Late night talk show host Jim­my Kim­mel recent­ly exco­ri­at­ed GOP Sen­a­tor Bill Cas­sidy, the co-spon­sor of the GOP’s lat­est health care bill, for lying to Kim­mel back in July about Cas­sidy’s com­mit­ment to only back a health care bill that pass­es “The Kim­mel Test”. The “Kim­mel Test” is a term that Cas­sidy him­self coined when he promised Kim­mel that Cas­sidy would only sup­port a health care bill that ensured chil­dren born with expen­sive med­ical com­pli­ca­tions — like Jim­mey Kim­mel’s recent­ly born son with a con­gen­i­tal heart con­di­tion — would be able to get the med­ical treat­ment they need to live a full life. That includes treat­ment to address the imme­di­ate med­ical need, like mul­ti­ple expen­sive heart surg­eries, but also access to life insur­ance cov­er­age with­out life­time caps (caps which can eas­i­ly be exceed­ed for peo­ple with expen­sive con­di­tions). And the Kim­mel Test isn’t lim­it­ed to new born infants but is sup­posed to include every­one. In oth­er words, Sen­a­tor Cas­sidy promised Kim­mel dur­ing that inter­view that he would­n’t sup­port a health care bill that basi­cal­ly says, “Ok, this per­son­’s life it too expen­sive to main­tain.” It’s the kind of thing that should be a no-brain­er for a mod­ern, decent soci­ety.

And, Of course, Cas­sidy’s new bill com­plete­ly fails that test. It’s a “Let ’em die (even­tu­al­ly, when they run out of finan­cial resources)!” bill.

So giv­en the GOP’s seem­ing­ly end­less attempts to “repeal and replace” Oba­macare include seem­ing­ly end­less attempts to sig­nif­i­cant­ly gut Med­ic­aid and leave the Unit­ed States with­out any sort of mean­ing­ful health care safe­ty-net for the poor, elder­ly, and dis­abled, it’s worth keep­ing mind that these goals — goals which are guar­an­teed to send mil­lions of Amer­i­cans to an ear­ly grave — aren’t just moral­ly out­ra­geous on their own. They also end up com­pli­cat­ing an array of oth­er inher­ent­ly dif­fi­cult moral ques­tions. Ques­tions where the answers are pred­i­cat­ed on the basic decen­cy of the soci­ety ask­ing them. In par­tic­u­lar, the ques­tions sur­round­ing assist­ed sui­cide, allow­ing peo­ple to die com­pas­sion­ate­ly and on their own terms, and how many resources should be spent to keep peo­ple alive when doing so is expen­sive.

On their own these are inevitably going to be dif­fi­cult ques­tion, but they’re also the kinds of issues that become a lot hard­er to answer the more and more is seems like soci­ety does­n’t care if peo­ple die. And if there’s one over­ar­ch­ing theme to the con­tem­po­rary GOP’s agen­da it’s an agen­da to restruc­ture soci­ety in such a way where peo­ple with­out the finan­cial means are sim­ply allowed to fall through the cracks and die. A soci­ety where we are not ‘all in it togeth­er’. That’s the goal and it’s the kind of goal that’s going to inevitably make issues like assist­ed sui­cide and whether or not peo­ple with expen­sive med­ical con­di­tions should be giv­en those resources much hard­er to answer. Or per­haps eas­i­er to answer since the answer will inevitably be “we don’t have the resources to care for you...good luck!”

Ques­tions like “is health care a right?” are still open ques­tions for Amer­i­can soci­ety. And one of the two major par­ties appears to be deter­mined to gut Med­ic­aid, a pro­gram designed to be a last resort for not just the poor but for a wide vari­ety of peo­ple with life­long expen­sive con­di­tions. As such, it’s going to be trag­i­cal­ly impor­tant to not for­get that the dis­abled and those deemed to be phys­i­cal­ly unfit were the first vic­tims of the Nazis (and the US has its own his­to­ry in this area):

The New York Times

The Nazis’ First Vic­tims Were the Dis­abled

Ken­ny Fries
SEPT. 13, 2017

I sit fac­ing the young Ger­man neu­rol­o­gist, across a small table in a the­ater in Ham­burg, Ger­many. I’m here giv­ing one-on-one talks called “The Unen­hanced: What Has Hap­pened to Those Deemed ‘Unfit’,” about my research on Aktion T4, the Nazi “euthana­sia” pro­gram to exter­mi­nate the dis­abled.

“I’m afraid of what you’re going to tell me,” the neu­rol­o­gist says.

I’m not sur­prised. I’ve heard sim­i­lar things before. But this time is dif­fer­ent — the young man sit­ting across from me is a doc­tor. Aktion T4 could not have hap­pened with­out the will­ing par­tic­i­pa­tion of Ger­man doc­tors.

I have a per­son­al stake in mak­ing sure this his­to­ry is remem­bered. In 1960, I was born miss­ing bones in both legs. At the time, some thought I should not be allowed to live. Thank­ful­ly, my par­ents were not among them.

