LaRouche Activist Confronts CDC Flu Ventilator Rationing "Ethicists" As Hitlerian

November 25, 2009 (LPAC)—A telephone-meeting of "ethics" advisers to the Centers for Disease Control and Prevention (CDC) Nov. 23, on the task of ratifying an "ethics guidance" on how to ration scarce mechanical ventilators in the United States, in the event of a severe flu pandemic, was transformed from its intended purpose of being a patsy-approval session, into a hot confrontation from LaRouche activist Marcia Merry Baker (EIR, Economics), over how unethical it is to refrain from calling for building up infrastructure, and instead to spell out how to send groups of people to death.

The ensuing flare-up among panelists, which included Norman Daniels, Harvard Professor of Ethics and Population Health, a eugenics apologist, Fellow of the Hastings Center, and author of many books on how-to-deny-medical-treatment "fairly," (e.g., Setting Limits Fairly: Can We Learn to Share Medical Resources, Oxford, 2002); has now gone viral in the political/health care media. Over the past 24 hours, coverage of the confrontation appeared in the ProPublica.org, Politico, and the NPR Blog, as the mood of revulsion against Washington grows. Excerpts appear below.

In the public comment period of yesterday's CDC hour-long session, after the Ventilator Guidance Workgroup voted up their 25-page draft "Ethical Considerations" report, Baker denounced it for involving such polite euphemisms for calculating who should die, as "Quality Adjusted Life Years" (QUALYS), "fair innings" and others, as the kind of pretense used by Tony Blair and his man Simon Stevens, now big at UnitedHealth Group, in England, when they set up their N.I.C.E. in 1999, to decide who must die. In reality, this talk, favored by Peter Orszag, is what Hitler did in 1939, with a decree about choosing whose life is worthy to be lived.

Baker said that, given the crash underway, the only ethical response is to build up health care facilities of all kinds—enough ventilators for a peak disaster, enough beds per 1,000 persons, enough mammography units per 10,000 women, etc., as an inherent part of building up all infrastructure—water, transportation, and the rest, as part of rebuilding the economy. Baker asked the CDC panelists to say how many ventilators there are today in the U.S.; Federal authorities didn't even start a survey until August, when they asked the Association of Respiratory Care to canvass their members. But no one could supply a number, saying only that "resources are not overwhelmed" at present. Dr. Drue Barrett, from the CDC office of the Chief Science Officer, and Designated Federal Official, for the Ethics Subcommittee of the Advisory Committee to the CDC Director, tried to smooth over the issue, by referring to another CDC report which is "proactive on infrastructure."

The standing estimate for the number of mechanical ventilators nationally is in the range of 65,000 to 105,000, and still less is known about their location.

- Press Reports -

From www.ProPublica:

By Sheri Fink, filed Nov. 23, 2009, 7 p.m. EST "Advisory Subcommittee to CDC Approves Ethics Guidance for Rationing Ventilators".

[Investigative reporter Fink is the main national journalist who has been covering—in The New York Times and elsewhere—the plans for rationing vaccine, and other scarce resources under conditions of pandemic.]

The vote to approve the document, which was unanimous among subcommittee members who attended the meeting, took place before the scheduled public comment period...

A caller who identified herself as Marcia Baker argued that the government should build for the peak of a severe pandemic rather than focusing on categorizing patients into what she referred to as polite terms for lives not worthy to live.

Harvard University ethics professor Norman Daniels responded that he was very puzzled by Baker's comments. It seems you're suggesting we could purchase ventilators to meet any crisis, he said. I'd like to know whether you want to pay the taxes.

Baker said, Yes, and not pay the bailout.

Daniels countered. You don't want a functioning economy but you want all these ventilators?

Drue Barrett, chair of the CDC's public health ethics committee, said that the ethics guidance discusses the importance of building our infrastructure to meet public health needs...

From Politico, Nov. 24, 2009:

By Josh Gerstein. "CDC Ventilator Rationing Panel Rejects Attack"

Members of a federal panel advising the Centers for Disease Control on guidelines for how ventilators should be allocated in the event swine flu worsens responded forcefully and, in one case angrily, on Monday to suggestions that the effort would cavalierly snuff out the lives of those deemed unworthy.

During a meeting of a CDC ethics subcommittee held via conference call Monday, a member of the public urged that, rather than focusing on who should and shouldn't get ventilators in a crisis, the focus should be on building up health care infrastructure to avoid such shortages.

"We don't even have enough beds per thousand in a lot of parts of the country," Marcia Baker said during the public comment period, before suggesting that the effort was akin to the kind of "rationing in England."

Baker, who did not further identify herself, later went beyond the England references, raising parallels to the Third Reich.

"If we otherwise keep presuming were not going to build for the peak of a severe pandemic, in case this current one even if it comes back in waves isn't, then we end up going down this road," she said. "It's kind of Hitlerian. You're going to have to decide who isn't worthy to live, and I think that's the basic ethical consideration that should be raised and not just accept the kind of triage decisions you're making. There's triage in the case of absolute catastrophe, but not self-made catastrophe."

Initially, the CDC's chief science officer, Drue Barrett, said the thrust of Baker's comment was a valid one.

That's a good point, Barrett said. It's something we do addressing terms of the importance of building infrastructure and being prepared for the next emergency. Our document does refer to that; it also refers to the need to balance pandemic preparedness requirements with other health care and public health needs.

However, one member of the panel took offense at the Nazi reference.

"Listen, I'm a member of the committee and I have to say, although you're perfectly free to express your point of view, I resent your assertion that anything we've done bears any resemblance to Hitlerian thinking," said Ron Bayer of Columbia University's Mailman School of Public Health.

Another panel member, Norman Daniels of the Harvard School of Public Health, suggested it was simply unrealistic and probably not even wise to stockpile enough ventilators to serve everyone who might need one in a severe flu epidemic that could sicken millions.

"I am really very puzzled at what you're suggesting," Daniels said to Baker. "It seems to me that you're suggesting we could purchase ventilators that would meet any crisis in number, regardless of how serious it was. And I'd like to know whether you'll want to pay the taxes?"

Earlier in the meeting, the subcommittee voted without dissent to adopt the proposed guidelines and send them on to the main advisory committee for approval. ProPublica has a write-up of the guidelines here and the near-final text here.

Panel members stressed Monday, at the request of CDC management, that the guidelines on rationing ventilators are not intended to be used at the moment, but only if hospitals and nursing homes become overburdened with severely ill flu patients.

"This document really applied to a time when the pandemic is so severe that the supply and resources are really overwhelmed," Barrett said. "At this point, it is not a severe pandemic."