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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-skepticalseniors."

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, andsuggested 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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