Torture, Euthanasia, and Decision-Making Without A Bright Line

Khalid_Shaikh_MohammedLawyers often talk about “bright-line rules.”  Example:  If you are at least 21 years old, you can legally buy liquor in the U.S.  If you will turn 21 when the clock strikes midnight tonight, you cannot. Never mind that certain 20-year-olds would be able to drink more responsibly than certain older people — there’s a bright-line rule.

Bright-line rules provide the comfort of easy decision-making. But many times there is no bright line, leaving people of good will to agonize about the lesser evil, often under intense pressure.

  • When does a ticking-time-bomb interrogation cross the line from harsh to torturous?
  • When does giving morphine to a dying patient cross the line from providing comfort to homicide?

The first question, of course, has been hotly debated for the past few years, with new information emerging this week. The second is cast in stark relief by an extraordinary 13,000-word cover story in the New York Times Magazine, about allegations of euthanasia in the wake of Hurricane Katrina.

First things first: On Saturday, the Washington Post published a front-page article describing how valuable intelligence was gathered from Khalid Sheik Mohammed:

These scenes provide previously unpublicized details about the transformation of the man known to U.S. officials as KSM from an avowed and truculent enemy of the United States into what the CIA called its “preeminent source” on al-Qaeda. This reversal occurred after Mohammed was subjected to simulated drowning and prolonged sleep deprivation, among other harsh interrogation techniques.

KSM, an accomplished resistor, provided only a few intelligence reports prior to the use of the waterboard, and analysis of that information revealed that much of it was outdated, inaccurate or incomplete,” according to newly unclassified portions of a 2004 report by the CIA’s then-inspector general released Monday by the Justice Department.

The debate over the effectiveness of subjecting detainees to psychological and physical pressure is in some ways irresolvable, because it is impossible to know whether less coercive methods would have achieved the same result. But for defenders of waterboarding, the evidence is clear: Mohammed cooperated, and to an extraordinary extent, only when his spirit was broken in the month after his capture March 1, 2003, as the inspector general’s report and other documents released this week indicate.

This was as close to a ticking-time-bomb scenario as you are likely to get in the real world:  The mastermind of 9/11 was replying “soon you will know” in response to questions about additional terror attacks.  It seems clear that specific terrorists were apprehended and actual American lives were saved based on the information KSM oh-so-reluctantly provided. The argument is over whether that justifies torturing him.

It’s hard to feel sympathy for KSM, but I’m troubled by the fact that techniques that arguably are torture seem to have been used on numerous prisoners.  However, at least in  the case of KSM, waterboarding was authorized and conducted in the belief, supported by legal counsel, that it fell short of torture.  We as a society seem to be deciding that waterboarding should not be permissible — but the desire by some on the Left to prosecute Bush Administration officials relies too much on the benefit of hindsight.

I’m struck by the parallels between this debate and the dying-patient issue, after reading Sheri Fink’s NYT Magazine cover story, the product of two and a half years of research.  After the Katrina floodwaters receded and 45 patients were found dead at Memorial Medical Center, an investigation was launched, focusing on patients who received morphine injections.

You really should read the whole thing, but because you probably won’t, here’s the key passage for this purpose:

Morphine, a powerful narcotic, is frequently used to control severe pain or discomfort. But the drug can also slow breathing, and suddenly introducing much higher doses can lead to death.

Doctors, nurses and clinical researchers who specialize in treating patients near the ends of their lives say that this “double effect” poses little danger when drugs are administered properly. [Dr. Ewing] Cook [of New Orleans' Memorial Medical Center] says it’s not so simple. “If you don’t think that by giving a person a lot of morphine you’re not prematurely sending them to their grave, then you’re a very naïve doctor,” Cook told me when we spoke for the first time, in December 2007. “We kill ’em.”

In fact, the distinction between murder and medical care often comes down to the intent of the person administering the drug. Cook walked this line often as a pulmonologist, he told me, and he prided himself as the go-to man for difficult end-of-life situations. When a very sick patient or the patient’s family made the decision to disconnect a ventilator, for example, Cook would prescribe morphine to make sure the patient wasn’t gasping for breath as the machine was withdrawn.

Often Cook found that achieving this level of comfort required enough morphine that the drug markedly suppressed the patient’s breathing. The intent was to provide comfort, but the result was to hasten death, and Cook knew it. To Cook, the difference between something ethical and something illegal “is so fine as to be imperceivable.

