The San Francisco Chronicle carries a helpful op/ed piece by two physicians to day on the mandatory counseling requirement in the Obamacare House bill by physician and USC School of Medicine professor emeritus Katherine Dowling Schlaerth. From her column:
This current legislation…seeks to prevent…costly overuse of health resources through a program of “advance care planning consultation,” wherein those on Medicare, or their families, could meet with a “practitioner of advance care planning” every five years, or sooner if illness supervened. Such an adviser need not be a physician, either. [Me: This is where the assisted suicide advocacy group Compassion and Choices would come in, as it is seeking to reposition itself as an educator of end of life choices]
This specialist would discuss care issues such as “the individual’s desire regarding transfer to a hospital … the use of antibiotics and the use of artificially administered nutrition and hydration.” The discussion may, in fact, be triggered if “there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease.” I would be loath to talk a person on dialysis or in a wheelchair from a stroke into forgoing antibiotics for a pneumonia that may itself be treatable.
HR3200 has created tiers of administrators, who do not necessarily have medical experience. They will attempt to facilitate your end-of-life care, probably with the assistance of the electronic medical records each medical facility will shortly be required to use.
These and other provisions of the health choices act frankly scare me. As a physician, I took an oath long ago to put my patient’s interests above all else, but provisions in the bill have a quality of coerciveness that make me wonder if I can fulfill my oath.
She’s right. When taken overall, this bill seeks to destroy the Hippocratic value that each physician give optimal care to each patient as an individual, and replace it with a divided loyalty in which there is also a duty to the public or to society. History shows that once such a dual mandate is instituted, the weak and vulnerable are the ones to suffer. Be afraid. Be very afraid.
July 29th, 2009 | 12:50 pm
I believe these were called “mercy centers” in the Harry Turtledove novel about where the Nazis won WWII.
July 29th, 2009 | 2:18 pm
>>Such an adviser need not be a physician, either. <<
Hey! Things are looking UP for me, and I thought that I wouldn't stand a chance with my grade ten Arts, Science and Matt program! "IT" just goes to show how wrong "ONE" can really be! Right Wesley? Now all you need do is put in another good word in for Victor and I'll be on my way to seeing how I can be of help to "The Almighty Dollar!"
I hear ya Wesley! Hey! I trust you Victor but sinner vic that's a totally different story and I wouldn't trust him as far as I could throw him cause he might eventually want to take the easy way out and give these seniors eternal sleeping pills and have them thanking him for "IT" at the same time. Victor have you ever seen the movie, 'Invasion of The Body Snatcher'? That's "IT" Victor! I'm not saying another word.
I guess you might be right Wesley so folks, Be afraid! Be verry afraid cause they'rrr hhunting human wabbit cells, I mean humanity! :)
Who's laughing?
Sorry! Peace?
July 29th, 2009 | 3:57 pm
This proposal is a response to those families who didn’t know their loved ones’ preferences when confronted with difficult decisions in an emergency. It empowers individuals to choose the best decisions for themselves, and better ensure their wishes are followed.
Section 1233 of the health care reform bill is being deliberately distorted.
Here is the section:
http://thomas.loc.gov/cgi-bin/query/F?c111:1:./temp/~c111keCFws:e513253:
Fact: Advance planning consultations are a completely voluntary, not mandatory.
Fact: No one will be forced to sign an advance care directive.
Fact: The legislation is endorsed by the Providence Health System, a Catholic health care provider.
Fact: Only a doctor or nurse practitioner can counsel patients.
Carla Axtman
Online Community Builder
Compassion & Choices
compassionandchoices.org
July 29th, 2009 | 6:08 pm
Nice of C and C to weigh in. The language is difficult to discern because of its reference to other law. But it could be interpreted to be mandatory, from this language: the
7 term ‘advance care planning consultation’ means a con8
sultation between the individual and a practitioner de9
scribed in paragraph (2) regarding advance care planning,
10 if, subject to paragraph (3), the individual involved has
11 not had such a consultation within the last 5 years. Such
12 consultation ,shall (my emphasis)
include the following:”
Then there is this language
‘‘Advance Care Planning Consultation
6 ‘‘(hhh)(1) Subject to paragraphs (3) and (4), the
7 term ‘advance care planning consultation’ means a con8
sultation between the individual and a practitioner de9
scribed in paragraph (2) regarding advance care planning,
10 if, subject to paragraph (3), the individual involved has
11 not had such a consultation within the last 5 years. Such
12 consultation shall include the following:
13 ‘‘(A) An explanation by the practitioner of ad14
vance care planning, including key questions and
15 considerations, important steps, and suggested peo16
ple to talk to.
