Is Euthanasia Really Part of Health Care Reform?
by Brian Doherty
For folks confused, or delighted, or driven to inchoate rage, by the bubbling controversy over whether Section 1233 of the proposed health care reform bill will mean strong-arming senior citizens into offing themselves, this Charles Lane piece from the Washington Post gives what strikes me as a pretty reasonable take on the matter.
He states with a setup of the controversy for those to whom the numerals 1233 don't yet summon visions of a sci-fi dystopia of the ill elderly turned to Soylent Green for the greater good of lessening health care costs:
Section 1233 of the health-care bill drafted in the Democratic-led House...would pay doctors to give Medicare patients end-of-life counseling every five years -- or sooner if the patient gets a terminal diagnosis.
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....Still, I was not reassured to read in an Aug. 1 Post article that "Democratic strategists" are "hesitant to give extra attention to the issue by refuting the inaccuracies, but they worry that it will further agitate already-skeptical seniors."
If Section 1233 is innocuous, why would "strategists" want to tip-toe around the subject?
Perhaps because, at least as I read it, Section 1233 is not totally innocuous.....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.
...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).
....the measure would have an interested party -- the government -- recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations. You don't have to be a right-wing wacko to question that approach.
It helps to remember in thinking about how any portion of this bill, if it were to pass, would be interpreted that job one for "health care reform" is keeping health care costs down. Rationing, whether thorough prices, waiting, or state dictates, is always a fact of life in a universe lacking utter plenitude of all resources.
Is it intellectually defensible to say that if a law does not explicitly demand or require something, then one is crazy to suggest that it eventually might do so in practice? If you don't believe laws often have results not obvious from their letter, then you aren't paying much attention to how government actually works. See Katherine Mangu-Ward on the Consumer Product Safety Improvement Act in Reason magazine's June issue, and me from back in April on the proposed Food Safety Modernization Act for examples.
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This is a very interesting view about the health care reform. Let me tell you that people are scared these days about retirement and not having the right resources. That's why it is so important for families to have the right assisted living placement resources and insurance. Does this reform cover these costs?
Yes. We've been doing it for years. Call Hospice, start the Morphone and it's all over. Ask any nurse who has worked with the elderly as I have. I said a long time ago, eventually at the patient's "Care Conference," the medical community would do a periodic review of the patient's "Quality of Life," and if it failed to meet "certain standards," the patient would become a "candidate for Euthanasia." Alayna Staggers, Nurse
The health care system that we now have began to be designed in the Nixon era is not broken; it does exactly what it was meant to do; privatize and corporatize sickness and death to make the greatest possible profits for executives and share holders. The current insurance aspect of health care is socialized because they cover a large amount of people and the healthy premium payers pay the hospital bills of those who get sick or injured plus the salaries of the health insurance company executives and the stockholders. The greatest profit margins possible within the business of sickness and death come through the denial of services to people that paid their health insurance premiums and then are denied care due to small print technicalities when they become sick or injured. So the health care system we now have reminds me of the National Socialist German Workers' Party because it uses popular propagandist words like free market, free choice etc. to justify transfer of money from the sick and dying to wealthy people of infinite greed who want to rule the world, people who never lift a finger to help a single sick person.
I propose a public national health care system built upon the current Medicade and Medicare programs where small increases in these taxes would eliminate the need for private "for profit" health insurance all together to guarantee health care to every citizen. Any person who has the least bit of compassion for his fellow citizens, and themselves for that matter, would also gladly pay a one cent on a dollar national sales tax if they knew that money would actually go to helping sick people. If you add up all the money that goes to profit rather than goods and services to help sick and injured people that number approaches half of the total amount we now pay for our Sicko™ health care system. The people who get this money for nothing are murderers and by depriving health care from our citizens they have become very wealthy and powerful. If the Senators and Congressmen in Washington DC continue to cater to the profiteers of sickness and death instead of enacting legislation similar to what I suggested above they are certainly not representing the majority of their constituents and must be voted out in 2010.
If you live in a state that has adopted the 2006 Uniform Anatomical Gift Act, it is presumed that you are an organ donor unless they can find information contrary to their assumptions. This change was made expressly to increase the supply of organs, tissue and body parts so that the $20 Billion in annual revenues for organ related medical services could keep growing.
Brain death and donation after cardiac arrest for as little as 75 seconds is becoming the standard in hospitals to start the organ harvesting process.
Removing your name from any list or erasing your consent from your driver's license means absolutely nothing under the 2006 version of the act.
Even if you have a written Advance Healthcare Directive that forbids the use of machines to keep your body alive, they can do so as long as they are talking to your family to give consent to start the organ harvesting procedure.
If you don't express a preference on organ harvesting, your family has to make the decision. Organ Procurement Organizations and Tissue Banks have to follow your instructions if you register your preferences with a known donor registry.
Unfortunately, no state that has adopted the 2006 UAGA has a state donor registry that allows you to register as a "no" or allows donation on condition of just compensation to your family or estate.
If you are one of the estimated 10% of Americans who does not support organ harvesting, you can register your objection and explore your options under the law at http://www.DoNotTransplant.com.
It's unfortunate that Advance Care Planning is falling victim to politics . This is a needed part of EVERYONE's healthcare process. Since 1991 with the Patient Self-Determination Act, no doctor can treat any patient without his or her consent. This "informed consent" stays your right, even if you are incapacitated and unable to speak for yourself. There are really three parts to Advance Care Planning. Advanced Directives are the documents that designate a 1.PERSON - Health care power of attorney: The person who makes decisions on your behalf if you cannot speak for yourself. 2. PROCESS - Living Will: Talks about treatments that you want or do not want at the end of life. 3. CONVERSATIONS: on-going communication with your Health Care Power of Attorney, your family and YOUR DOCTOR. The purpose of the conversations is so that you or your loved ones are informed and making decisions about the type of care and treatments that you do or don't want until the end.