I first dis­cov­ered that peo­ple with dis­abil­i­ties were ster­il­ized and killed by the Nazis when I was a teenag­er, watch­ing the TV mini-series “Holo­caust” in 1978. But it would be years before I under­stood the con­nec­tions between the killing of the dis­abled and the killing of Jews and oth­er “unde­sir­ables,” all of whom were, in one way or anoth­er, deemed “unfit.”

The neu­rol­o­gist does not know much about what I’m telling him. While he does know that approx­i­mate­ly 300,000 dis­abled peo­ple were killed in T4 and its after­math, he doesn’t know about the direct con­nec­tion between T4 and the Holo­caust. He doesn’t know that it was at Bran­den­burg, the first T4 site, where meth­ods of mass killing were test­ed, that the first vic­tims of Nazi mass killings were the dis­abled, and that its per­son­nel went on to estab­lish and run the exter­mi­na­tion camps at Tre­blin­ka, Belzec and Sobi­bor.

Three years ear­li­er, when I first arrived in Ger­many, I was con­sis­tent­ly con­front­ed with the treat­ment of those with dis­abil­i­ties under the Third Reich. But I soon real­ized I had to go back even far­ther. In the 1920s, the dis­abled were mis­treat­ed, ster­il­ized, exper­i­ment­ed on and killed in some Ger­man psy­chi­atric insti­tu­tions. In 1920, the psy­chi­a­trist Alfred Hoche and the jurist Karl Bind­ing pub­lished their trea­tise, “Per­mit­ting the Destruc­tion of Unwor­thy Life,” which became the blue­print for the exter­mi­na­tions of the dis­abled car­ried out by the Third Reich.

In Dr. Ewald Melzer’s 1923 sur­vey of the par­ents of the dis­abled chil­dren in his care, they were asked: “Would you agree def­i­nite­ly to a pain­less short­cut of your child’s life, after it is deter­mined by experts that it is incur­ably stu­pid?” The results, which sur­prised Melz­er, were pub­lished in 1925: 73 per­cent respond­ed they were will­ing to have their chil­dren killed if they weren’t told about it.

I am also Jew­ish. At the Karl Bon­ho­ef­fer psy­chi­atric hos­pi­tal in the Berlin sub­urb of Wit­te­nau, where the exhi­bi­tion “A Dou­ble Stig­ma: The Fate of Jew­ish Psy­chi­atric Patients” was held, I learned about, as the exhi­bi­tion title sug­gests, how Jew­ish patients were dou­bly stig­ma­tized by being sep­a­rat­ed from oth­er patients, denied pas­toral care, and were cared for not at the expense of the Reich but by Jew­ish orga­ni­za­tions. Jew­ish patients were sin­gled out for ear­ly exter­mi­na­tion; by Decem­ber 1942, the destruc­tion of the Jew­ish patient pop­u­la­tion at Wit­te­nau was com­plete.

...

It is only at the end of my talk with the neu­rol­o­gist that I notice he wears a hear­ing aid. I want to ask if he knows about “100 Per­cent,” the film pro­duced by deaf Ger­mans to show they could assim­i­late and be pro­duc­tive cit­i­zens who worked. Did he know the hered­i­tary deaf were sin­gled out not only by the Ger­man author­i­ties but also by those with acquired deaf­ness who tried to save them­selves? Too often, even those of us with dis­abil­i­ties do not know our own his­to­ry.

Not many peo­ple know about dis­abil­i­ty his­to­ry in the Unit­ed States. They do not know that in the Unit­ed States in 1927, Jus­tice Oliv­er Wen­dell Holmes wrote that “three gen­er­a­tions of imbe­ciles are enough” as part of his opin­ion in Buck v. Bell, in which the Supreme Court ruled that com­pul­so­ry ster­il­iza­tion of the “unfit” was con­sti­tu­tion­al. This deci­sion has nev­er been express­ly over­turned.

Many Amer­i­cans still do not know about the so-called “ugly laws,” which in many states, begin­ning in the late 1860s, deemed it ille­gal for per­sons who were “unsight­ly or unseem­ly” to appear in pub­lic. The last of these laws was not repealed until 1974.

Why is it impor­tant to know this his­to­ry? We often say what hap­pened in Nazi Ger­many couldn’t hap­pen here. But some of it, like the mis­treat­ment and ster­il­iza­tion of the dis­abled, did hap­pen here.

A read­ing of Hoche and Binding’s “Per­mit­ting the Destruc­tion of Unwor­thy Life” shows the sim­i­lar­i­ty between what they said and what expo­nents of prac­ti­cal ethics, such as Peter Singer, say about the dis­abled today. As recent­ly as 2015, Singer, talk­ing with the radio host Aaron Klein on his show, said, “I don’t want my health insur­ance pre­mi­ums to be high­er so that infants who can expe­ri­ence zero qual­i­ty of life can have expen­sive treat­ments.”

