WASHINGTON — Does Ben Carson have a “death panels” problem?
Before he was a 2016 presidential candidate, Carson, a retired neurosurgeon, frequently raised questions about the high cost of end-of-life medical care — and asked whether patients should be able to pursue every available treatment. The statements touched on many of the most sensitive questions about care for the elderly.
“Do people just get to choose on their own, you know, ‘I’ve been, you know, completely devoid of any mental faculties for 10 years, but want to be kept alive regardless of anything that comes down the pike?’” Carson asked at a September 2004 meeting of the President’s Council on Bioethics.
When President Obama and congressional Democrats proposed five years later allowing Medicare to pay doctors to talk with elderly patients about their desires and expectations for end-of-life care, conservatives blasted them for trying to set up “death panels.”
But a STAT review of Carson’s statements — first as a member of President George W. Bush’s bioethics council and later in one of his books — found that the candidate in some ways went further than Obama in calling for society to carefully weigh the value of providing aggressive treatments for the gravely ill.
At a June 2004 meeting of the bioethics council, for instance, Carson wondered whether “we need to make a distinction between just using resources on people who are ill and using resources on people who are terminal.” He also noted in September 2005 that the ability to prolong the lives of the elderly has “significant implications in terms of population, and in terms of jobs for the next generation.”
While some of his remarks on end-of-life care have been previously reported, others have received no scrutiny — and could come back to hurt Carson with his base of Christian conservatives.
“They could provide a problem for him with pro-lifers if he doesn’t contextualize them,” said Richard Land, president of Southern Evangelical Seminary in Charlotte, N.C. “It’s one thing for individuals and families to make these decisions. It’s another thing for government to make them. That’s what Dr. Carson needs to amplify.”
In an interview with STAT, Carson said patients should be allowed to make their own decisions by using their own money through special health savings accounts. If they want to pursue aggressive and expensive treatment, “they can,” he said.
But, he noted, “the whole concept of people who have terminal illnesses spending all that money at the end and really not accomplishing much doesn’t make a whole lot of sense. Most people, if you ask them, they would much rather be kept comfortable than to be poked and prodded until they give up their last breath.”
Carson’s aides said his comments at the bioethics council meetings were only meant to raise questions that should be the focus of a broader discussion — not to outline a policy prescription.
“Dr. Carson was simply pointing out that as technology to keep us breathing and our hearts beating have seriously advanced our ability to cure, the result has created the great medical ethics issue of our time,” said campaign spokesman Doug Watts. “These questions confront more and more families across the country each day. We need to have a national discussion about these issues. He has not advocated a solution but simply highlighted the ethical dilemma.”
Still, Carson has shown that he isn’t afraid of tackling ethical questions that would make many people squirm.
During a September 2006 meeting of the President’s Council on Bioethics, members debated whether it’s appropriate for a surgeon to remove organs for donation from a patient who isn’t dead, but is on the verge of it.
“You know the surgeon in me says, you know, if somebody is irreversibly injured, they are not going to come back to a functional state, and if [there is] somebody else who could use their organs, we should take the organ and give it to the one that can stop going through all this silliness,” Carson said in remarks that have not been widely reported. “But I recognize that I’m not speaking as a surgeon today. I’m speaking as a member of the President’s Council on Bioethics.”
The question of whether to extend people’s lives as long as medical technology allows is a subject Carson raised in council meetings and repeated in his 2012 book, “America the Beautiful: Rediscovering What Made This Nation Great.” In the September 2004 meeting, for example, Carson asked: “Because we have the ability to keep elderly people going now for long periods of time, even though there may be significant quality-of-life issues … should we do it?”
In his book, Carson returned to the theme and suggested he was worried about the consequences for society.
“The emotional answer would be, yes, of course, we should use our knowledge to extend every life, and we can worry about the consequences later,” Carson wrote. “A more rational response would include examining the effect on the entire population of such action and perhaps advocating a more measured course of action.”
The issues Carson raised are hardly radical in the medical community. Doctors have spent years debating the right balance between offering patients the full range of advanced medical treatments and not raising false hopes when those treatments are likely to have minimal benefit. But in the political arena, those same questions can sound like ominous threats about government power over the most personal medical decisions — as Obama found out the hard way.
David O’Steen, executive director of the National Right to Life Committee, said the group hasn’t had a chance to ask Carson about the questions he raised. But he said the organization, which is mainly known for opposing abortion, is “just as concerned with protecting medically dependent people and older people who need lifesaving care.”
“People who want lifesaving treatment should be able to get it,” O’Steen added. “We think the decision should be the individual’s, not the government’s. We don’t think the government should put impediments in the way.”
Obama had proposed that Medicare pay doctors for end-of-life conversations as part of the Affordable Care Act. After the provision sparked heated controversy, though, the administration dropped it from the proposed bill.
Since then, the Obama administration has revived the policy without stirring much controversy. Some Republican lawmakers even say they like the idea. In late October, the Centers for Medicare and Medicaid Services said that in 2016 it will start reimbursing for services associated with end-of-life planning.
Before the decision, Carson himself seemed to have realized that his statements could revive the “death panels” issue. In his book, he acknowledged the possibility but insisted issues related to end-of-life medical care deserve a serious discussion.
“Again, I can hear some people screaming after reading this that I am advocating for ‘death panels,’ ” Carson wrote. “Some people like to put forth terms like this because they stir up emotional responses rather than encouraging people to engage in rational dialogue aimed at resolving issues.”
Karen Weintraub contributed to this report.