Jewish tradition sanctifies life and honors the elderly. But the Trump administration has yet to put forward any coherent ethical position about how older Americans will be treated in a coronavirus health care crisis
By Jonathan S. Tobin, HAARETZ
An elderly patient treated in an emergency structures set up to ease coronavirus procedures outside the hospital of Brescia, Northern Italy. March 10, 2020Claudio Furlan,AP
“Discard me not in my old age; as my strength fails, do not abandon me” (Psalm 71)
Events in Italy — one of the countries where the suffering from COVID-19 is taking a particularly heavy toll — provides a sobering example of what may happen as the coronavirus continues to spread.
Numerous reports speak of Italian medical facilities being overwhelmed. As a report in the Atlantic by political scientist Yascha Mounk notes, doctors are unable to care for everyone who seeks treatment. There is also a critical shortage of ventilators needed to help those in the greatest danger.
If, as experts continue to suggest, the problem gets before it gets better, then choices will have to be made. The published guidelines of the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care for nurses and doctors to follow provide a shocking preview of what awaits the demographic group that is most vulnerable to the coronavirus: the elderly.
Their prescription for coping with the crisis is utilitarian. Their conclusion is as shocking as it is obvious: “It may become necessary to establish an age limit for access to intensive care.” Those who are too old to have a good chance of recovery or with few years left to live will be allowed to die.
As Mounk writes, this means the coronavirus crisis could present us with impossible moral choices. Moreover, if even the extraordinary efforts now being made in many countries fail to contain the contagion, then hospitals could be forced to conduct the sort of battlefield triage decisions that will likely mirror the Italian recommendations.
If worst-case predictions about the virus — or the next pandemic challenge — prove either accurate or insufficiently gloomy, then respirators may well be allocated along criteria that we already accept with respect to organ transplants where waiting lists have always taken into account age and likelihood of recovery.
Triangulating these moral choices with Jewish values in particular will most clearly face healthcare workers in Israel, where there is a long history of grappling with triage and priorities, not least between terrorists and their victims.
But the more pertinent question to ask is whether our values — and, in particular, those ethical teachings handed down by Jewish tradition and faith — require us to take actions to prevent the elderly from being put in that position even if they impose hardships on the rest of the society.
Even a cursory study of Jewish texts — starting with the Ten Commandments and all the way through Talmudic teachings and the writings of modern Jewish thinkers like Rabbi Abraham Joshua Heschel — mandate that every possible effort should be expended to promote policies that will seek to avoid such dilemmas.
A retirement home employee helps an elderly woman as outside visits are restricted due to coronavirus concerns in Grevenbroich, Germany. March 16, 2020. THILO SCHMUELGEN/ REUTERS
The problem is not just the avalanche of snark on Twitter from those who oppose closing public venues and “social distancing” on the grounds that they don’t see why they should be inconvenienced for the sake of the over-80s.
The real problem is the fact that we are already being prepared for rationing care to the elderly. That groundwork has been laid by the debates about how to administer government-funded health care even when we are not threatened by pandemics.
Citizens of countries with national health care programs overwhelmingly reject the notion of discriminating against the elderly. But such systems are generally better at providing routine care than in allowing all patients access to the most advanced treatments. While not explicit, all financing of health care — whether by government agencies or insurance companies-involves some form of rationing.
The debate about rationing was part of the discussion in the United States about the implementation of the national health care program implemented by the Obama administration, popularly known as ObamaCare. One of the architects of that scheme was Dr. Ezekiel Emanuel, a University of Pennsylvania professor who is also the brother of President Bill Clinton chief-of-staff Rahm Emanuel.
Emanuel is now the most prominent member of a committee formed to advise former Vice President Joe Biden, the likely Democratic Party presidential nominee, about the coronavirus crisis.
That is significant because Emanuel has been a prominent advocate not merely of rationing,but of more general utilitarian attitudes about health care for the elderly. In 2014, the then-57 year-old Jewish bioethicist wrote in the Atlantic about how he only wished to live to the age of 75, which he saw as the optimal life-span for Americans. While in no way explicitly advocating eugenics or denying care to the elderly, Emanuel argued that most of those who lived into their late 70s and beyond were experiencing diminished, uncreative lives as well as falling prey to dementia and debilitating illnesses.