These philoso­phers talk about the drain on “resources” caused by lives lived with a dis­abil­i­ty, which eeri­ly echoes what Hoche and Bind­ing wrote about the “finan­cial and moral bur­den” on “a person’s fam­i­ly, hos­pi­tal, and state” caused by what they deem lives “unwor­thy of liv­ing.”

Experts point out the recent Repub­li­can health care pro­pos­als would strip Med­ic­aid fund­ing that helps the elder­ly, the poor and the dis­abled live health­i­er and more dig­ni­fied lives. A recent New York Times arti­cle quot­ed the Rev. Susan Flan­ders, a retired Epis­co­pal priest, as say­ing: “What we’re pay­ing for is some­thing that many peo­ple wouldn’t want if they had a choice. It’s hun­dreds of dol­lars each day that could go towards their grandchildren’s edu­ca­tion or care for the peo­ple who could get well.”

In the arti­cle, Flan­ders, whose father had Alzheimer’s, is described as “utter­ly unafraid to mix mon­ey into the con­ver­sa­tion about the mean­ing of life when the mind dete­ri­o­rates.” Prac­ti­cal ethi­cists are sim­i­lar­ly unafraid to do this. As were the Nazis. Third Reich school text­books includ­ed arith­metic prob­lems on how much it would cost to care for a per­son with a dis­abil­i­ty for a life­time.

Three years ago, I was the only vis­i­tor at a muse­um ded­i­cat­ed to the his­to­ry of the Reinick­endorf area of Berlin. The muse­um build­ing was once part of Wiesen­grund, which, in 1941, housed the “wards for expert care” of the Munic­i­pal Hos­pi­tal for Chil­dren.

Down a hall with flu­o­res­cent light­ing, in a white-walled room, were 30 wood­en cribs. On each of the cribs was a his­to­ry of a child, some as young as a few months old. This was the room in which these infants and chil­dren were exper­i­ment­ed on and killed: the 30-bed Ward 3, the “ward for expert care” at Wiesen­grund.

My heart raced; my breath short­ened. I couldn’t stay in that room for long. The room evoked the first four weeks of my own life spent in an incu­ba­tor. Nobody knew if I would live or die.

What kind of soci­ety do we want to be? Those of us who live with dis­abil­i­ties are at the fore­front of the larg­er dis­cus­sion of what con­sti­tutes a val­ued life. What is a life worth liv­ing? Too often, the lives of those of us who live with dis­abil­i­ties are not val­ued, and feared. At the root of this fear is mis­un­der­stand­ing, mis­rep­re­sen­ta­tion, and a lack of knowl­edge of dis­abil­i­ty his­to­ry and, thus, dis­abled lives.

———-

“The Nazis’ First Vic­tims Were the Dis­abled” by Ken­ny Fries; The New York Times; 09/13/2017

“What kind of soci­ety do we want to be? Those of us who live with dis­abil­i­ties are at the fore­front of the larg­er dis­cus­sion of what con­sti­tutes a val­ued life. What is a life worth liv­ing? Too often, the lives of those of us who live with dis­abil­i­ties are not val­ued, and feared. At the root of this fear is mis­un­der­stand­ing, mis­rep­re­sen­ta­tion, and a lack of knowl­edge of dis­abil­i­ty his­to­ry and, thus, dis­abled lives.”

What kind of soci­ety do we want to be? Well, if the GOP gets its way we’re going to be a “let ’em die!” soci­ety. Which means we’re also going to the kind of soci­ety where any dis­cus­sions about assist­ed sui­cide and the com­pas­sion­ate end­ing of life is going to be mired in the hor­rif­ic pol­i­tics of health care aus­ter­i­ty and the GOP’s end­less war on the poor, espe­cial­ly poor dis­able peo­ple or oth­ers with expen­sive med­ical ser­vices. You know, kind of like the Nazis. The GOP is just a lit­tle less explic­it about it.

Adding to the sick nature of this polit­i­cal sit­u­a­tion is that a lack of ade­quate health care cov­er­age is exact­ly the kind of thing that’s going to put more and more peo­ple in the kind of med­ical sit­u­a­tion where they have to con­sid­er some sort of assist­ed sui­cide because a painful, slow or quick, death will be the only oth­er option they’re left with. The ethics of end­ing life is one of the most chal­leng­ing top­ic a soci­ety can grap­ple with and it’s going to a lot more dif­fi­cult to grap­ple with at the same time soci­ety is pon­der­ing whether or not we can pay to keep each oth­er alive. But this is where we are. Lot’s of eth­i­cal grap­pling is in store for Amer­i­ca.

So don’t for­get as we grap­ple with this night­mare sit­u­a­tion: the Nazis failed the “Kim­mel test” too. And they did­n’t casu­al­ly fail it. They failed it out of an ide­ol­o­gy that viewed entire cat­e­gories of peo­ple as not wor­thy of life.