The article does a masterful job of taking the reader through the thought processes and decisions involved in triaging patients as the floodwaters rose, knowing some of them will die either because of the conditions or from the stress of evacuation.  Faced with an evacuation order and a shortage of helicopters, medical personnel had to decide whether to leave dying patients alive but unattended, or to hasten the inevitable with a large dose of morphine.

Although a grandstanding attorney general called some of the deaths “simple homicide” and staged SWAT-team arrests, a grand jury ultimately refused to issue any indictments against medical personnel at the hospital.

I think declining to indict was the right call in New Orleans — and I think it would be the right call regarding the Bush Administration’s use of harsh interrogation techniques, or torture if you prefer.  People in unique situations and under incredible life-and-death pressure have to have some latitude in choosing the lesser evil.

(I told the Web Goddess what I was writing about, and she said she thought the analogy between the two situations was “tortured.”  What do you think?)

These scenes provide previously unpublicized details about the transformation of the man known to U.S. officials as KSM from an avowed and truculent enemy of the United States into what the CIA called its “preeminent source” on al-Qaeda.

This reversal occurred after Mohammed was subjected to simulated drowning and prolonged sleep deprivation, among other harsh interrogation techniques.

ad_icon

“KSM, an accomplished resistor, provided only a few intelligence reports prior to the use of the waterboard, and analysis of that information revealed that much of it was outdated, inaccurate or incomplete,” according to newly unclassified portions of a 2004 report by the CIA’s then-inspector general released Monday by the Justice Department.

The debate over the effectiveness of subjecting detainees to psychological and physical pressure is in some ways irresolvable, because it is impossible to know whether less coercive methods would have achieved the same result. But for defenders of waterboarding, the evidence is clear: Mohammed cooperated, and to an extraordinary extent, only when his spirit was broken in the month after his capture March 1, 2003, as the inspector general’s report and other documents released this week indicate.

Ted Kennedy Liked Chappaquiddick Jokes

Mary_Jo_KopechneI’m generally not inclined to speak ill of the recently dead.  I also want to keep my distance from the reflexively venomous commentary I’ve seen from some, though certainly not all, conservative bloggers and pundits.  Finally, I didn’t think there was anything new worth saying about Chappaquiddick, 40 years later.

So although I’ve been annoyed by some of the excessive adulation, I didn’t plan to write anything about the passage of Ted Kennedy.  Then I read, in James Taranto’s Best of the Web Today, that a sympathetic biographer told a radio interviewer this week that Kennedy’s famous sense of humor extended to Chappaquiddick jokes.

I don’t know if you know this or not, but one of his favorite topics of humor was indeed Chappaquiddick itself. And he would ask people, “have you heard any new jokes about Chappaquiddick?” That is just the most amazing thing. It’s not that he didn’t feel remorse about the death of Mary Jo Kopechne, but that he still always saw the other side of everything and the ridiculous side of things, too.  (Update: Here’s the audio.)

Ted Kennedy was one of the most influential Senators in history, and though I disagreed with him on many issues, I recognize he was a passionate and effective advocate for his causes.  My Christian faith teaches me to believe in forgiveness and redemption, and his career can be seen as an effort to atone for his appalling actions that night.

But surely true remorse — or even just common decency — would preclude making jokes about an incident where he put his political career ahead of a young woman’s life.  If justice had been served, his path to redemption would have included a stay in prison.  When he joked about it, he mocked justice.

Requiescat in pace, Edward M. Kennedy.

Requiescat in pace, Mary Jo Kopechne.  She would be 69 years old.

The Perverse Incentives of Our Health-Care System

healthcare costsAn article in the September Atlantic does the best job I have ever seen of describing why health care is so resistant to cost-control efforts.  At 11,000 words, “How American Health Care Killed My Father” is not a quick read, but it’s not a dry policy treatise by any means.  (Hat tip: TigerHawk.)

When David Goldhill’s father died from an infection he contracted in the hospital, Goldhill went looking for someone to blame.

But my dad’s doctors weren’t incompetent—on the contrary, his hospital physicians were smart, thoughtful, and hard-working. Nor is he dead because of indifferent nursing—without exception, his nurses were dedicated and compassionate. Nor from financial limitations—he was a Medicare patient, and the issue of expense was never once raised. There were no greedy pharmaceutical companies, evil health insurers, or other popular villains in his particular tragedy.

As a business executive, Goldhill is no enemy of capitalism or market-based systems.  As a self-identified Democrat, he is no enemy of government.  And while he may have started his year-long research effort in anger over his father’s premature death, he has produced an absorbing essay that is remarkably measured and clear-eyed. Anyone of any political stripe who cares about America’s health-care system would benefit from reading it.