In his view, those living in developed societies are living too long and becoming burdens not only to themselves but also to their children and society. Health care should not be denied to those who are over 75, but from thatpoint on, it should no longer be about prolonging life.
Chillingly, in light of today’s crisis, he also recommended that the over 75 should not have flu shots, especially in the event of a pandemic where shortages might occur. He quoted approvingly a classic medical text that spoke of pneumonia as “the friend of the aged,” since it allows the elderly to escape distressing years of “decay.”
That such attitudes may beinforming the 77-year-old Biden about health care is alarming as well as ironic. Yet while Republicans have long embraced critiques of health care rationing as part of their ideological opposition to any government health care program, the Trump administration has yet to put forward anycoherent response to questions about how the elderly will be treated if the coronavirus crisis should overwhelm American health care facilities.
While that can be put down to the Trump administration’s general slowness to react to the pandemic, it’s not clear that the U.S. government will be any more prepared to make informed ethical decisions about rationing if events where to move in that direction than their counterparts in Rome.
President Donald Trump’s remarks about the coronavirus threat have, from the outset of the crisis, been all over the map. Until the last week, it was clear that he viewed it primarily as a political issue and an attempt by his political foes to undermine his re-election chances. While he was right that Democrats wanted to weaponize the issue against him, he was far too slow to realize that there actually was a potentially catastrophic public health crisis that transcended politics.
But the problem wasn’t merely Trump’s characteristically uninformed comments. The administration was clearly unprepared for the virus. A 2018 consolidation of a reduced National Security Council staff combined those professionals tasked with global health and biodefense with other bureaus and may have called into question its ability to get the attention of their West Wing superiors.
But even after a hastily organized crisis management team headed by Vice President Pence was put in place, it was too caught up with coping to even consider who would be tasked with offering bioethics input into fateful federal decisions.
Presidents Bill Clinton and George W. Bush had bodies that formally advised them on bioethics, while Barack Obama chose to have a Commission for the Study of Bioethical Issues. But Trump has chosen not to have any group working on the topic.
The White House has been focused, not without reason, on the enormous damage that these events have had on the economy. But there has been relatively little said by the president or those in charge that spoke about the need for a compassionate response to victims and nothing at all about ethical guidelines for how medical facilities should cope with the possibility of shortages of resources should the number of those seriously ill start to soar.
The tone taken by Israel’s leader has been different. Though his opponents have accused him of exploiting the crisis, it is at least to Prime Minister Benjamin Netanyahu’s credit as well as to the emphasis that the Jewish state has always placed on the importance of families, that in advocating for Israel to take urgent action to combat the spread of the virus, he spoke of its primary victims as grandfathers grandmothers, fathers and mothers, rather than merely the elderly or those over 65.
It may be that the only way to avoid awful decisions about allocating life-saving measures should an illness like COVID-19 generate millions of patients needing care is to stop it before it gets to that point. But since it is unclear whether efforts to make up for the U.S. administration’s relatively slow response to the crisis will succed in containing it, that makes it all the more vital that Trump now appoint his own national bioethics commission.
That body should advise Pence — a man whose public devotion to religion became a source of controversy when he was given the coronavirus portfolio because he was widely and unfairly mocked when he began a meeting of his group with a prayer — and help craft a response to the problems that Americans may soon face that will be informed by ethical as well as logistical and eocnomic considerations that will ensure that the needs of elderly victims are not sacrificed to expediency.
Treating the lives of older citizens as a precious and loved resource rather than a group who has lived too long to be of any use is an imperative for an ethical society that is faced with difficult health care policy questions. That is true for a nation, such as Israel, that is avowedly informed by Jewish faith, teachings and ethics. But in the midst of this crisis, it is vital for the Trump administraiton to reaffirm that these are mainstream American values too.