17 ‘‘(B) An explanation by the practitioner of ad18
vance directives, including living wills and durable
19 powers of attorney, and their uses.
20 ‘‘(C) An explanation by the practitioner of the
21 role and responsibilities of a health care proxy.
22 ‘‘(D) The provision by the practitioner of a list
23 of national and State-specific resources to assist con24
sumers and their families with advance care plan25
ning,
C and C is trying to rebrand itself as a supplier of end of life information, meaning you will try to get your organization listed under D. Thus, it isn’t true that only a doctor or nurse practioner can counsel. Their counseling could include a referral to you.
I agree no one will be forced to sign an advance directive. I never said they would. I have also said that full care is an option under advance care planning in my posts. But we also know the way the current would be flowing since it is about cutting costs.
If the counseling sessions aren’t mandatory, very easy to add a clause stating explicitly that they are entirely voluntary and that there will be no sanction to the patient for refusing the sessions.
Here is my original take: http://www.firstthings.com/blogs/secondhandsmoke/2009/07/18/house-health-care-reform-bill-mandatory-counseling-to-end-life-sooner-in-health-care-bill
July 29th, 2009 | 9:03 pm
Doctors even now have various ways of pressuring patients to do things. They can refuse or delay non-emergency yearly prescription unless one will have this or that test, for example. They can insist on a particular set of tests as part of one’s annual physical, with the implicit idea that that doctor will not want to work with you anymore if you won’t follow that program. It’s all very informal. The Obama plan formalizes a lot of things, and i would think there could easily be other mechanisms for pressuring patients. My guess is that the law simply doesn’t say what would or wouldn’t be done if a patient refused and that that would be developed as the law was applied. You start with bluff, “You have to do this.” “This is now the standard of care.” “This is now what everybody does.” Statements like that. Most people just assume there is some mechanism for sanction if you don’t. When somebody calls the bluff, the officials have to make something up to try to twist the arm a little more. Perhaps, “I’m afraid it will be more difficult for us to plan your care if you don’t help us to understand your preferences.” Translation: You might be sent to the end of the line if you don’t do this.
These are just my guesses–that the coercion would be informal and ad hoc and would follow bluffing attempts simply to herd people into doing this as a routine matter without actually telling them what happens if they refuse.
July 30th, 2009 | 2:22 am
Lydia: This is why I suggested in a more recent post that a provision be added, akin to the Kennedy/Brownback bill about genetic counseling of women testing positive for a Down fetus, that would prohibit the counseling to be directed toward refusing treatment.
http://www.firstthings.com/blogs/secondhandsmoke/2009/07/29/obamacare-mandatory-counseling-provision-really-a-pay-the-provider-provision
July 30th, 2009 | 1:18 pm
First they will coerce the frail elderly out of life; these “counseling” sessions may begin with a compassionate atmosphere, but will shortly morph into pressure sessions — visualize hot bright lights aimed at the frail elderly grandmother in her wheelchair and the hale-but-hapless granddaughter. Only the crabbiest s*bs and b***hes will be able to resist, God bless ‘em. Not long after, they will do the same for the disabled who are not close to death, but require ongoing care. Not long after that, they will mandate “counseling” for women whose unborn babies don’t pass the government standard prenatal tests; they will decline any medical “care” other than abortion for women who resist killing the babies. Not long after that, the “life clocks” will be implanted in everyone’s palms ….
August 2nd, 2009 | 2:26 pm
Hi,
http://www.firstthings.com – da best. Keep it going!
Charlie
August 19th, 2009 | 9:38 am
Sort of like a famously unethical car dealer tactic: sure, this is the price you agreed on, but let’s see what happens when we delay the process for a couple hours until you’re tired and hungry and just want to go home.
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