Hat tip to Francis Beckwith over at First Thoughts: The Washington Post’s Charles Lane analyzes the notorious section 1233 of the House health care reform bill, the part dealing with end of life counseling. From the story:
Section 1233, however, addresses compassionate goals in disconcerting proximity to fiscal ones. Supporters protest that they’re just trying to facilitate choice — even if patients opt for expensive life-prolonging care. I think they protest too much: If it’s all about obviating suffering, emotional or physical, what’s it doing in a measure to “bend the curve” on health-care costs?
Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive — money — to do so. Indeed, that’s an incentive to insist.
Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit “formulation” of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would “place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,” I don’t think he’s being realistic.
What’s more, Section 1233 dictates, at some length, the content of the consultation. The doctor “shall” discuss “advanced care planning, including key questions and considerations, important steps, and suggested people to talk to”; “an explanation of . . . living wills and durable powers of attorney, and their uses” (even though these are legal, not medical, instruments); and “a list of national and State-specific resources to assist consumers and their families.” The doctor “shall” explain that Medicare pays for hospice care (hint, hint).
Which is why a provision needs to be put in, as I have suggested, requiring the “counseling” to not be directed at a particular result. I also still believe that it should be spelled out clearly that the counseling is voluntary, both for the treating professional and the patient.
August 8th, 2009 | 8:16 pm
Lane also talks about the fact that under current federal law federal funds can’t be used to pay for euthanasia drugs. But it seems to me that since Obamacare would be this vast overhaul of the healthcare system, we cannot assume that that would continue. I _assume_ that nothing in this vast bill overturns the law against use of federal funds for euthanasia drugs (though that is just an assumption based on the “someone would have mentioned it” argument from silence), but that aspect of federal law could easily be changed down the line. Moreover, since the interaction between state government healthcare plans and this new federal plan is, I gather, a bit vague, the question arises: What happens in Oregon? Currently, Oregon _does_ refuse to pay for other care (such as certain kinds of chemotherapy) while at the same time paying for euthanasia, as documented here at SHS. It seems likely that there would immediately be a question arising as to how those euthanasia drugs would be paid for once the Oregon plan was supplemented? superseded? by the federal plan. So, since it is now not unprecedented even in the U.S. for a government (so far, state) plan to pay for euthanasia but not for treatment, I think Lane is a little too dismissive about the concern that this would arise in the federal plan, later if not sooner.
But his article is indeed useful and informative, especially in making the point about the initiation of the idea on the part of the healthcare provider.
August 8th, 2009 | 8:27 pm
I think also that when Lane says the following, he is overlooking another important concern. He says,
“On the far right, this is being portrayed as a plan to force everyone over 65 to sign his or her own death warrant. That’s rubbish. Federal law already bars Medicare from paying for services ‘the purpose of which is to cause, or assist in causing,’ suicide, euthanasia or mercy killing.”
Here he seems to assume that the only way to “sign one’s own death warrant” is to agree to accepting active “services” that cause one’s death. He overlooks the fact that the federal bill _expressly_ discusses suggesting that people refuse fluid and foods if administered by tube, which, when a person is not already dying swiftly of something else, certainly can be legitimately considered to be a matter of signing one’s own death warrant!
Again, though, I don’t want to run down the article. I appreciate his careful analysis. I just think that the “that’s rubbish” statement is a bit too strong even regarding “signing one’s own death warrant.”
August 8th, 2009 | 11:31 pm
If this becomes the standard, much of the discussion depends on the nuances of the doctor. I am required to offer the triple/quad screen for pregnant patients. Fine. I end up telling them it is a statistically crappy test, and makes mothers worry. If I am quite assured that the couple would never abort the baby, I am more prone to change my explanation somewhat; it may be helpful to prepare for a Down’s baby, if they want to go down that path. I often tell patients beforehand that if the test is “positive”, I will not help them get more potentially harmful tests, nor an abortion. The above mandate for end-of-life is more complicated, but the “counseling” can be spun in different ways. If it passes, patients can find a prolife doctor.
