Health Care Reform is the issue for the rest of this year, and it talks a good deal about end of life planning. End of life planning is costly for the patient, for families, and for the government. Especially after Sarah Palin's 'Death Panel' myth, people are confused about the details and the intent of Section 1233 of the health care bill which talks about end of life planning.
Here is more on the myth of 'death panels', a quick summary of end of life planning up till recently, and what the new legislation is attempting to do.
The Myth of 'Death Panels'
First, there is a myth going about that states that health care legislation includes a "panel" which will ration health care to seniors or those with terminal illnesses. Sarah Palin gave this myth a lot of power in early August when she misinterpreted end-of-life consultations (suggested to help ease grief and reduce health care costs for familiies facing terminal illnesses) as 'death panels'. The sinister name, 'Death Panels', has scared many away from including end of life planning, including an NPR correspondent reflecting on a townhall hosted by Senator Robert Mendez (D-New Jersey). End of life planning is a significant cost that needs to be addressed by successful health care reform. Here are some more opinions on this myth:
- http://www.healthcarelawyerblog.com/2009/08/no_need_to_run_from_advance_...
- http://tpmcafe.talkingpointsmemo.com/talk/blogs/robert_reich/2009/08/sar...
Need for Counseling
Why, in a bill of financial details, is Section 1233 discussing counseling? Does not 'counseling' aim for the emotional and mental aspects of a situation? To understand the movement for counseling, a quick review of current end of life planning is prudent.
How End Of Life Planning Is Done Now
Generally, an incapacitated patient is brought in by family members to be diagnosed as terminally ill. Medicare foots the cost of life support, which is very expensive even though a third of people have some sort of advance directives prepared on what to do if they reach a vegetative state.
Then, in 1997 a ban on assisted suicide specifically allowed doctors to honor such advance directives. However, the problem remained that many still did not plan advance directives.
Last year a mandatory chat on end of life planning was put into place. This chat would be given by the doctor to the patient as part of a Medicare orientation. It would only be given once, and the doctors are not paid to give this chat.
See these links for more info on how end of life planning is down currently:
- Washington Post Article by Charles Lane - http://www.washingtonpost.com/wp-dyn/content/article/2009/08/07/AR200908...
- "SEC. 1233. ADVANCE CARE PLANNING CONSULTATION" on page 424 of this pdf - http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-0...
End of Life Planning And Section 1233
Now, Section 1233 of the health care reform bill incents doctors to start a dialog with a patient on end of life planning, including optins for pulling the plug. The idea is to have more people provide advance directives with the hopes that fewer will opt for expensive life support care, especially if they cannot afford it.
There are two issues people have with this. The first issue is that it seems unethical for the Federal Government to pay doctors to start this conversation. It feels like the government is paying the doctors to make seniors sign to a termination order in their advance directives.
Although the choice is upto the patient, the doctor carries enough authority that the patient may submit to signing advance directives without thinking the issues through completely. This is the second issue, that patients may end up choosing termination orders simply because 'the doctor said it was a good choice.'
Here is the actual text of section 1233 so you may read and interpret it for yourself:
- "SEC. 1233. ADVANCE CARE PLANNING CONSULTATION" on page 424 of this pdf - http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-0...
