  That sociology and history – the history of transformation of valued elders to useless, dependent old people – has been covered elsewhere.  In radical free market economic systems, individuals not needed are vulnerable.  Public policy tends to reflect the power of industrialists and the economic values guiding politicians.

It has not been uncommon for media personalities to suggest that people dying in nursing homes were probably near death anyway.  So, not a big loss.  As Bill O’Reilly on FOX put it, “they had one foot in the grave any way.”  Some suggested that diseases “cull the herd,” and who better to go than old people. 

In a country as wealthy and advanced as the United States, there is absolutely no reason to deny health care to citizens and other residents based on their worthiness as human beings.  There should be no place in a humane society for “deserving” and “undeserving” people in need of medical care.  Medical ethics require nothing less than deference to physician-patient decisions about needed, beneficial, care.  Unfortunately, in the privatized system now dominating U.S. medicine, the needs of shareholders and executives take precedence over people with medical needs.


[1] See e.g., Daniel Callahan (2009) Taming the Beloved Beast.  Princeton University Press; Lawrence J. Schneiderman (2011) “Rationing Just Medical Care,” American Journal of Bioethics, Volume 11, Number 7, 7-14.; Norman Daniels (2013) “Global Aging and the Allocation of Health Care Across the Life Span” American Journal of Bioethics, American Journal of Bioethics, Volume 13, 2013, 1-2.

[2] Schneiderman, ibid, page 8.

[3] Schneiderman, ibid, page 8.

[4] Schneiderman, Ibid, page 8.

[5] Schneiderman, Ibid, page 8.

[6] Ezekiel J. Emmanuel (2014) “Why I Hope to Die at 75,” The Atlantic, October,2014 Issue. https://www.theatlantic.com/magazine/archive/2014/10/why-i-hope-to-die-at-75/379329/.

What Does Ageism in the Media Look Like? Michelle Cottle’s Article re “The Villages” in the New York Times Today – That’s What It Looks Like.

By:

Dave Kingsley

The Villages Is Not a Place I Want to Be in Elderhood. No One I Know Wants to Be There Either.

Michelle Cottle, a member of the New York Times editorial board, has demonstrated the type of dangerous stereotypes regarding so-called “Baby Boomers” that recur frequently in mainstream media. In her article today with the blaring headline “The Nihilism of The Golden Years,” she generalizes from attitudes and behavior of a few elderly residents of a senior housing and entertainment enclave in Florida to a group of people born between 1946 and 1964 that now comprises most of the 65+ population in the United States.

I’ve seen a documentary on the Villages and am frankly somewhat embarrassed for my fellow elderly Americans who choose a second childhood over a life of productivity, societal contributions, and family and community leadership. If that is indeed a fair statement about the people who choose to move there in their retirement years. I’ve never been to the Villages, so all I know is what I’ve heard, seen in the media, and learned from the documentary.

Ms. Cottle presents the residents of The Villages as hedonistic and politically oriented toward Trump’s MAGA movement. Two-thirds of a full two page spread was filled with photojournalism displaying golf courses, golf carts, dancing to “Jimmy Buffet’s Margaritaville,” and MAGA demonstrations. This may or may not fairly describe the people living in The Villages, but the article drags the entire group of 65+ Americans into the negativism she focuses on people living there. For instance, toward the end Ms. Cottle writes, “Big Government is eyed with skepticism, even as the aging populace commands an increasing larger chunk of the federal budget for programs such as Social Security and Medicare.”

That article also states that “Baby boomers long accustomed to setting the agenda are being eased out of their slot atop the sociopolitical ladder – especially conservative white boomers.” According to Ms. Cottle, the underlying problem, in the final analysis, are aging Americans: …the community is a distillation of the cultural crosscurrents at play in an America that is simultaneously graying and diversifying.” I don’t think I need to tell the readers of this blog post how many ugly stereotypes and ill informed generalizations are included in these types of statements.