August 9th, 2009 | 8:29 am
Considering the extreme pro-eugenic “experts” advising Obama on this legislation, namely E. Emannuel, and John Holdren, it cannot be trusted. Once they get a hand into our medical care, the door will be wide open for government control, rationing, or God-forbid, worse.
August 9th, 2009 | 9:34 am
Just as I find ‘human exceptionalism’ circular and self-defeating, I have to say, Wesley, that even considering your being an attorney and a powerfully gentle soul, the thing to do here is not to say that this bill or whatever it is be worded differently, but to castigate its very existence, just as even using the term ethicist applying to oneself or participating in any of their activities only further supports their existence, which is a thing that shouldn’t be.
August 9th, 2009 | 9:46 am
HOW THE **** *(in capital letters) IS THE END OF ANYONE’S LIFE ANYONE ELSE’S BUSINESS LET ALONE THE SUBJECT OF “COUNSELLING” LET ALONE SUCH COUNSELLING BEING LEGALLY MANDATED? I’d like to get my hands on Ann Lander’s departed spirit for five minutes and tell her what I think of the damage she did with every day in her column the advice to every poor schmo who wrote to her to undergo counselling. There are so many stupid people in this country now who think they are educated when all they did was go to college which is not the same thing, let alone taking any courses in psychology, DOING NO ACTUAL WORK, that it was possible for this bill and everything that has anything to do with it to exist. Everything — parents, schools, poice, judges — has been made no longer what it is supposed to be. We are LOST. Please God let the Tea Parties be enough. Personally I think it’s going to take more than that — like a bunch of people with shotguns taking up with what’s going on the way happened over two centuries ago when this country got started in the first place. Only this time please God get it right and don’t give the country an astrological chart that’s the mess — beginning with its sun sign — that it’s got now. It’s too late, of course. And where is anyone supposed to go? To Europe that hasn’t been able to handle its own problems and we’ve had to save them from themselves at the cost of American lives over and over, and what do we get back? Well now they’re trying to tell people on what days they can’t eat meat. We never separated from them, really — and that’s our problem. With its sun in Cancer, this country is still too attached to its parents and is rife with boundary, addiction, weakness, overindulgence, and chaos/bohemian issues. Otherwise the death culture never would have gotten a foothold HERE. And if we’d minded our own business as we should have, and could have if the U.S had had been “born” at a better time, Europe wouldn’t have ended up as the mess IT is. Yes we are in for very dark times.
August 9th, 2009 | 9:55 am
I’m not advocating nuclear warfare or anything against the interests of the United States, and I’m JUST speaking FIGURATIVELY when I say this: Any country that doesn’t do everything possible to make sure that every one of its citizens lives as long as possible, and glories and prides itself on how many of its people are centenarians and well beond, has no right to exist. For God’s sakes what are nuclear weapons FOR? We used them on Japan, where as far as I know people knew how to live and die, so that we could end up with more horrors of the laboratory, “better living through chemistry,” labor unions, the stinking hippie commie 1960s, the continuing sickness of the 1970s, 1980s, 1990s, and what we’ve got now — and we continue to elect people to government and then are surprised when they come up with THIS? I don’t think humans are so exceptional, Wesley, that a huge purge isn’t in order. I mean huge. Otherwise the culture of death WILL win.
August 9th, 2009 | 10:01 am
I know, I know, Christians will say that every human is capable of redemption, that the idiots can learn and turn themselves around, etc. Well let’s see them do it. I’ll allow them five minutes. Then the rest of us had better do something about them. Very uncharitable of me, I know, doesn’t allow for infinite patience, the boundless possibilities of every human soul which in fact don’t exist. Isn’t that just too bad. All humans are NOT equal, and it’s not the disabled and the elderly who aren’t, it’s those who know they are not and want to get rid of the disabled and the elderly in their place. Discoursing with them as if they had as much right to be called humans as their betters do only is signing our own death warrants.