Some excerpts, with emphasis added:

But health insurance is different from every other type of insurance. Health insurance is the primary payment mechanism not just for expenses that are unexpected and large, but for nearly all health-care expenses. We’ve become so used to health insurance that we don’t realize how absurd that is. We can’t imagine paying for gas with our auto-insurance policy, or for our electric bills with our homeowners insurance, but we all assume that our regular checkups and dental cleanings will be covered at least partially by insurance.

Insurance is probably the most complex, costly, and distortional method of financing any activity; that’s why it is otherwise used to fund only rare, unexpected, and large costs. Imagine sending your weekly grocery bill to an insurance clerk for review, and having the grocer reimbursed by the insurer to whom you’ve paid your share. An expensive and wasteful absurdity, no?

Is this really a big problem for our health-care system? Well, for every two doctors in the U.S., there is now one health-insurance employee—more than 470,000 in total. In 2006, it cost almost $500 per person just to administer health insurance. Much of this enormous cost would simply disappear if we paid routine and predictable health-care expenditures the way we pay for everything else—by ourselves.

The unfortunate fact is, health-care demand has no natural limit. Our society will always keep creating new treatments to cure previously incurable problems. Some of these will save lives or add productive years to them; many will simply make us more comfortable. That’s all to the good. But the cost of this comfort, and whether it’s really worthwhile, is never calculated—by anyone. For almost all our health-care needs, the current system allows us as consumers to ask providers, “What’s my share?” instead of “How much does this cost?”—a question we ask before buying any other good or service. And the subtle difference between those two questions is costing us all a fortune.

How would the health-care reform that’s now taking shape solve these core problems? The Obama administration and Congress are still working out the details, but it looks like this generation of “comprehensive” reform will not address the underlying issues, any more than previous efforts did. Instead it will put yet more patches on the walls of an edifice that is fundamentally unsound—and then build that edifice higher.

You get the idea.  Read the whole thing.

(Illustration from The Atlantic.)

Is Pro-Obama News Coverage Hurting ObamaCare?

At Commentary Magazine‘s Contentions blog, Jennifer Rubin argues that the news media has done Obama a disservice by not being more skeptical on health care:

140px-CaduceusMoreover, while the press often has acted as an early-warning sign for troubled presidential initiatives, the press corp did not perk up until the public was in open rebellion. Only the most tepid questions were raised, and few hard questions about rationing and costs were posed before August. As a result, the White House was largely caught unprepared for the storm of anger and protest that greeted congressional Democrats this month.

She then provides the most succinct explanation I’ve seen of the reasons why ObamaCare is foundering (although “threatening to consume the presidency” is a little over the top):

slow_d16None of this is to diminish the responsibility that the president and his advisers bear for the debacle now threatening to consume the presidency. They made the decision to delegate draftsmanship to Congress. They decided to reinvent a health-care system that serves a large majority of Americans very well. They chose to conceal the costs of their plan until the CBO blew the whistle. And Obama personally and repeatedly spun nonsense (e.g., red/blue pills, bending the cost curve by spending more money, a guarantee that Americans could keep their plan while pushing a government option that would chase private insurers from the market). So the fault is the president’s. But his devoted fans in the media certainly helped.

The thing I find most appalling is that the administration was intent on passing health care “reform” before the August Congressional recess… even while taking a hands-off attitude toward what should actually be in the legislation.  Watching Congress pass the porkulus bill without even reading it made people nervous, but hey, the whole idea was to throw money at the economy as quickly as possible.  (Ooops, they didn’t achieve even that.)  Now that the focus has moved on to health care — which people passionately care about — the public appetite for radical change at breakneck speed has evaporated.

Hitler Comparisons are Odious, Whether About Obama or Bush

bushitler2You may have seen and applauded the YouTube video of Barney Frank’s verbal smackdown of a twit who accused him at a town hall of backing Obama’s “Nazi” healthcare plan.  I agree that Frank’s righteous put-down was well-executed, but I have to protest the notion that anti-Obama rhetoric represents a recent coarsening of the public discourse.

Bush=Hitler comparisons were common throughout Bush’s tenure.  They got little exposure in the mainstream media — journalists recognized that the Bushitler loonies undermined more serious criticisms of Bush.  But Zombietime spent years collecting photos — the two here are chosen from hundreds on his site.

Interestingly, the young moron in Barney Frank’s audience turns out to be a member of the LaRouche cult.

bushitler4Lyndon LaRouche doesn’t operate on the same political spectrum as most Americans, but he is a seven-time candidate for the Democratic presidential nomination, and LaRouchians say ObamaCare is a “Nazi” policy because it does not include complete socialization of healthcare through a single-payer structure.