Jonathan S. Tobin is editor-in-chief of JNS (the Jewish News Syndicate) and a contributing writer for National Review. Twitter: @jonathans_tobin
@ deanblake: All very useful information for all of us to think about. May God grant you many more years of life and good health, Blake?
@ Michael S: Fascinating, Michael. I am learning a lot from you.
Now MY comment has disappeared.
I replied to Michael’s reply.
Mr. Belman, could you please find it?
@ Michael S:
Thank you.
I think your reply to me was finally posted.
We are basically on the verge of the next industrial revolution which will completely transform the world – for the better or for worse?
This depends on the goodwill and intelligence of the ruling classes of the world.
I hope they are not going to try the “easy” and stupid way which is to exterminate everyone they deem either enemies or “useless eaters” by plague, by war, or by famine while screaming that they will never allow “socialism or communism” to flourish. If they do that, they might be the the last ones to perish but they will perish, too.
You are absolutely right, and I hope the mankind will turn to God before it’s too late.
No one knows how long they will live. At age 71 I have outlived by first general practitioner. My second general practitioner upon initial intake my listing my surgeries and ailments prescribed that I should buy lottery tickets! Abandoning the elderly at a specified age or mental condition is betting on the Grim Reaper rather than the patient. This action by physicians is hiding behind the Hippocratic Oath rather than see Jewish obligation to save life. Economics should not weigh in the balance because this is governed by the hand of God not money nor chance. I am the living proof of it having survived in the Last 5 Years seven surgeries + 6 major infections. I even went back to work for a while and I’m enjoying my retirement while looking for work again. God gave me a life and I hope after years of helping other people no one would simply abandon me for a few pennies.
Reader, I replied at length to your remarks, but the system discarded all of it. I’m tired of fighting City Hall here.
God bless and keep you, and thank you for your thoughtful observations.
Hi, Reader
At last, a substantive discussion on Israpundit! You said,
“The “job creation” thing, and moving the manufacturing facilities around the world (unless done to make the country independent of foreign imports – which is what Israel should be doing, BTW) will stop working anyway several decades from now because of the growing automation and robotization (and not only of manufacturing).”
What you are effectively saying, is that changing technology changes the parameters of our ambient problems: In the early 1800s, for instance, the invention of the cotton gin spurred a profitable cotton industry in the US South, which led to their peculiar dependence on African slaves. The growth of transportation and mass manufacturing in the North, meanwhile, led to the growth of the Proletariat class. This led not only to the US Civil War, but also to the disintegration of farm-based agrarian society, and ENCOURAGED the break-up of families.
Since then, the collapse of families grew even worse. Pulling the men off the farms to work in mills and logging camps led to alcohol abuse and a skyrocketing divorce rate. The company replaced the family in the US North, just as plantations replaced many black families in the South. What was particularly damaging in the latter case, was the replacement of patriarchal AUTHORITY by the plantation owner.
These disruptions in society were not directly caused by religious change. Other factors came into play as well: With the men away (or in bondage) much of the time, for instance, instruction and discipline of the children fell disproportionately on the women. Being a woman began to be associated with attending church, while being a man began to be associated with attending saloons. The two World Wars exacerbated these problems; enter eugenics (euphemistically called “abortion” or “choice”), all sorts of “lib” movements, out-of-control youth, illicit drug use, the whole ball of wax.
These changes were not caused by religion, nor by the lack of it. Rather, the guidance of scriptures, taken in its spiritual and allegorical sense, is able to help men adapt to all circumstances: to living under oppression, to famine, to war and to plagues. It wasn’t the periodic changes in physical life, therefore, that caused men to abandon God and the Bible; but once they did, they found themselves having to “reinvent the wheel” and temporarily deal with problems as they came up, on an ad hoc basis. That is where we are today: with immigration, with automation, with pandemics, etc.
You went on,
“What I am trying to say is that in several decades most of the world’s population will be effectively unemployed and no amount of birth control or Nazi eugenics measures will fix the fact that someone’s labor will no longer buy him any means of survival (food, clothing, shelter, etc.)… The power will be not with those who control manufacturing (although this will be a factor, too) but with those who control DISTRIBUTION.”
