Obama Health Bill: Those on Social Security - Mandatory Counseling on Asst. Suicide

On Page 425 of Obama’s health care bill, the Federal Government will require EVERYONE who is on Social Security to undergo a counseling session every 5 years with the objective being that they will explain to them just how to end their own life earlier. Yes...They are going to push SUICIDE to cut medicare spending!!! And no, I am NOT SH—ing YOU! So those of you who voted for Obama have now put your own parents in dire straights...Congratulations!

Rahm Emanuel's BROTHER Ezekiel Emanuel was appointed as the Obama Administration Healthcare Advisor and has authored articles explaining in a dry bureaucratic tone that government run health care spending will be directed to those most useful to the state: " Because none of the currently used systems satisfy all ethical requirements for just allocation, we propose an alternative: the complete lives system. This system incorporates five principles (table 2): youngest-first, prognosis, save the most lives, lottery, and instrumental value.5 As such, it prioritises younger people who have not yet lived a complete life and will be unlikely to do so without aid. Many thinkers have accepted complete lives as the appropriate focus of distributive justice: “individual human lives, rather than individual experiences, [are] the units over which any distributive principle should operate.”1, 75, 76 Although there are important differences between these thinkers, they share a core commitment to consider entire lives rather than events or episodes, which is also the defining feature of the complete lives system. Consideration of the importance of complete lives also supports modifying the youngest-first principle by prioritising adolescents and young adults over infants (figure). Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. Similarly, adolescence brings with it a developed personality capable of forming and valuing long-term plans whose fulfilment requires a complete life.77 As the legal philosopher Ronald Dworkin argues, “It is terrible when an infant dies, but worse, most people think, when a three-year-old child dies and worse still when an adolescent does”;78 this argument is supported by empirical surveys.41, 79 Importantly, the prioritisation of adolescents and young adults considers the social and personal investment that people are morally entitled to have received at a particular age, rather than accepting the results of an unjust status quo. Consequently, poor adolescents should be treated the same as wealthy ones, even though they may have received less investment owing to social injustice." http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60137-9/fulltext?_eventId=login

Here is the appropriate section...

