Should We Ration End-Of-Life Care?

As the presidential candidates make their cases to the nation, health care is taking up a lot of talking points. But one subject that's less likely to be debated forthrightly is end-of-life care.

A big driver of U.S. health care expenditure is what's spent in the last year of life. Those who argue in favor of rationing that care say the country cannot afford to provide unlimited health care — either the government or insurance companies have to ration end-of-life care as a policy response.

Others argue that that kind of care should be the subject of a discussion between the doctor, the patient and the patient's family. Essentially, no one wants death panels.

A panel debated the pros and cons of both sides in the latest edition of Intelligence Squared U.S. They faced off two against two in an Oxford-style debate on the motion "Ration End-of-Life Care."

Forty-three percent of the audience started out in favor of the motion, while 22 percent were against it and 35 percent undecided. After the debate, 12 percent were against the motion and 81 percent were for it — making those arguing for the motion the winners.

The experts debating were:

FOR THE MOTION

Arthur Kellermann holds the Paul O'Neill Alcoa Chair in Policy Analysis at the RAND Corp. 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 chairman from 1999 to 2007. As a Robert Wood Johnson health policy fellow, Kellermann worked for the professional staff of the U.S. House of Representatives' Committee on Oversight and Government Reform. A clinician and researcher, he practiced and taught emergency medicine for more than 25 years.

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. Since 2005, 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.

AGAINST THE MOTION

Sally Pipes is president and CEO of the Pacific Research Institute, 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, British Columbia. Pipes' latest book, The Pipes Plan: The Top Ten Ways to Dismantle and Replace Obamacare, is a follow-up to her book The Truth About Obamacare (2010). She writes a weekly health care column called "Piping Up" for Forbes.com.

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 Gov. Jeb Bush in Bush v. Schiavo, one of the country's most-watched cases in the long-running legal battle involving a severely disabled woman, Terri Schindler Schiavo, and a court order to remove her feeding tube. Because of Connor's 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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