“Flash Forward” is a new and interesting television drama presented on the ABC Television Network. The premise is brilliant – due to reasons still unknown, everyone in the world (except the bad guys) blackout for two minutes seventeen seconds.
Planes crash, people collapse on the streets, swimmers drown, it is an utter catastrophe that results in the deaths of 20 million people. Being unconscious, blackout victims experience a “flash forward” – a vision of precisely what they would be doing for two minutes and seventeen seconds at the same specific time in April 2010. Some have happy futuristic visions of new loves, some unhappy of broken marriages and deaths, some terrifying such as being murdered, one hilarious – an FBI supervisor is chagrined to admit he spent his entire flash forward on the toilet. Still others have nothing but blackness, indicating that they may be dead next April. The show raises several fascinating questions; whether free will exists, can “the future” be changed , indeed, can it really be predicted.
Well, it’s time for our very own “flash forward” as the CBC has again asked me to prognosticate about our bioethical future in 2010:
Obamacare Will Pass
I was caught flat footed in last year’s predictions by the intense heat generated over health care reform in 2009. Rather than target health care reform to the need to expand access to health insurance as I supposed would happen, the proposals sought instead to remake the entire health care system. This stirred a hornet’s nest, raising important questions of affordability, fears of health care rationing – provocatively labeled “death panels” by Sarah Palin – coverage for abortion, illegal immigrants, and the definition of what constitutes medical treatment.
How will it all turn out? I predict a health care reform bill will be signed into law in 2010. That’s the easy part. The question becomes, what will it look like? That is hard to say since many of the important details will be determined by the tens of thousands of regulations promulgated to carry out the law in over the next few years. Still, the outlines are growing clear in my crystal ball. Here is my personal Obamacare flash forward:
The Public Option. One of the biggest controversies surrounding Obamacare is whether there will be a government health care plan to compete with private insurance companies. I predict that the pure PO will not become law in 2010. Instead, there will be a hybrid alternative enacted permitting non-profit companies – and only non profit companies – to join a government authorized purchasing collective. Whether they will actually threaten the private insurance sector – which I believe is the intent – will not become clear until after the law goes into effect in 2013.
Heath Care Rationing. Obamacare doesn’t call explicitly for health care rationing, but creates its foundation with the establishment of cost/benefit/best practices boards that will be given tremendous sway over the standards of medical care and extent of coverage for both private and public plans. There is almost zero chance these boards will not be part of any law that passes. That means health care rationing will remain a looming specter and a cause for continuing societal debate for years to come.
Abortion. Companies participating in the public exchanges will be required to provide some abortion coverage, but there will not be direct public funding of most abortions. However, the law will permit regulators to require indirect public funding, for example, allowing abortion coverage to be purchased with government vouchers or tax credits.
End of Life Counseling. The provision allowing doctors to be compensated for providing end of life counseling will pass. But the law will require that it be voluntary and not directed to any particular decisions or outcomes.
Illegal Aliens. The law will not explicitly provide for coverage for people who are not legally in the country. But it will not require purchasers of government underwritten health insurance to provide proof of legal status, meaning that undocumented aliens will find ways to purchase health insurance under Obamacare.
The passage of Obamacare will not be the end of the controversy over national health insurance, but the beginning. There will be much wrangling over the regulations, attempts to roll back the law if and when Republicans regain control of Congress, and anger over increased taxation before benefits are paid. Expect the issue to be politically volatile for many years to come.
Stem Cell/Cloning Research
Now that President Obama has opened the door to federal funding for many more embryonic stem cell lines – as accurately predicted by me last year in a no brainer – there will be little, if any changes in public policy in 2010. Here are some potential news makers:
Human Stem Cell Trials. Human trials will continue to show great progress with adult stem cells, but will continue to receive scant attention from the media. The first human trial using embryonic stem cells will commence to great media acclaim.
Dickey/Wicker Amendment. Promoters of an almost anything goes ethic for embryonic stem cell research will try to block passage of the Dickey/Wicker Amendment, which forbids federal funding for the creation of embryos destined for use in research, or the destruction of embryos for research. Elimination of Dickey/Wicker would also be required to federally fund human cloning research. Because next year is an election year, there will be little appetite for radically changing the law in this field, and so, Dickey will pass again. One caveat: If scientist finally succeed in creating cloned human embryonic stem cell lines, all bets are off.
Therapeutic Cloning. Human cloning research will advance, with announcements that human cloned embryos have been created and maintained. But the field will not advance sufficiently to constitute a major breakthrough. As a consequence, the issue of human cloning will remain generally quiescent.
Induced Pluripotent Stem Cells. The field of creating pluripotent stem cells with normal differentiated cells, such as skin, will continue. But they will not be used in human therapies.
Federal Funding for ESCR. There will be modest increases in federal funding for ESCR, but the increase will not dramatically exceed that provide annually by the Bush Administration.
The Montana Supreme Court will confirm a trial court ruling establishing the right to assisted suicide in that state. The pending lawsuit in Connecticut seeking a ruling that the state’s law against assisted suicide does not apply to “aid in dying,” meaning when a physician provides a lethal prescription to a terminally ill patient, will fail. The case will be appealed. Similar lawsuits will be filed in other states. No states will legalize assisted suicide in the USA in 2010. However, some form of limited license for assisted suicide will be permitted in Scotland.
The Bush Conscience Clause, a regulation prohibiting employment discrimination against medical professionals who refuse to participate in a medical procedure that violates their religion or morality will be revoked or substantially weakened. Lawsuits over conscience rights will proliferate, with the courts generally rejecting the right of medical conscience, particularly for pharmacists. A few states will pass stronger conscience laws protecting doctors, nurses, and others from participating in abortion or assisted suicide. But pharmacists will be prohibited from refusing to dispense contraception.
Abortion. The Freedom of Choice Act (FOCA) – which would erase all state laws limiting abortion will not pass in 2010.
Medical Futility. There will be a major political fight in Idaho to legalize medical futility in 2010. A compromise bill will pass, but it will not be as liberal as the existing law of Texas. At least one lawsuit will make the news in which a family fights a hospital in court to continue wanted life-sustaining treatment that the hospital wishes to end.
Great Unkown. The field of bioethics is moving so fast and growing so exponentially, that the biggest bioethics story of the year may be one that hasn’t yet appeared on the horizon. That means, I predict, that these predictions will not have mentioned one of the most important stories in bioethics of the year.
It’s going to be a volatile year in 2010. In such an atmosphere, it is more important than ever to defend the sanctity/equality of human life. The CBC is dedicated to this struggle and promises to do its utmost to maintain morality and decency in the world of bioethics in the coming year.