August 9th, 2009 | 11:17 am
Lydia, I haven’t read the whole bill, but I think they can get around these things through the health benefits advisory committee. See section 123. There will be 26 appointments, 17 by the president. They’ll decide a lot of what happens at the end of life, abortion and etc. All that will be mainly determined by the person appointing them, GWB, BHO etc. The camoflage/defense/pretense for this is that it will take medicine or these issues out of politics and let it be decided by medical experts and etc. That’s the Planned Parenthood et al line on abortion. But that makes us ask, “whose experts?” This makes it all the more political just like everything else. And advocates like myself will not only stress the importance of electing a president to appoint justices, but these health commissioners too… geez….
And as SHS has noted, whoever has the power (to appoint these commissioners) will be deciding who and what gets treated, as has happened in OR. SHS has noted that in Oregon this criteria has changed several times in the seven or so years it’s been instituted. So this commission is an end run around Congress and the way to bring these things about without it being explicitly in the text. We pro-lifers can say this bill will mandate abortion funding, abortion coverage, an abortion clinic mandate and pre-empt state laws because of this and other sections. They’ll determine the benefits, and once something is regarded as a federally protected “essential benefit,” then coverage and provision will be mandatory. No more 87 percent of counties without “comprehensive reproductive services.” Providers will have to make sure that all reproductive services-including abortion-are made available everywhere, even though many of these counties do not have advanced trauma, cardiac or cancer facilities.
The upshot of all this will be politically correct medicine.
August 9th, 2009 | 12:47 pm
Wesley, that definition of voluntary is disingenuous. What doctor is going to ask your permission to discuss your weight? Or cholesterol? Or to counsel you to quit smoking? By that definition, all of those things would be involuntary. There are certain things that it is just good medicine to bring up from time to time, and a discussion of plans for end of life care is one of them. Even if it’s just for you to tell me that you want everything done. Otherwise I’m left trying to read your mind in an emergency situation.
August 9th, 2009 | 5:25 pm
Just watched an hour you tube of Advance Care Planning: Role of the Primary Care Physician–Ben A. Rich, J.D., Ph.D. – 2008
http://www.youtube.com/watch?v=UpFRUIxyHZY&feature=related
Univ. of CA-Davis
At one point he suggests the doctor say to the patient while they still have “decisional capacity”: “Do you want us to fight with you for every last breath or heartbeat, or do you want us to be responsible to other priorities–your own sense of what it means to have a death with dignity–a death without unneccesary flogging at the end of life to buy another minute of life of physical surviving?”
Gee, sounds like unbiased “counseling” to me!
August 9th, 2009 | 6:31 pm
With cigarillo in hand and going in mouth, I’m sure that I just read that my friend ‘Ian the great’ said in so many words that he thinks that there is a GOD so as far as I’m concerned things are looking UP!
I hear ya Wesley! sinner vic, leave him alone cause he’s entitled to change his mind and I’m sure that Victor would be happy for him also!
God Bless,
Peace
August 10th, 2009 | 3:22 pm
VICTOR: Of course there has to be a God; otherwise how could one say for God’s sake etc. Which one has to be able to do, with the mess we’ve got to deal with.
Dr. Dredd: The problem is that one can’t really KNOW what one will want until one is IN the situation — a situation one has never been in before, any more than anyone working in a hospital, or anyone else who isn’t old, knows what it is like to be old. One can only know, before one gets there, what one THINKS one would want. Which isn’t the same thing, let alone enough. Plus when someone else brings up the subject it wasn’t even one’s own idea to be thinking about it in the first place. These things work to the convenience of the hospital, the medical personnel, etc., not to that of the patient. It’s appalling that no one mentions, or even seems to have thought of, what I’ve just pointed out.
August 10th, 2009 | 8:08 pm
Of course, knowing what one thinks one would want isn’t enough. But’s it’s certainly a starting point. And my same argument holds true about bringing up the subject: doctors do that all the time; otherwise, no one would ever discuss smoking, diet, or exercise.
August 11th, 2009 | 3:10 pm
[...] Obamacare: End of Life Counseling Not as Benign as Supporters Claim [...]
August 20th, 2009 | 12:25 am
Also, the things (quitting smoking, losing excess weight) mentioned by the good Dr. are conducive to health and life…the thing we are talking about (pressure to refuse care) is conducive to death, and decreased expense for Uncle Sam. The savings from which Congress would probably blow on some wasteful program anyway.
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