Scapegoating the Elderly

“Isms,” whether they be racism, sexism, ageism, or any other type of ism such as those against sexual orientation, and religion, are dehumanizing and damaging to the victims of stereotyping. In many cases they are dangerous and can lead to physical harm – indeed often do. A psychological boundary is placed around groups of individuals who are themselves often very diverse and then misinformation is used to scapegoat them. For instance, an aging population or the elderly in general are not causing an increase in the cost of government. That is well accepted in the literature. I have debunked that myth in my own research. I would be happy to supply a list of references to support that.

Not one bit of Social Security is “on budget.” Approximately two-thirds of all Medicare expenditures are paid into the program through payroll taxes, premiums, and other out of pocket expenses. Traditional Medicare and Social Security have administrative costs equal to 1.5% and .9% of revenue respectively. So Ms. Cottle is ill informed and misinforming her readers. These two programs are a model of government run retirement and medical programs. If that doesn’t remain as such, it won’t be the fault of the beneficiaries.

“The Nihilism of The Golden Years” Does Not Represent the 65+ Population of the U.S.

The 65+ population is comprised of veterans, poor people, middle class people, people who have worked hard throughout their lives, and on and on and on when we talk about 70 million Americans 65 years of age or older. They have raised families, robbed banks, worked for corporations at a variety of levels. Some have made a fortune, some are living in dire poverty, some are struggling to live on pensions and Social Security. The variety of people 65 or older is so diverse that it would take a book or volumes to describe it. What we all have in common are needs for healthcare, housing, and basic other living necessities.

Turning a group of people born in an 18 year span of time into a “thing” with negative characteristics is a form of human thinking that has led to more human tragedy and suffering than any other mental disposition characteristic of homo sapiens. It is one reason that we can institutionalize elderly people in subhuman nursing homes and mistreat them. They are seen as a “silver tsunami,” a disaster, a problem. What else are we going to do with them?

Attitudes Need Work in The United States

At Kansas University Medical School, I taught class after class of marvelous graduate students headed into health care professions. I designed and validated an attitudinal survey to measure their attitude toward the elderly. In the next few blog posts, I will report some results from that survey and write about the need to change the way we think of aging. Here is a hint at the findings from my survey: To the item “In the next 20 years, the 65+ population will have the greatest impact on health care costs,” only 12 of 100 of the students responded strongly disagree or disagree. Two were uncertain and the rest either agreed or strongly agreed. This is false and scapegoating. It should concern us.

Thank You For Your Service! Now Go Rot In A Veteran’s Nursing Home!

By:

Dave Kingsley

As a veteran myself, I find the maudlin, mawkish, displays of affection for military personnel hypocritical and disgusting. Flyovers at football games, the shallow emotional “thank you for your service” cliché, and phony, baloney outpourings of appreciation through little privileges (first in line to get on an airplane) are no-sacrifice forms of super-patriotism that keep the real sacrifice of our troops out of sight and out of mind.

Elderly and disabled veterans in state run nursing homes are certainly out of sight and out of mind these days. We don’t know how many of these places are deplorable and full of neglect and abuse. However, I was initially alerted by family members about conditions in a very large state run veterans’ facility in New York. It appears that that their loved ones are not well treated, nor are they as family members. We are looking at COVID data in that facility and what we are finding is alarming. However, given the resistance of any state to come clean with the information advocates and family members need, we will need to keep fighting this out so that we can find out what really happened.

I’ve been reading the inspection reports for the Kansas Soldiers’ Home in Fort Dodge, Kansas. The staffing levels, condition of the facility, and treatment of patients are shocking. In the state of Missouri, we can’t see the inspection reports online. Missouri veterans’ facilities aren’t on Nursing Home Compare. We are told that we have to go into the facility and ask to see reports for those facilities.

We will stay on this issue. This is just the beginning of our investigation into what is happening to veterans in America’s nursing homes. Let’s not overlook the $788 billion defense budget that sailed through the Senate this week, which doesn’t even include the VA and military retirement benefits. Nor does it include the nuke stuff in the Department of Energy. Can’t we spend an adequate amount on veterans’ in nursing homes in a $trillion military budget?

Watch this blog. We will keep investigating and writing about how our veterans are treated.

This Country Simply Does Not Care About Old And Disabled People: We Are Expendable for the Sake of Profit

By:

Dave Kingsley

At Least 150,000 COVID Deaths in Nursing Homes & The House Select Subcommittee on the Coronavirus Crisis Doesn’t Even Bother to Mention It.