In other words, the video shows Barney Frank taking fire from his left.

My point here is not to say “the Left brought this on themselves” with eight years of Bush Derangement Syndrome.  My point is that the flamethrowers on both sides of the aisle do a disservice to their own cause by distracting from more worthy arguments. Also: comparisons with Hitler should be reserved for people with eight-figure death tolls.

At least when the extremist is a protester, it’s relatively easy to shrug it off.  It’s a little bit harder when the inflamed rhetoric comes from the Senate Majority Leader.

Update: GayPatriotWest, who is not a Barney Frank fan, has some parallel thoughts.

Senator Reid’s Odd Notion of Evil

harry-reid“Evil” is a central concept for me.  I named my blog about the need to fight evil.  Two presidents in my lifetime have issued clarion calls about evil, and I think history may well ratify Bush’s usage as it already has ratified Reagan’s.

If “evil” is to mean anything, it must be reserved for the worst of the worst.  So let’s take an inventory of evil:

  • Stalin and his legacy? Check.
  • Saddam Hussein? Check.
  • Iran and North Korea, the other members of the Axis of Evil? Check, check.
  • People with opposing viewpoints on health care policy? Umm….

In yesterday’s Wall Street Journal, William McGurn reviews the grief that Reagan and Bush both caught for calling evil by its name, then writes:

With all this history, you would think Harry Reid (D., Nev.) had ample warning. Nevertheless, the Senate majority leader invoked the e-word himself last week at an energy conference in Las Vegas, where he accused those protesting President Barack Obama’s health-care proposals of being “evil mongers.” So proud was he of this contribution to the American political lexicon that he repeated it to a reporter the next day and noted the phrase was “an original.”

This is the same Senator Reid who openly rooted against his own country in 2007 by declaring that “this war is lost, and the surge is not accomplishing anything.”  People in high leadership positions should not indulge in partisan flame-throwing about critical issues.  Reid’s rhetoric is disgraceful.

A Center-Right Nation Balks at Obamacare

Newsweek-ConservativeOn the eve of the election last fall, Editor Jon Meacham wrote a cover story for Newsweek titled “America the Conservative — How a President Obama Might Govern a Center-Right Nation.” Predictably, he caught a lot of partisan grief for it, with one commentator calling him “conservative dittohead Jon Meacham” — an odd comment about the editor of one of America’s most resolutely pro-Obama publications.

The center-right label seemed right to me at the time, even though it was clear that Obama was about to win the election.  Obama’s movement toward the right, both before and after the election, has been a recurring theme on this blog.

Now comes Gallup with a poll that seems to indicate that America is not just center-right as a whole, but pervasively throughout the country.

We all know that some states are more conservative than others, and the Gallup poll supports this.  But the poll also found that self-identified conservatives outnumbered self-identified liberals in every single state.  In three states (Hawaii, Vermont and Massachusetts), the conservative margin was small enough to be statistically insignificant — but only in the District of Columbia were liberals found to outnumber conservatives.  The map below shows the relative conservative strength in each state, and as you’d expect, the most conservative states are clustered in the South and the non-coastal West.

2009 -08-04-consumer-confidence-better

How then does it occur that Democrats control not just the White House and both houses of Congress, but also a majority of the governorships and state legislatures?

Partly it reflects the fact that Republican does not equal conservative, and Democrat does not equal liberal.  But I also think the poll results may be skewed because of a difference of acceptance level of the terms liberal and conservative.   I have no data to support this, but it seems like the word “liberal” has become tainted in the minds of many people in a way that “conservative” has not. Some liberals choose to call themselves “progressive” to avoid the taint, while there is no similarly popular synonym for conservative.  If I’m right about this, people who are somewhat left of center would be more likely to call themselves “moderate,” while people the same distance to the right of center would be more willing to cop to being conservative.

Reeling this all back into the policy realm, I think this center-right orientation explains why Obama and the Democrats are having trouble selling health care “reform” — which, as Melissa Clothier points out, would more accurately be described as health care “transformation.”

The Democrats managed to ram through a porkulus bill that included hundreds of billions dollars of non-stimulative long-term spending on Democratic priorities because the country was perceived to be in an economic crisis — something had to be done now now now now now.  Certainly some people across the spectrum were concerned about committing to so much spending, but hey, deficit spending is just politics as usual.