15 SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.
16 (a) MEDICARE.—
17 (1) IN GENERAL.—Section 1861 of the Social
18 Security Act (42 U.S.C. 1395x) is amended—
19 (A) in subsection (s)(2)—
20 (i) by striking ‘‘and’’ at the end of
21 subparagraph (DD);
22 (ii) by adding ‘‘and’’ at the end of
23 subparagraph (EE); and
24 (iii) by adding at the end the fol
25 lowing new subparagraph:
1 ‘‘(FF) advance care planning consultation (as
2 defined in subsection (hhh)(1));’’; and
3 (B) by adding at the end the following new
4 subsection:
5 ‘‘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, including the national toll-free hotline, the ad-
1 vance care planning clearinghouses, and State legal
2 service organizations (including those funded
3 through the Older Americans Act of 1965).
4 ‘‘(E) An explanation by the practitioner of the
5 continuum of end-of-life services and supports avail6
able, including palliative care and hospice, and bene7
fits for such services and supports that are available
8 under this title.
9 ‘‘(F)(i) Subject to clause (ii), an explanation of
10 orders regarding life sustaining treatment or similar
11 orders, which shall include—
12 ‘‘(I) the reasons why the development of
13 such an order is beneficial to the individual and
14 the individual’s family and the reasons why
15 such an order should be updated periodically as
16 the health of the individual changes;
17 ‘‘(II) the information needed for an indi18
vidual or legal surrogate to make informed deci19
sions regarding the completion of such an
20 order; and
21 ‘‘(III) the identification of resources that
22 an individual may use to determine the require23
ments of the State in which such individual re24
sides so that the treatment wishes of that indi25
vidual will be carried out if the individual is un-
1 able to communicate those wishes, including re2
quirements regarding the designation of a sur3
rogate decisionmaker (also known as a health
4 care proxy).
5 ‘‘(ii) The Secretary shall limit the requirement
6 for explanations under clause (i) to consultations
7 furnished in a State—
8 ‘‘(I) in which all legal barriers have been
9 addressed for enabling orders for life sustaining
10 treatment to constitute a set of medical orders
11 respected across all care settings; and
12 ‘‘(II) that has in effect a program for or13
ders for life sustaining treatment described in
14 clause (iii).
15 ‘‘(iii) A program for orders for life sustaining
16 treatment for a States described in this clause is a
17 program that—
18 ‘‘(I) ensures such orders are standardized
19 and uniquely identifiable throughout the State;
20 ‘‘(II) distributes or makes accessible such
21 orders to physicians and other health profes22
sionals that (acting within the scope of the pro23
fessional’s authority under State law) may sign
24 orders for life sustaining treatment;
1 ‘‘(III) provides training for health care
2 professionals across the continuum of care
3 about the goals and use of orders for life sus4
taining treatment; and
5 ‘‘(IV) is guided by a coalition of stake6
holders includes representatives from emergency
7 medical services, emergency department physi8
cians or nurses, state long-term care associa9
tion, state medical association, state surveyors,
10 agency responsible for senior services, state de11
partment of health, state hospital association,
12 home health association, state bar association,
13 and state hospice association.
14 ‘‘(2) A practitioner described in this paragraph is—
15 ‘‘(A) a physician (as defined in subsection
16 (r)(1)); and
17 ‘‘(B) a nurse practitioner or physician’s assist18
ant who has the authority under State law to sign
19 orders for life sustaining treatments.
20 ‘‘(3)(A) An initial preventive physical examination
21 under subsection (WW), including any related discussion
22 during such examination, shall not be considered an ad23
vance care planning consultation for purposes of applying
24 the 5-year limitation under paragraph (1).
1 ‘‘(B) An advance care planning consultation with re2
spect to an individual may be conducted more frequently
3 than provided under paragraph (1) if there is a significant
4 change in the health condition of the individual, including
5 diagnosis of a chronic, progressive, life-limiting disease, a
6 life-threatening or terminal diagnosis or life-threatening
7 injury, or upon admission to a skilled nursing facility, a
8 long-term care facility (as defined by the Secretary), or
9 a hospice program.
10 ‘‘(4) A consultation under this subsection may in11
clude the formulation of an order regarding life sustaining
12 treatment or a similar order.
13 ‘‘(5)(A) For purposes of this section, the term ‘order
14 regarding life sustaining treatment’ means, with respect
15 to an individual, an actionable medical order relating to
16 the treatment of that individual that—
17 ‘‘(i) is signed and dated by a physician (as de18
fined in subsection (r)(1)) or another health care
19 professional (as specified by the Secretary and who
20 is acting within the scope of the professional’s au21
thority under State law in signing such an order, in22
cluding a nurse practitioner or physician assistant)
23 and is in a form that permits it to stay with the in24
dividual and be followed by health care professionals
25 and providers across the continuum of care;
1 ‘‘(ii) effectively communicates the individual’s
2 preferences regarding life sustaining treatment, in3
cluding an indication of the treatment and care de4
sired by the individual;
5 ‘‘(iii) is uniquely identifiable and standardized
6 within a given locality, region, or State (as identified
7 by the Secretary); and
8 ‘‘(iv) may incorporate any advance directive (as
9 defined in section 1866(f)(3)) if executed by the in10
dividual.
11 ‘‘(B) The level of treatment indicated under subpara12
graph (A)(ii) may range from an indication for full treat13
ment to an indication to limit some or all or specified
14 interventions. Such indicated levels of treatment may in15
clude indications respecting, among other items—
16 ‘‘(i) the intensity of medical intervention if the
17 patient is pulse less, apneic, or has serious cardiac
18 or pulmonary problems;
19 ‘‘(ii) the individual’s desire regarding transfer
20 to a hospital or remaining at the current care set21
ting;
22 ‘‘(iii) the use of antibiotics; and
23 ‘‘(iv) the use of artificially administered nutri
24 tion and hydration.’’.
1 (2) PAYMENT.—Section 1848(j)(3) of such Act
2 (42 U.S.C. 1395w-4(j)(3)) is amended by inserting
3 ‘‘(2)(FF),’’ after ‘‘(2)(EE),’’.
4 (3) FREQUENCY LIMITATION.—Section 1862(a)
5 of such Act (42 U.S.C. 1395y(a)) is amended—
6 (A) in paragraph (1)—
7 (i) in subparagraph (N), by striking
8 ‘‘and’’ at the end;
9 (ii) in subparagraph (O) by striking
10 the semicolon at the end and inserting ‘‘,
11 and’’; and
12 (iii) by adding at the end the fol13
lowing new subparagraph:
14 ‘‘(P) in the case of advance care planning
15 consultations (as defined in section
16 1861(hhh)(1)), which are performed more fre17
quently than is covered under such section;’’;
18 and
19 (B) in paragraph (7), by striking ‘‘or (K)’’
20 and inserting ‘‘(K), or (P)’’.
21 (4) EFFECTIVE DATE.—The amendments made
22 by this subsection shall apply to consultations fur23
nished on or after January 1, 2011.

SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.

(a) MEDICARE.—

(1) IN GENERAL.—Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—

(A) in subsection (s)(2)—

(i) by striking ‘’and’’ at the end of subparagraph (DD);
(ii) by adding ‘’and’’ at the end of subparagraph (EE); and
(iii) by adding at the end the following new subparagraph:

P. 425

‘’(FF) advance care planning consultation (as defined in subsection (hhh)(1));’’; and

(B) by adding at the end the following new subsection: ‘’Advance Care Planning Consultation ‘’(hhh)(1) Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:

‘’(A) An explanation by the practitioner of advance care planning, including key questions and
considerations, important steps, and suggested people to talk to.

‘’(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.

‘’(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.

‘’(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the ad-

P. 426

vance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).

‘’(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

‘’(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include—

‘’(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;

‘’(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and

‘’(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is un-

P. 427

able to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).

‘’(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State—

‘’(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and

‘’(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).

‘’(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that—

‘’(I) ensures such orders are standardized and uniquely identifiable throughout the State;

‘’(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment;

P. 428

‘’(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and

‘’(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.

‘’(2) A practitioner described in this paragraph is—

‘’(A) a physician (as defined in subsection (r)(1)); and

‘’(B) a nurse practitioner or physician’s assistant who has the authority under State law to sign orders for life sustaining treatments.

‘’(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).

P. 429

‘’(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.

‘’(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.

‘’(5)(A) For purposes of this section, the term ‘order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that—

‘’(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care
professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;

P. 430

‘’(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;

‘’(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and

‘’(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.

‘’(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items—

‘’(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;

‘’(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;

‘’(iii) the use of antibiotics; and

‘’(iv) the use of artificially administered nutrition and hydration.’’.

P. 431

Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.