This may happen, or (far more likely) we will have a catastrophic world war. In either case, people will still need to deal with one another and with God. There is a Godly way to do business, and an ungodly way; a Godly way to distribute goods, and an ungodly way, etc.
@ Michael S:
” All sorts of perverse things have come from this practice, including replacing younger Americans in manufacturing and other jobs with foreign workers.”
The “job creation” thing, and moving the manufacturing facilities around the world (unless done to make the country independent of foreign imports – which is what Israel should be doing, BTW) will stop working anyway several decades from now because of the growing automation and robotization (and not only of manufacturing).
In China several years ago they had McDonalds where the servers were robots (that’s what I read, anyway, in the light of which the fight in the US for the $15.00 minimum wage at McDonalds sounds kind of pathetic), and in Japan they even have lecturers who are robots, and even an “actress”-robot (“she” played a role of a woman in a wheelchair in a Japanese movie).
What I am trying to say is that in several decades most of the world’s population will be effectively unemployed and no amount of birth control or Nazi eugenics measures will fix the fact that someone’s labor will no longer buy him any means of survival (food, clothing, shelter, etc.).
The power will be not with those who control manufacturing (although this will be a factor, too) but with those who control DISTRIBUTION.
Obviously, “getting rid” (a euphemism) of most of the world population would be as unthinkable (unless to certified lunatics) as it would be stupid, so entirely different solutions need to be developed before a worldwide crisis sets in.
@ Reader:
5 Reasons to Doubt China’s Claim It Has Stopped Seeing Coronavirus Cases
https://www.breitbart.com/national-security/2020/03/19/5-reasons-to-doubt-chinas-claim-it-has-stopped-seeing-coronavirus-cases/
We certainly don’t need any help from those lying commies.
If we listen to Sanders and the democrats and adopt socialize medicine, the elderly will not be cared for because of rationing. President Trump will not allow that to happen. We need a vigorous free market. This is what happens when the government is too involved in health care:
How State Certificate-of-Need (CON) Laws Affect Access to Health Care
https://medium.com/concentrated-benefits/how-state-certificate-of-need-con-laws-impact-access-to-health-care-b8d3ec84242f
I think this was the article Mark Levin read over the air on Wednesday night’s show.
@ Reader:
Stop praising those commie bastards. They covered this virus up for months, not only killing their own people, but inflicting it on the world. And on top of that killed the whistleblowers. Yet here you are once again an apologist for the chinese commies while condemning us, the victims of their evil treachery. Ask them for help? President Trump offered to send our best scientists over to Wuhan and he was turned down. China isn’t the solution, it is the cause of the problem. Yet you continue to be an apologist and defender of the chicoms.
@ Michael S:
“The main reason our elderly are becoming medically marginalized, is probably the indiscriminate use of abortion.”
I doubt that the overuse of abortion is the reason but it goes hand in hand with a certain disregard for (allegedly useless) human life – the idea that before or after a certain point or under certain conditions or coming from an “inferior” race or ethnicity human lives can be just terminated “for a good reason”.
And this is where it leads (take a look at the German poster in the article):
https://en.wikipedia.org/wiki/Aktion_T4
BTW, Trump now wishes to be known as a pro-lifer:
https://www.pop.org/48-pro-life-organizations-in-latin-america-thank-president-trump-for-defending-the-right-to-life-abroad/
The country seems to be changing direction quickly.
Here is an anti-China organization created by Steven Mosher exactly a year ago (an interesting guy, an almost life-long professional China-hater AND a fanatical pro-lifer – you can read about him online if you wish), their rhetoric sounds like the 50s :
https://www.pop.org/distinguished-team-launches-the-committee-on-the-present-danger-china/
Call me a conspiracy theorist but this tells me that powers that be are preparing to do some serious damage to China.
I just hope that some old crazies up there are not dreaming up “a quick, victorious war” (in a few years, after we MAGA) just like the Germans in 1914 and 1939 (except that was before a whole bunch of countries acquired nuclear weapons).
