Ed Brayton has done good job the ridiculousness of Republican “death panel” rhetoric, specifically regarding the idea that providing counseling = killing people. But there’s another variation on this idea, being pushed by Lester Hunt and now, Alex Tabarrok: realizing some end-of-life care isn’t worth it = advocating killing people (or, in Hunt’s words, deciding certain people “ought to die.”)

This rhetoric amounts to a denial of an idea famous to ethicists, and implicit in the way normal people talk: the distinction between doing and allowing, between killing and letting die. Hunt’s and Tabarrok’s targets aren’t talking about offing anyone, they’re just talking about not providing certain medical treatments. This distinction is basic enough to our ethical thought and language that anyone who ignores it in characterizing their opponents’ views is just a liar.

While it’s possible to acknowledge the idea but use some clever thought-experiments, to argue that the distinction breaks down an an ultimate theoretical level (a view I’m sympathetic to) in the distinction is clearly of great practical importance. In a murder, we can definitely identify a small number of culprits, but if the British government handed down “death sentences” (Hunts words again) to kidney patients by not paying for their Sutent, then a lot of other people were also handing kidney patients death sentences. The Bill and Melinda Gates Foundation would be guilty for spending money helping people in the Third World rather than buying British people Sutent. Numerous billionaires who don’t give much money at all to charity would be guilty. Even middle-class people with 100k savings would be guilty, because that’s more than enough to pay for a year of the treatment.

In the case of Hunt’s target Peter Singer, his use of the word “rationing” might be worrisome if he were using it in the sense of WWII civilian rationing, where limits were placed on how much of certain things private citizens could buy, regardless of their ability to afford it. But it’s explicit that this isn’t how Singer is defining the word “rationing,” and even if it was, such a policy would be more of a “preventing-from-saving” than “killing.” As a side note, while it’s easy to see that such a policy would be wrong under current circumstances, it’s just as easy to see that a Spanish Flu-level health crisis would make, it quite reasonable to require that, say, providers of vital services get medicine before other people.

Furthermore, there’s a deep hypocrisy in this rhetoric (in Hunt’s case, at least–I’m less familiar with Tabarrok’s overall views). Hunt is a borderline-anarchist who thinks that when the government provides health care, it’s guilty of stealing from whosever tax dollars are paying for the health care. It’s inconsistent for him to get huffy at the prospect the government deciding not to pay for some people’s health care when he doesn’t want the government to pay for anyone’s health care. He’s basically just looking for extra reasons to call the government evil, at the price of consistency.

Depressing to see such nonsense coming from people who, under other circumstances, seem quite intelligent.