On any given day in the United States, approximately 1.5 million Americans will be patients in nursing homes. Throughout the year, 3 million people will either be permanent (long-term) or short-term rehabilitation patients in government-funded, long-term care/skilled nursing facilities. During the past two years, these institutionalized individuals have accounted for at least 150,000 of the 800,000 U.S. COVID deaths. Hence, nearly 20% of COVID fatalities occurred in one institutionalized group comprising less than 1% of the U.S. population.

Yesterday the House Select Select Subcommittee on The Coronavirus Crisis under the leadership of Chairman James Clyburn released a report of the committee’s oversight hearings regarding the COVID pandemic. The report entitled “More Effective More Efficient More Equitable: Overseeing an (sic) Improving and Ongoing Pandemic Response” (https://coronavirus.house.gov/news/press-releases/select-subcommittee-s-year-end-staff-report-highlights-oversight-work-releases) makes no mention that I can find of the largest mass fatality occurring in any institutionalized population in U.S. history. Not even the troops during WWI suffered as large a fatality rate from the flu pandemic as have elderly and disabled patients in U.S. nursing homes during the COVID pandemic.

Lack of the public’s interest in accountability for 150,000+ preventable deaths is a signal to the elderly and disabled that we are not valued as human beings. Politicians are acting like “nothing to see there.” The press, the public, and politicians, are ready to move on like “that didn’t really happen.” “Did it?” The nursing home system is sickening and disgusting as it is. But for a society to seemingly not care much about the failure of a very profitable, taxpayer funded industry to properly care for patients in their charge and agencies like CMS failing to make them care amounts to euthanasia by neglect.

I’m outraged that “aging enterprises” aren’t raising bloody hell about the disaster brought on vulnerable, unprotected, aging and physically challenged people. These organizations claim they represent the elderly, but their silence is deafening:

  • American Geriatrics Society (AGS)
  • American Society on Aging.
  • Leadership Council of Aging Organizations (LCAO)
  • National Association of Area Agencies on Aging (N4A)
  • National Council on Aging.
  • Justice in Aging.
  • Alzheimer’s Association.
  • Senior Medicare Patrol.
  • Administration on Aging.
  • National Center on Elder Abuse.
  • AARP
  • Kansas Advocates for Better Care
  • And Many Others

That the boards of these groups and their paid professional staffs haven’t come together in a coordinated effort to hold accountable a very profitable well-rewarded, industry and the agencies of government they have captured (e.g. CMS, KDADs, etc., etc., etc. …… .) is shameful. Congressman Clyburn and other politicians need to hear from organizations purporting to advocate for the elderly and disabled.

Congresspersons and Senators have certainly heard from the nursing home industry. Congressman Clyburn and Speaker Nancy Pelosi both received $10,000 from the AHCA PAC. Indeed, Democrats are beneficiaries of two-thirds of AHCA PAC money. They don’t need to buy the Republicans – they are on board with whatever corporations want. Any hearing, any report, any statement, from a politician regarding the elderly are of dubious value when the politicians involved are taking money from the industry.

I’m afraid that aging enterprises and paid professionals have fallen comfortably into the good ole boy and girl networks operating inside the Washington, D.C. beltway and all of the state capitols. Speaking truth to power is a risk that might get them marginalized and ousted from the group.

Stereotyping the Elderly

Creating a dehumanizing, negative stereotype is a precursor to harming a demographic segment of a population.  Lack of respect displayed toward older Americans and blamed heaped on them for everything from traffic jams to bankrupting the health care system are evidence of creeping ageism in the United States.

While teaching a class a number of years ago on racism and groupism in general at Kansas State University, I found a full-page Newsweek  photo of nursing home residents sitting in chairs, holding their arms above their heads.  They were being led in exercises by a young woman.  The caption read, “Geezer Boom.”

These older Americans were characterized in the article as helpless invalids who are a burden to younger members of society.  This kind of portrayal of the elderly is pervasive in the mass media and is becoming fixed in the psyche of the under-65 population.  During the recent debates on health care, we heard “unplugging granny” over and over.  This metaphor is supportive of the notion that the fruits of a long life are, at the end, intubation and ventilation.  As I will discuss with very good evidence in a later post, nothing could be further from the truth.