The doctors have often been outside these conversations because in the world of billing to the 15 minute visit, there is no billable time to have these essential conversations.
As a clergy person, I have been trained as an Advance Care Planning Facilitator and Instructor. I try to give people facts in a world of confusion. I advocate that people have MORE conversations with their doctors, not less.
Yes -- we will have different perspectives on how to fix health care , that's real and necessary. But distorting this valuable process of Advance Care Planning with fears of euthanasia is NOT helpful to anyone.
These Advance Care Planning conversations are already confusing and difficult. No one wants to think about the end of their life. But we want to make these very personal decisions within our families and with our loved ones and in consultation with our doctors. Mandatory euthanasia is not part of this conversation.
All of us need to talk to our aging parent. To help us all learn to understand more about Advance Care Planning go http://www.talk-early-talk-often.com/advance-directives.html
I think most of the "it's euthanasia " crowd's main concern is that there is no clear definition of what "end of life counseling" is and that a physician receives incentive to initiate it. Why would the government be so anxious to initiate or such discussions? Why is there an incentive to the physician to hold the discussion?
For a system that is basing its entire validity on cost control, the concern for most is whether a doctor will receive greater incentive, for example, if he had more patients sign a "do not resuscitate" order. This would certainly help with cost. It may not be direct euthanasia but why would the government want to spend money to encourage a doctor to have a discussion if it had no financial benefit to a system focused on cost reduction.
Additional concern arises in that, the federal government has had a history of continuing to infringe upon the rights of individuals. Bush did it with "No Child Left Behind" just like nearly every other president has done. The idea that this bill is really a single, small step away from including euthanasia as an option or possibly a requirement is what concerns most people.
The simple fix...
1. Remove physician incentive
2. Declare what counseling covers and what it doesn't
But here is a thought for your euthanasia fearful folks, and the rest.
The current administration has made it legal to receive government assistance to have an abortion if the child presents a "social or economic hardship". 50 years ago people would have NEVER anticipated that...
So, with section 1233, how difficult would it be to extend the same "social or economic hardship" clause to an elderly parent? Or, instead of having the child make that decision for the parent, could "end of life counseling" be a persuasive discussion about the "social and economic hardship" that the parent would place on their child and how ending their life sooner could allow them to control the circumstances, arrangements, financial details, and burden on their children . The end result being that many parents commit physician assisted suicide because they believe it will be easier on their children.
Again, the bill is unclear as to what "end of life counseling" entails so, no one can argue against this idea really, without saying things like "that's not the intention". How can someone judge the intention of words on paper? If it was not the intention of the author then the author should be a little more insightful.
Just my thoughts... if people can read it to imply euthanasia then a lawyer could argue it in a court of law and likely make a case for it.
You want to stop the fear mongering, then change the bill to clearly state the intentions.
Exactly.
What most of the Obama supporters fail to understand is the opposing position.
We do not want everything to remain exactly as it is. We do want change. We just do not want the brand of change which is being offered.
Reform the tort process so that it does not make overnight millionaires out of greedy lawyers, thus saving countless dollars a year. These costs are passed on to us in the form of higher insurance premiums. Dissuade barbaric practices by Insurance company brass with the penal code, not the civil code.
This alone would save ridiculous amounts of money . Yet Liberals on the hill will not even consider it.
Why?
Because the same liberals have their campaign coffers filled to overflowing by these lawyers. Lawmakers are being bought out and they have the audacity to call regular town-hall Americans "un-American Mobs".
I will call you out on this, though.
"You want to stop the fear mongering, then change the bill to clearly state the intentions."
Pointing out the problems in a bill is not always "fear-mongering". Mislabeling the opposing view and arguing against the new label is called a Straw Man.
The plural of 'anecdote' is not 'data'.
at least this will alleviate world hunger , every cloud has a silver lining
I say this because we already have available end of life and living wills on the books. Why does the government feel the need to push into this area. As a nurse we discus this issue with patients fairly often. Especially if they have a health condition that is life threatening. I don't know of any Doctor who isn't already doing this without being required by law . It is part of total patient care. So when I see the government wanting it included it does raise red flags.
Example of why as a law it would be bad. We have a vicious dog law here meant to get vicious pit bulls off the streets. The way it is written even if your puppy nips at you it would be considered vicious and put down. Now there is a huge public outcry but its the law . Easier to make a law then to get rid of it.
So. We put something like this on the books. People over a certain age, the age that needs it, stop going to the doctor. They worry about what the pill they are getting really is, it opens the doors for insistence and abuse. This part of the health care is not broken. Leave it alone.
I've read the section of the bill in question and it does not say anything about offering euthanasia . That said, I found what it does say, and what the supporters say, very curious.
1. Is there any prohibition against a doctor advising a medicare patient or patient's family regarding DNRs? If not, why does this need to be addressed at all?
2. As the above article states, many of the concerns that the Bill addresses are legal , not medical. Why are these burdens being put on a doctor who is unqualified in this area?
3. It occurred to me that these "discussions" could be interpreted as mandatory. If so, that opens doctors up to potential lawsuits if they do not give all of the appropriate information. This is difficult - see item two.
4. One of the things we keep hearing is that huge sums of money are spent in the last months/years of a patient's life. It is no stretch to imagine this clause being used to push for reductions in those costs by a national health plan.