C: We haven’t talked for a long time!
D: Major major.
C: I received a solicitation from the AARP today.
D: What’s the AARP?
C: How old are you?
C: You’re fifty-five and you don’t know what the AARP is?
D: Just tell me. Maybe I’ve heard of it.
C: The AARP is the American Association of Retired Persons.
D: The what?
C: That’s right: the American Association of Retired Persons.
D: What do they do?
C: They lobby for retired people.
C: The government gives lots of benefits to retired people.
C: Retired people are a privileged group.
C: Stop with the why business. They just are. Everybody wants to be retired.
C: I give up. Why don’t you, too?
D: Okay, just tell me what this organization is all about.
C: AARP lobbies government to protect and increase benefits to old people.
D: You mean old people are an interest group?
C: Yeah, just like the NRA.
D: What’s the NRA?
C: The National Rifle Association.
D: What do they do?
C: They make sure no one has a rifle to shoot old people.
C: Just kidding. The NRA lobbies to protect the right to bear arms.
D: Just like the AARP?
C: Well I suppose the AARP has a lot of gun owners, and the NRA has a lot of retired people. But their goals are pretty different.
D: But they’re both in the protection business, you say?
C: You could say that.
D: How does it work?
C: They say to a congressman, “You vote for our bills, and we’ll protect your seat.”
D: And if they congressman says no?
C: The AARP and the NRA say, “We’ll kill your career. We know how much you love your family – you want to support them, right?”
D: Lobbying groups aren’t supposed to operate that way!
C: No siree. They’re supposed to educate and inform.
D: So what exactly does the AARP protect?
C: The big one is social security.
D: Isn’t that guaranteed?
C: Sure, but you have to be vigilant.
C: Because the government might cut your benefits at any time.
C: When the government runs a deficit, it starts looking for ways to cut benefits.
D: Why don’t old people take benefit cuts like everyone else?
C: Like I said, old people are a privileged group.
D: Who said they’re privileged?
C: They did.
D: Why should we go along with that?
C: I guess because we’re all going to be old someday.
D: It’s the universal interest group, then.
C: You got it. Everyone’s either a member or a future member.
D: That’s quite a pool for recruits. How big is the AARP?
C: I don’t even know. Millions.
D: Are you a member?
C: Of course not.
D: Well how old are you?
C: Fifty-five, just like you are.
D: So why aren’t you a member?
C: Not every fifty-five year old is a member of AARP!
D: You’re evading the question.
C: Well, I don’t think they like me too much.
D: How come?
C: I founded an organization to counter their lobbying efforts.
D: Did that make you unpopular with your friends?
C: I’ll say it did.
D: So tell me about the organization!
C: It’s the American Death Panel Association – ADPA.
D: Carlo, c’mon! You can’t have an organization to support death panels!
C: You can lobby for anything you want.
D: What is a death panel, anyway? Is that one of those coffin liners?
C: I wish. A death panel decides whether you live or die.
D: That sounds like a jury in a capital case.
C: A death panel is kind of like that, except you’re not accused of anything.
D: How does it work?
C: Let’s say you have a terminal illness –
D: They say life is a terminal illness.
C: Are you interested in this or not?
D: I think so.
C: Well you should stop cutting up. This is serious.
D: Death panels sound sort of not-so-serious to me.
C: Yeah, I know. The phrase sounds a little strange to me, too.
D: So what is a death panel?
C: Say you have a terminal illness, and it’s time to die.
D: How do you know it’s time to die?
C: That’s the whole problem. No one wants to think that death is something you decide.
D: That’s right – death by decision is suicide, and we have strong norms against killing yourself.
C: Those norms extend to end-of-life decisions. Euthanasia and all those questions are so hard to talk about. Death is hard enough to think about. We don’t want anything about it to be purposeful.
D: How come?
C: Why were we horrified when we saw people throw themselves out of the twin towers?
D: That was death in public, dramatic ones at that.
C: We do want death to stay out of sight. Even executions aren’t public anymore.