Epithets are evidence of isms such as racism, sexism, gayism and ageism.  I find myself having to confront friends, students, and relatives for using terms like “geezer,” “codger” and “coot.”  These terms may seem funny but they are disrespectful, harmful and insulting.  I have the same concern about using “granny” in the context of plugging and unplugging.

Ageism is characterized by blaming, epithets, infantilization and neglect.  If older Americans can be reduced to being thought of as nothing more than a “pain in the neck,” it will be acceptable to commoditize them as revenue producing objects to be placed in sub-human, profitable, nursing home conditions.

Are We Setting the Elderly Up for Benefits Reductions, Lower Quality of Life?

Beginning with the Reagan Administration, there has been a steady, incrementally-successful movement under way to rig the economic and political system against the interests of the bulk of the U.S. population.  People in perhaps the bottom four income quintiles are now paying a disproportionate share of taxes in comparison to the top 20 percent, which amounts to an income redistribution toward the wealthy classes.  At the same time, most Americans are receiving fewer benefits for the taxes they do pay, which is resulting in a lower quality of life as measured by health care availability, educational opportunity, employment income and housing affordability.

At this time, two targets of the plutocratic, ruling class are Medicare and Social Security.  Pay attention to the steady “drum beat” of dire warnings about the coming of the budget-busting, elderly hoard.  It is important for all citizens to inform themselves about the demographics of the U.S. population and the realities of Social Security and Medicare financing.

An Aug. 17, 2009, column by Ross Douthat–one of a bevy of conservative columnists for the New York Times (along with David Brooks and Tom Friedman)–is one good example of the propaganda perpetrated on an unsuspecting public by conservatives. In an ageist, “blaming-the-elderly,” ill-informed, insulting column, “Telling Grandma ‘No,”  Douthat put out the following false information:  “…by 2030, there will be more Americans over 65 than under 18….”

We have to be on watch for this type of propaganda. 

Here is the truth:

According to the Population Division of the U.S. Census Bureau, by 2030, the percentage of our population under age 18 will be 23.51%, while the percentage of those 65 and over will be 19.3%.  After 2030, these percentages will change very little. By 2050, those under age 18 will constitute 23.14%, while those 65+ will account for 20.17% of the U.S. population.  This leaves approximately 57% of the population as potential wage earners who will be funding their own future benefits of Social Security and Medicare.

This should hardly be viewed as a major, unabsorable shock to the U.S. budget. Indeed, it should be much much less of a problem for our country’s coffers than continuing to finance the folly of war, bank bailouts, give-aways to the pharmaceutical industry and the military-industrial complex welfare programs.

(I will write more about the Social Security and Medicare Trust Funds in later posts.)

Blaming Elderly and Poor Americans

The Nov. 21-27, 2009,  issue of the Economist was devoted to the U.S. budget deficit–its causes and solutions.  I found it disconcerting that this conservative, business-oriented publication chose to focus on programs for the elderly as the main causal factor in our current 13 trillion dollar debt.  For instance, on page 13, an editorial writer had the following to say: 

“America’s deficit problem is in essence a spending problem, so spending must bear the brunt of adjustment.  An aging population and health care inflation are inexorably driving up the cost of the country’s three big entitlements: Social Security (pensions), Medicare, and Medicaid (health care for the elderly and the poor, respectively).”

This is reminds me of the blame for U.S. budget woes heaped on welfare recipients during the Reagan and Clinton Administrations.  And, indeed, a punitive so-called “welfare reform” act was passed during the Clinton Presidency.

Nothing was said in the Economist about spending on the military-industrial complex, the trillion or so that was gifted to Wall Street gamblers, tax cuts for the rich, handouts to the pharmaceutical industry, and on-going wars of choice–just to name a few other drains on the Federal budget.  In terms of adjustments, the Economist might have mentioned some of the current proposals to tax financial transactions, taxing hedge fund managers as employees rather than treating their income as capital gains, increasing the capital gains tax, and so on.  Why does the debt problem have to be solved, again, on the backs of the elderly and the poor?