Ration End-Of-Life Care

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Wednesday, October 10, 2012 


Just because we can extend life, should we? The U.S. is expected to spend $2.8 trillion on health care in 2012. Medicare alone will cost taxpayers $590 billion, with over 25% going toward patients in their last year of life. If health care is a scarce resource, limited by its availability and our ability to pay for it, should government step in to ration care, deciding whose life is worth saving? In other words, how much is an extra month of life worth? 


  • Art-Kellermann-web


    Dr. Art Kellermann

    Chair in Policy Analysis, RAND Health

  • petersinger web


    Peter Singer

    Ira W. DeCamp Professor of Bioethics, Princeton University

  • sallypipes web


    Sally Pipes

    President and Chief Executive Officer, Pacific Research Institute

  • kenconnor web


    Ken Connor

    Chairman, Center for a Just Society

    • Moderator Image


      John Donvan

      Author & Correspondent for ABC News

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For The Motion

Dr. Art Kellermann

Chair in Policy Analysis, RAND Health

Arthur Kellermann holds the Paul O'Neill Alcoa Chair in Policy Analysis at the RAND Corporation. Before joining RAND, he was a Professor of Emergency Medicine and Public Health and Associate Dean for health policy at the Emory School of Medicine in Atlanta. Kellermann founded Emory's Department of Emergency Medicine and served as its first chair from 1999 to 2007. As a Robert Wood Johnson Health Policy Fellow, Kellermann worked for the professional staff of the Committee on Oversight and Government Reform, U.S. House of Representatives. A clinician and researcher, he practiced and taught emergency medicine for more than 25 years.

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petersinger web

For The Motion

Peter Singer

Ira W. DeCamp Professor of Bioethics, Princeton University

Peter Singer is the Ira W. DeCamp Professor of Bioethics in the University Center for Human Values at Princeton University. He specializes in applied ethics and approaches ethical issues from a secular, preference utilitarian perspective. Singer is well-known for his book, Animal Liberation, a canonical text in animal rights/liberation theory. From 2005 on, Singer has also held the part-time position of Laureate Professor at the University of Melbourne, in the Centre for Applied Philosophy and Public Ethics.

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sallypipes web

Against The Motion

Sally Pipes

President and Chief Executive Officer, Pacific Research Institute

Sally Pipes is President and Chief Executive Officer of the Pacific Research Institute (PRI), a San Francisco-based think tank founded in 1979.  In November 2010, she was named the Taube Fellow in Health Care Studies.  Prior to becoming President of PRI in 1991, she was Assistant Director of the Fraser Institute, based in Vancouver, Canada. Pipes' latest book, The Pipes Plan: The Top Ten Ways to Dismantle and Replace Obamacare, is a follow-up on her book The Truth About Obamacare (2010). She writes a weekly health care column called “Piping Up” for Forbes.com.

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kenconnor web

Against The Motion

Ken Connor

Chairman, Center for a Just Society

In 2005, Ken Connor founded the Center for a Just Society, where he serves as the organization’s Chairman. Connor is affiliated with the law firm of Connor & Connor, LLC, a firm nationally known for its successful representation of victims of nursing home abuse and neglect.  He served as Counsel to Governor Jeb Bush in Bush v. Schiavo, one of the country’s most watched cases in the long-running legal battle to protect a severely disabled woman, Terri Schindler Schiavo, from a court order to remove her feeding tube. Because of his advocacy on behalf of nursing home residents, the state’s Democratic Attorney General appointed him to Florida’s Task Force on the Availability and Affordability of Long Term Care.

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Declared Winner: For The Motion

Online Voting

About This Event


  • Comment Link Max Friday, 04 January 2013 17:00 posted by Max

    Liberals voted for obamacare not realizing that they too would get old and the same death panels would decide their fate. Ignorance has high consequences and liberals voted for it. They voted for empty promises and that is just what they will get, lots of emptiness....

  • Comment Link Manix Friday, 04 January 2013 12:55 posted by Manix

    Good debate. Any legislation implemented should encourage the responsible parties to advocate for realistic decisions about the life of their loved ones, while in the hospital bed. Kellermann has a strong, humane argument that facilitates realistic and sensitive decision-making regarding under what conditions a person's life should be extended: communication and objective medical information at the most basic level, between relatives, patient, and physicians. Laws must facilitate this process, while ensuring that a 20 y/o person will not die because resources were not properly allocated. We all want to keep our loved ones with us "a little longer". But the right decision, at that very moment, may not necessarily be what we want. It is at this moment when something or someone needs to step in and help us understand that it's time to let go. We also need to hold the government accountable in reducing wasteful spending, not just in the healthcare system, but across the board. Let us remember that, as someone else said, "you can have all the money in the world and the best technology is not going to keep you alive when your day has come".