D: So we want intentionality and death to stay apart. Well apart.
C: That brings us back to death panels. When a patient is reaching the end of life, the patient’s physicians call in family members to meet with them.
D: The family members are a death panel?
C: No, the physicians are.
D: The physicians call in the family to recommend death?
C: Hey, you’re getting away from me here. They call in the family members to talk about what to do next.
D: The very act of calling the meeting sets the agenda. You don’t need a meeting unless it’s time to talk about death.
C: That’s right. The doctors know when they’ve reached the end of the line.
D: How do they know that?
C: You can eliminate all the cases where the chances of recovery are greater than zero, right?
D: Correct – no death panels for patients who might get better.
C: For the patients who aren’t going to get better, you have to estimate how much longer they’re going to hang around.
D: That’s not such a nice way to put it.
C: Remember the senator who said, “We’re not going to let them pull the plug on granny”? That wasn’t such a nice way to put it, either.
D: We just don’t have good ways to talk about these things.
C: Everyone wants to respect the dead, and the dying. It’s just part of being human.
D: For the patients who won’t improve, then, we estimate how long they’ll live.
C: Yes, and the difficult cases are those where the prospects are for a relatively long life with no recovery.
D: You don’t need a death panel if death appears imminent.
C: Problem is, whenever death isn’t imminent, the actual time till death is almost always uncertain. Highly uncertain.
D: You mean doctors can’t tell how long it’ll take?
C: That’s exactly right. They can go from experience and from professional knowledge, but all honest predictions’ll have a large plus-or-minus range.
D: So the implicit purpose of the meeting is to talk about pulling the plug?
C: In so many words.
D: What’s the family supposed to say? We want to spend a couple of million to prolong this unrecoverable state indefinitely?
C: They’re not going to say that.
D: They’d like to. The default path is prolongation.
C: That’s why the doctors have to get together.
D: You mean they place the family in a situation where they accede to a comfortable death?
C: For what other purpose would you convene a meeting like that?
D: Perhaps the doctors just want to gather some information from family members.
C: They could do that without a meeting. They could just talk to family members individually.
D: They know that if they talk to individuals, family members will usually want to wait a little longer. Wait and see.
C: When you have a lot of patients in that situation, it gets expensive.
D: What situation?
D: The situation gets more urgent if you’re trying to save people money.
C: Family members aren’t paying for the care from their own bank accounts.
D: They’d never acknowledge that money was a factor, even if they did pay the medical bills themselves.
C: That’d be hard, but money would still be a factor.
D: So you’re saying death panels address the money issue, without actually raising the subject.
C: After all, you want to use your hospital’s resources to serve patients who will actually recover.
D: If the hospital’s resources come primarily from taxpayers, the issues of life and death become even more problematic.
C: We want to be frugal with public money. We also want to be generous with care near the of life. It’s true for private insurance – it’s doubly true for public funding.
D: When the doctor calls you in, you don’t have to try to guess his thoughts. The meeting’s subject matter is set.
C: You just have to talk about when to pull the plug, or how to handle the last stage of life when there is no plug.
D: That’s not such an easy discussion.
C: No, it’s certainly not.
D: So why did the name death panel stick in the first place?
C: You know how political debates get in this country.
D: You mean death panel was one more epithet in the partisan debate?
C: Hey, I only listen. I don’t actually shovel the stuff out.
D: Well, good luck with the ADPA.
C: Thanks! Wanna help with our membership drive?
D: You have members?
C: We want to build up the list a little.
D: Who do you have on the list now?
C: We have Bill Maher. He’s the first member, other than me.
D: Why did he sign up?
C: He hosts the American Death Panel game show.
D: I don’t believe it.
C: Check it out. You can watch it at Huffington Post.
D: What about your website?
C: The game show is our website.
D: Got it. Now tell me. How much does it cost to join the ADPA?
C: You can donate whatever you like – or you can make it free.
D: Will you protect me?
C: We’ll protect your death panel benefits.
D: That’s great! Now I can rest in peace!
C: We haven’t talked for a long time!