The proposed health care transformation is different.  Certainly our health care system is not perfect, but most Americans see that it functions pretty well in their personal experience, however much they may grumble about costs.  Despite Obama’s disingenuous talk about having the insurance companies “compete” with a “public option” backed by the vast resources and regulatory clout of the government, most people recognize that no such competition is sustainable.

With a public option, the corporations who currently fund health insurance for their employees will have two choices — they can continue to negotiate with insurance companies to try to get the best deal for themselves and their employees, or they can get out of the middle, stop bothering with insurance companies and just dump all their employees into the public “option.” Hmmm… decisions, decisions.

slow_d16People intuitively understand that the “public option” is a first step toward a single-payer world in which the government directly controls one-sixth of the economy, and has no competitive incentive to reduce costs and improve service. Some on the Right refer to this as “postalizing health care,”  although that’s not really fair.  Thanks to Fedex, UPS, email and the telephone, the post office has a lot more competition than a single-payer health care system would have.

Maybe single-payer is the way to go.  I don’t think so, but let’s have that debate.  But let’s stop pretending that it’s not the direction the Left intends to head.

Moderate Muslims Hold the Key to the War Against Islamic Fascism

m-z-jasser-media-photo_010507For some time I’ve been meaning to highlight the work of M.  Zuhdi Jasser and the American Islamic Forum for Democracy.  As their website describes, “AIFD was formed as an unmistakable expression of American liberty and freedom in an attempt to take back the faith of Islam from the demagoguery of the Islamo-fascists.”  Dr. Jasser is a Wisconsin-born Muslim of Syrian extraction, and a practicing physician in Arizona.

In a letter to the Washington Times this week, Dr. Jasser calls out the White House for its use of dangerous euphemisms:

According to John Brennan, head of the White House’s homeland security office, the war on terrorism is over. From now on, the administration will never use terms like “jihadists” and “global war” because doing so, as Mr. Brennan said, “risks giving these murderers the religious legitimacy they desperately seek but in no way deserve.” He insisted that the U.S. is at “war with al Qaeda” (“U.S. no longer at war with ‘terrorism’,” Page 1, Friday).

Could we be more blind? Acts of terror are rooted in the aspirations of Islamists to create an Islamic state and impose their version of Shariah law.

As a devout Muslim who, like many others across the world, is dedicated to fighting Islamism and its radical offshoots, I believe there is nothing more dangerous to our security in the long term than the leader of the free world remaining in categorical denial about the essence of this ever-so-real contest of ideas.

One of the first steps toward winning any war is correctly identifying the enemy.  The current enemy is not “terrorism,” any more than the enemy in World War II was the V-1 bomb.  And as Dr. Jasser goes on to point out, the enemy we face is broader than merely “al Qaeda.”

Some have argued that Islam itself is inherently incompatible with peace.  However, because of the very nature of Western Civilization, most of us are instinctively repelled by the idea that we are at war with “Islam.”

I prefer to believe that an Islamic Reformation — parallel to the wrenching changes Christianity experienced a few centuries ago — can rescue the world’s second-largest religion from its worst instincts.  Brave Muslims like Dr. Jasser are trying to lead the way.

Kudlow Supports A.T.I.N. on Clunkers

kudlow_Bio.standard

Kudlow's with me!

For days after conveying the coveted All That Is Necessary Seal of Approval on the Cash for Clunkers program, I’ve watched a parade of conservative commentators weigh in against it.  Some of the critics were straining too hard to find a way to bash a Democratic initiative, but there were enough substantive concerns that I began to worry about having my conservative decoder ring revoked.

So I was relieved when prominent conservative economist and columnist Lawrence Kudlow came out in support of my position.  (Disclaimer: Kudlow did not actually consult with me, and may not have been aware that he was backing my play.)

At this moment in history, if we’re going to use fiscal stimulus as Washington insists, I favor extending the cash-for-clunkers car-rebate program.

In virtually no time, the clunker program has become a national pastime. It has captured the public’s imagination in a way that no other federal stimulus has. Everyone is talking about it. And I truly believe that consumer spirits have been buoyed by the prospect of going out and buying a new car — even with federal assistance, and even under the duress of federal mileage standards.

Note that Larry and I are not advocating government giveaways to stimulate the economy.  (I call him Larry ’cause he agrees with me.)  We’re just saying that IF the government is going to dump tax money into a stimulus scheme, Cash for Clunkers is a particularly good way to do it.  It’s an artificial and ultimately unsustainable feel-good program — but if that’s what Dr. Congress has prescribed, at least it takes advantage of the fact that economic recovery and improved consumer sentiment go hand in hand.