  • Comment Link Stephen Malinowski Thursday, 03 January 2013 00:19 posted by Stephen Malinowski

    I don't see how end-of-life care --- or *any* kind of health care, for that matter --- can help but be rationed. Any time you need health care, there is the opportunity to spend arbitrarily more money --- more tests, more doctors' opinions, more drugs, more therapy. We're *always* rationing, always drawing the line somewhere, and saying "that's enough --- more than this just isn't worth the money (or the effort)." The question is how this rationing is to be done. Should we let a young person without health insurance die because they don't have the money for a life-saving treatment? Should we spend thousands of dollars a day to keep a patient with advanced Alzheimer's alive? If we only have enough money to pay for one or the other, which should it be? These are the kinds of questions we need to be addressing; the question of whether we must ration is moot.

  • Comment Link Dan Sunday, 11 November 2012 21:37 posted by Dan

    Just heard a re-broadcast of the debate. How could they NOT have a doctor on the against side? Although, I think that the arguments of Kellermann and Singer were sharper, I actually agreed with Ken Connor when he said during his closing argument: This does not have to be a case of one or the other. I believe this to be true.

    As Americans, we should be willing to pay a large amount for health care - period -- so this means NO to rationing for the elderly as well as making sure everyone is insured. Does this mean an amazingly expensive Star Trekian health care system? You bet, but that's what we should want. Thus, we should focus our time on reducing costs in other areas of our lives. Besides finding ways to reduce waste in the health care industry, energy, could be a lot cheaper if we really wanted it to be. Also, we have become a more materialistic society wasting our money on many gadgets we don't need. Maybe it's time to set our priorities a little differently -- we can't have it all, but we when it comes to our health, we should want no less.

  • Comment Link Terri Thursday, 08 November 2012 14:27 posted by Terri

    As an ER nurse I could not agree more with this motion . We intubated 97 yo people with sepsis and send them to the ICU , I ran across a 98yo guy who was getting chemo for lung cancer and don't for one minute think your advanced directive means anything - I recently took care of a woman who had a dnr/dni on file - she was gravely ill and would have died but even though she had the directive in place , when asked , her husband asked that she be intubated , which she was and then admitted to the ICU , only to die a day or two later but not before racking up 10's of thousands of dollars in - yes- wasted care and resources . It really is a travesty .

  • Comment Link Paul G Thursday, 08 November 2012 00:49 posted by Paul G

    This debate was, for me, a microcosm of the 2012 presidential election.

    In one corner (for the motion), was a side I don't particularly agree with philosophically. But the individuals were well spoken, thoughtful, and frankly sounded like they knew what they were talking about.

    In the other corner (against the motion), was a side I initially felt very good about. But the debaters were wretched. Their logic was flawed, their attacks were ad hominem, and they generally made no sense. Ms. Pipes essentially took the position that all people should have access to all procedures at all times, which certainly sounds nice... unless one considers the fiscal implications of her proposal.
    Both of these debaters against the motion were so unpalatable, I found myself thinking, "if they're against the motion, I think I'm for it."

    What happened to the intelligent conservatives?

  • Comment Link GEDouglas Wednesday, 07 November 2012 04:37 posted by GEDouglas

    So, we start by classifying the old as not worth the expense, then the IPAP decides that a mentally retarded person does not warrant the expense, then a person with certain physical disabilities or deformities are deemed unworthy. Where does it end? I believe history shows us where this disregard for life mentality leads. Recent history...say 1937-45 under the the National Socialist regime.

  • Comment Link Mike Friday, 02 November 2012 23:33 posted by Mike

    I call bs on Mrs. Pipes stories about Canada. I'm Canadian and I've never heard of any of the problems Mrs. Pipes complains about. I've had several family members who've had to deal with the medical establishment and most are more than happy with the outcome. I would suggests that her story is an exception, not the average

  • Comment Link Paula Lee Sunday, 28 October 2012 11:00 posted by Paula Lee

    I was for the motion before and after the debate. I don't mean to disrespect the against panelist, but I believe that they were not at the level of the other side. The quality of their oratory was sub-par, Intelligence square needs to bring better representatives for the conservative side. Kellerman and Singer tried to engage them, but Pipes and Connor were arguing from a very emotional place.
    The only concern I have for rationing is the possibility that it stifles innovation. For example, a lot of the safety technology we have in cars were first developed in luxery cars, which later trickled down to all of us, could the same dynamic be applied to healthcare?