@ Sebastien Zorn:
Until recently, i.e., before China introduced its “one child only policy” (which has been now cancelled, I believe), the children of the family were supposed to take care of their parents in their old age. However, this policy resulted in families that were too small to accomplish that.
I am not sure how China is coping with this.
I don’t think they will go back now to the large numbers of children per family they used to have.
¨In sum, Italy did not announce it would abandon elderly patients with COVID-19 wholesale. Instead, health care workers in various circumstances and locales might be forced to ration treatment and make judgments based on who is expected to live longest, if treated. Chinese doctors have faced this situation, and some fear it may be in store for the U.S. health care system if the number of active coronavirus cases in the United States isn’t successfully controlled. We therefore rate this claim a “Mixture” of true and false.
https://www.snopes.com/fact-check/italy-elderly-coronavirus/
¨If the early Chinese people had any chivalry, it was manifested not toward women and children, but toward old people. That feeling of chivalry found clear expression in Mencius in some such saying as, “The people with gray hair should not be seen carrying burdens on the street,” which was expressed as the final goal of good government. – Lin Yutang
@ Reader:
Hi, Reader
The eugenics issue is part of a larger problem, which is part of an even larger problem. The main reason our elderly are becoming medically marginalized, is probably the indiscriminate use of abortion. This has created “age pyramids” shaped like Russian onion-dome churches — with few able-bodied young adults available to help their elders. All sorts of perverse things have come from this practice, including replacing younger Americans in manufacturing and other jobs with foreign workers. The bigger problems concern our moral depravity, a chasing after a youth-oriented sex-and-pleasure culture, which of course derives from our abandonment of God and of His guidance.
Concerning physical equipment to contain the virus, a bottleneck seems to exist in the regulation-hobbled FDA having been unable until now to release needed materials. President Trump and the federal government have been working to undo this problem. cf:
https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html
This “dilemma” is entirely FALSE.
THE ONLY VALID RESPONSE (which no one even mentions) to the “lack of equipment, supplies, and facilities” is TO PRODUCE MORE EQUIPMENT, SUPPLIES, AND BUILD MORE FACILITIES like the “accursed Chinese commies” did in all of two weeks for their potential coronavirus patients. Maybe instead of cursing them, the incompetents should ask them for help doing what the incompetents are failing to do.
Any other response is akin to NAZI EUGENICS, like it or not.
It is unbelievable that this “dilemma” is even being contemplated by the so-called civilized world.
Unfortunately, as I said elsewhere, coronavirus may be conveniently viewed as the Boomer Reducer and Entitlement Economizer, and it’s not only the elderly who will suffer from the rationing but the poor also (of all ages).
Emmanuel is a dangerous lunatic who should have never been allowed to be in the advisory position he ended up in but the fact that he did is also indicative of the attitudes of the powers that be.
I can hear the moans already: “But where will the money come from?!”
How about taking a pinch from the 25 trillion $$ of the American government borrowings from the whole world? Might as well take the 2nd pinch (with shaking hands) and replenish the cash stolen by politicians from the Social Security fund.
It is NOT the lack of funding that creates rationing, it is the ACCEPTANCE OF THE JUSTICE OF RATIONING (Nazi eugenics) that CAUSES the lack of funding.
For some reason, it is considered unacceptable to let some banks or airlines fail but it is considered quite acceptable to let some allegedly “useless eaters” die because they dared to live too long and hoped to enjoy their retirement years as valued members of society.
@ LIZ WATSON:
Trump has been put in a real bind. He has to make policy based on how it will look to hi9s detractors. The headwind is so strong he can’t buck it. He has to go with the flow.
I have no doubt if he were trusted like Obama was trusted, he would have come out with entirely different policies.
I have great regard for Jonathan S. Tobin. However, this article misstates numerous facts including Tobin’s stating that there were cuts in the relevant staffing of the National Security Council and his criticism of certain actions andcertain lack of actions on this matter by Donald Trump. I would expect such a smear job in HAARETZ or in the Washington Post, but I expect much better and more accurate reporting from Jonathan Tobin and from JNS