Deadly Discrimination in Doublethink Disguise

The following article I am reprinting in full from Social Justice Review (Vol. 100, No 9-10, 2009)

Deadly Discrimination in Doublethink Disguise
Donald DeMarco, Ph.D.

Arbitrary discrimination and justice are mutually exclusive. This is a fundamental tenet of social justice. Considering all the current laws that protect women, minorities, the handicapped and disabled and various other groups from discrimination, one might think that America has tightly bound its anti-discrimination policies to social-justice principles. One would, however, be far from correct in so thinking. The will to discriminate is alive and well; it is simply disguised. In Current literature, the most salient and outrageous example of promoting discrimination by disguising it appears in the form of what its author and champion, Dr. Ezekiel Emanuel, calls "The Complete Lives System".

Dr. Emanuel first put forward his notions in 1996, in The Hastings Center Report (Volume 26, No.6) where, strangely enough, he linked justice with discrimination. Here, Dr. Emanuel argued that what he called "a just allocation of health care resources" should not be considered "socially guaranteed or basic" to "individuals who are irreversibly prevented from being or becoming participating citizens". An "obvious" example of this, he went on to say, would be "patients with dementia". " A less obvious example", he added, "is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason."

The non-discriminatory notion, Christian in its essence, that human life is sacred and that all human beings possess unalienable dignity, is not present in Dr. Emanuel's thinking. Human beings, according to his reckoning, have no intrinsic value and justify their continued existence solely in terms of their supposedly and potentially positive contributions to society. One might rightly conclude, therefore, that Dr. Emanuel, by denying unalienable human dignity, discriminates against everyone. Nor does he appear to have much regard for either the U. S. Constitution or the Declaration of Independence.

Dr. Emanuel's notion of "The Complete Lives System" was clearly, though less than convincingly, proposed in 2009 in The Lancet (Vol. 373, No.9661) in an article that he penned with two colleagues. "Consideration of the importance of complete lives", they write, "also supports modifying the youngest-first principle by prioritizing adolescents and young adults over infants. Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Similarly, adolescence brings with it a developed personality capable of forming and valuing long-term plans whose fulfillment requires a complete life."

Discrimination, however, remains discrimination even when it is called "prioritizing". Or, as Abraham Lincoln once said, a dog still has four legs, even if you call one of them a tail. The order of naming may or may not coincide with the order of being.

In the context that Dr. Emanuel establishes, what does "complete" mean? The word is ambiguous to begin with, but in the hands of Emanuel et al. it contradicts the intended meaning. We say that something is "complete" either when it is fully present (a collection is complete when all the elements are present, as in a complete set of stamps) or simply when it comes to an end (a person's life is complete even though he dies at an early age; in this sense, he has run the complete course of his tenure on earth). Emanuel et al. draw on both of these meanings at the same time, favoring complete lives in some instances and incomplete lives in others: "Strict youngest-first allocation directs scarce resources predominantly to infants. This approach seems incorrect. The death of a 20-year-old young woman is intuitively worse than that of a two-month-old girl, even though the baby has [lived] less life."

Surely, not everyone will have this same "intuition", especially parents who look upon their infant children through loving eyes. Also, the infant stands to lose more future life than the 20-year-old woman. If we measure the tragedy of premature death in terms of future years lost, then the death of the infant is worse. At any rate, Emanuel et al. are saying that the more complete life of the twenty-year-old (even though potentially shorter) is somehow better than the less complete life of the two-month-old (even though it is potentially longer). They say this under the rubric of "The Complete Lives System", but how do they rationalize it? They write: "The twenty-year-old has a much more developed personality than the infant, and has drawn upon the investment of others to begin as-yet-unfulfilled projects."

Allegedly, we should favor those individuals in whom society has made substantial investment and who are more likely to have "complete lives". Yet, there can be no investments without investors. And a goodly percentage of the latter are older people who do not have much time left for ''as-yet-unfulfilled projects". Moreover, this calculus fails to protect adequately those in whom society has not made substantial investments. In other words, "The Complete Lives System" discriminates against both the young and the old: "When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantive chance, whereas the youngest and oldest people get chances that are attenuated."

This is not exactly "universal" health care. It is, rather, a staggering form of deadly discrimination, disguised by doublethink, against the majority of Americans. Who would take such a system seriously? The matter becomes all the more serious when we realize that Dr. Emanuel is a chief advisor on health care to President Obama. He works in the White House Office of Management and Budget as a health policy advisor and is a member of the Federal Council on Comparative Effectiveness Research. His brother Rahm Emanuel is White House Chief of Staff.

Doublethink, as George Orwell described it in 1984, is the act of believing two contradictory thoughts at the same time. Dr. Emanuel strains logic to the breaking point in a studied attempt to convince readers that his patently discriminatory proposal is not discriminatory: "Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds received priority over 65-year-olds, everyone who is 65 now was previously 25 years old. Treating 65-year-olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not."

What is the moral difference, the inquiring reader may ask, between being 65-years-old or older and having 65 or more "life-years"? Discrimination against the former is supposedly "ageist," but discrimination against the latter is consistent with "The Complete Lives System"! If we are to take the above paragraph seriously, we should have to conclude that it is permissible to discriminate against a 65-year-old because we did not discriminate against him when he was 25. It is probably only small consolation to elderly subjects of discrimination to think back and remember that they were not discriminated against as they passed between the ages of fifteen and forty.

Has there ever been a more strained, illogical, inconsistent, and unpersuasive proposal put forth in the guise of health care? The current moral vacuum created by the decline of Christian values in contemporary society is being filled by sheer nonsense. But it is a dangerous nonsense that threatens everyone's well-being.

Donald DeMarco, Ph.D., Social Justice Review, Vol. 100, No 9-10, 2009