  • Comment Link Greg Monday, 22 October 2012 11:52 posted by Greg

    The results of this debate were extremely disturbing. I don't want insurance companies or the government making these kinds of decisions.

  • Comment Link Lindsay Thursday, 18 October 2012 02:22 posted by Lindsay

    A rationing board would not restrict the decisions around end-of-life. It would limit the government's (and taxpayer's) responsibility for paying for unlimited health care when the vast majority of doctors agree that further treatment will not lead to meaningful improvements in the quality of life.

    Every individual has the right to live as long as they want to, but I can assure you that if those individuals and their families incurred the costs of that end-of-life care, they would not choose unlimited care.

    Luckily, if some policymakers (party affiliation unnamed) are able to push their voucher plans for Medicare forward, we will be able to see what happens very clearly, sort of a "natural experiment." At that point, end-of-life care will be rationed for everyone, regardless of the ability to improve quality of life. It's sad that some don't see the contradictions in their policies...

  • Comment Link Paul Moore Wednesday, 17 October 2012 19:53 posted by Paul Moore

    But that's the thing, Willy. This is already happening - insurance companies are doing this all time time. Heck, the side against admitted this and even said that this should continue!

    In fact, before Obamacare sick folks could be denied coverage (because it wasn't profitable to insure them), so plenty of people died that would otherwise have lived.

    So really the question evolved to "Are people for government rationing over insurance companies rationing" and 81% felt that the government would be fairer and more sympathetic than private (profit motivated) companies.

  • Comment Link AndreK Wednesday, 17 October 2012 14:00 posted by AndreK

    I remember seeing a study that said that an average person contributing to MediCare contributes in the vicinity of $100K, but uses around $300K. Just how long do you expect this to last?

    I am not saying it is impossible to increase MediCare tax, although I would rather pay for Johnny's new textbook than for John Sr.'s 3rd heart-lung transplant. Life was not meant to be infinite (you can wrestle with your god about that), and just because doctors can keep you breathing ad infinitum, does not mean that a society is obligated to pay for it.

    Given that money available for government services is a limited resource, we should treat it as such. My proposal would be to define a maximum limit of medical benefits paid by the society for any given individual, and once the limit is reached, provide a person with means to end their life peacefully. "But this means that the rich will get to live longer", you will argue, and you are right, they will. They already drive fancier cars, live in fancier houses, vacation in fancier resorts, and use stay in fancier hospital rooms - that's life. Look on the positive side, they still do die, just like the rest of us, and I doubt that they insist on spending more money for the right to suffer for one more year.

  • Comment Link Art Kellermann Wednesday, 17 October 2012 09:46 posted by Art Kellermann

    Willy: Did you actually listen to the debate or read the transcript prior to posting your note? It really helps to do so.

  • Comment Link DevinM Tuesday, 16 October 2012 15:57 posted by DevinM

    Your life is already monetized by people you have never met, whether it's via whatever salary you're paid, taxes you pay on your property, the money given to your school district, or healthcare allotted you. To think otherwise is naive. Things in the medical industry are unsustainable as they currently exist, so changes must be made. What do the people who oppose the motion propose as an alternative?

    Also, on a more lighthearted note - Ken Connor is a laughable panderer, referring to the "smoke-filled rooms" in the "federal city." You've got to be kidding me with this absurd rhetoric. And to bring in alternative energy, wow. *facepalm*

  • Comment Link WillyP Thursday, 11 October 2012 15:49 posted by WillyP

    This is chilling. Only in Chicago would 81% of an audience approve of removing the decisions around end of life care to a rationing board. Maybe this seems like a good idea, but I can't imagine thinking so as they weigh the advantage of keeping you alive as you watch helplessly from your hospital bed.

    A patient can always choose DNR. A patient can always request to die naturally. To invite a bureaucratic third party with implicit judicial and legislative authority - with an inimical interest in reducing costs - into the hospital room strikes me as a very dangerous idea.

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