Death Panels? Obama Admin May Pay Doctors to Conduct “End of Life” Discussions With Patients

In a recent Politico Magazine article titled, “Let’s Talk About Death Panels,” Harold Pollack urges reviving one of the most notorious proposals that did not make it into the Obama Health Car Law – “advance planning consultations.”

During the debate over Obamacare’s enactment, there was considerable controversy over a provision in an early version under which health care providers would have been paid by Medicare to discuss with their patients whether they would want life-saving medical treatment.

After former Alaska governor and vice-presidential candidate Sarah Palin dubbed the planning sessions “death panels,” the provision was dropped from the law ultimately enacted.

As Pollack acknowledges, “The ‘death panel’ charge stuck because it tapped into the primeval fears of millions of Americans. It’s only human to worry that we might someday be abandoned when we are old and sick, and thus judged to be a social burden. Such worries run especially deep among senior citizens, who had the most reason to feel vulnerable, and who perceived that they had the least to gain from the ACA.”

In the time since the “advance care planning” provisions were struck from the Obama Health Care law, there have been several attempts to resurrect the concept through various stand-alone bills in the House and Senate. Now, according to media reports, the American Medical Association (AMA) is working directly with the Obama Administration to implement reimbursement by administrative action, bypassing Congress.

In to a Stateline Article from the Pew Foundation titled, “Feds to Consider Paying for End-of-Life Planning,” Michael Ollove writes, “The current effort began last year, when the Illinois State Medical Society recommended that the AMA adopt specific medical codes for the reimbursement of doctors for advance care conversations. Medical codes provide a uniform description of hundreds of medical procedures and services and are used by medical providers, hospitals and insurers across the country. In response to the Illinois request, an AMA panel approved a new code for advance planning.”

The AMA is expected to submit the proposal to the Centers for Medicare & Medicaid Services soon so that providers all across the country can be reimbursed for these “advance planning conversations.”

Such federally funded “advance care planning” conversations pose a very real danger, because they are likely to be used to nudge people to reject life-saving medical treatment they might otherwise want.

Advocates of using tax dollars to pay for “advance care planning” claim it is intended to promote neutral, fully informed planning by which patients can be assisted to implement their own values through legally valid advance directives. Unfortunately, however, there is abundant evidence that a combination of cost pressures and the ideological commitment of a significant number of health care providers to limitation of life-saving treatment for those deemed to have a “poor quality of life” would in practice lead to many federally funded advance care planning sessions being used to exercise subtle – or not-so-subtle – pressure to agree to reject life-preserving treatment.

While the advance care planning provision in the early version of what became Obamacare was being debated in Summer 2009, author and blogger Lee Siegel, in general a strong advocate of President Obama’s approach to health care restructuring, wrote:

[O]n one point the plan’s critics are absolutely correct. One of the key ideas under end of-life care is morally revolting.

The section, on page 425 of the [original House] bill, offers to pay once every five years for a voluntary, not mandatory, consultation with a doctor, who will not blatantly tell the patient how to end his or her life sooner, but will explain to the patient the set of options available at the end of life, including living wills, palliative care and hospice, life sustaining treatment, and all aspects of advance care planning, including, presumably, the decision to end one’s life.

The shading in of human particulars is what makes this so unsettling. A doctor guided by a panel of experts who have decided that some treatments are futile will, in subtle ways, advance that point of view. Cass Sunstein, Obama’s regulatory czar, calls this “nudging,” which he characterizes as using various types of reinforcement techniques to “nudge” people’s behavior in one direction or another. An elderly or sick person would be especially vulnerable to the sophisticated nudging of an authority figure like a doctor. Bad enough for such people who are lucky enough to be supported by family and friends. But what about the dying person who is all alone in the world and who has only the “consultant” to turn to and rely on? The heartlessness of such a scene is chilling.

It has become widespread to now talk about treatment as being costly and burdensome, depending on one’s ‘quality of life.” Pollack himself illustrates this, writing, “Under the current system, physicians can bill Medicare for aggressive imaging, procedures and chemotherapies treatments that may bring little patient benefit in advanced illness. Doctors and hospitals are far more handsomely rewarded for the placement of a feeding tube or a ventilator than they are for meeting with patients and families to determine whether these therapies are helpful or wise.”

In a taxpayer-funded advance care planning session, a patient with cancer might well be told chemotherapy provides little benefit because it will leave him or her with a disability and only “prolong life,” without a cure. The extra period of life might be exactly what a person would want, but because the treatment was presented in such a negative way the patient might well be lead to agree to reject treatment.

A major campaign (the subject of a forthcoming NRL News Today article) is now being waged to show videos to patients that are clearly weighted to persuade them to forego cardio-pulmonary resuscitation, and its proponents do not hesitate to cite the financial savings associated with the increased number of viewers (as opposed to patients not subjected to the videos) who agree to DNRs. Importantly, there is no apparent realistic way to adequately monitor the interactions in such tax-funded sessions to ensure that the presentation of options is done in a neutral way, rather than one biased toward rejection of treatment.

A precedent on the federal level is a Veterans Affairs patient decision-making aid that was the subject of considerable discussion during the debate over the Patient Protection and Affordable Care Act, a 53-page production entitled “Your Life, Your Choices.” The booklet had worksheets to fill out for “Current Health,” “Permanent Coma,” “Severe Dementia,” “Severe Stroke” and “A future situation of concern when I might not be able to express my wishes.”

For each of these there was a section on “quality of life.” Only for current health was there a choice to affirm that life is worth living without reservation. For all of the others, the choices were “Life like this would be difficult, but acceptable,” “Life like this would be worth living, but just barely,” and “Life like this would not” – the “not” is underlined – “be worth living.” In each circumstance except current health a negative picture was given. For example, “Terminal Illness” was described as a state in which you “have a lot of discomfort that requires medication [,] are in bed most of the time due to weakness [, and] need help with getting dressed, bathing, and bowel and bladder functions.” You can read more about this at www.nrlc.org/archive/news/2009/NRL07-08/RationingPage1.html; and www.nationalreview.com/articles/228199/your-life-not-worth-living/jim-towey.

Of course, what people experience when terminally ill varies widely depending on the particular illness and many other factors, but this booklet seemed designed to lead people to believe that life with terminal illness will be almost unremittingly bleak. In the words of Paul Malley, President of the national non-profit organization Aging with Dignity, “’Your Life, Your Choices’ encourages our nation’s service men and women to look at illness and disability as things that render life not worth living.”

When “advance planning” is so heavily promoted by advocates of cost-cutting and the “quality of life” ethic, we need to consider it with a critical eye – one that asks “who is driving these conversations, and what will they say to people in a vulnerable position?”

Note: The National Right to Life Committee supports the use of advance directives by which individuals may indicate their wishes regarding medical treatment should they become incapable of making health care decisions; indeed, we promote our own alternative, the “Will to Live,” and make available separate forms complying with the laws of each of the states.

Our concern is that in practice federally funded “advance care planning sessions” are likely to pressure patients into rejecting treatment essential to preserving their lives in a manner they would be unlikely to agree to under conditions of truly informed consent.

LifeNews Note: Jennifer Popik is a medical ethics attorney with National Right to Life. This column originally appeared in its publication National Right to Life News Today.

You are an A$$%OLE...and I find you ignorant, and there is NO APOLOGY DUE.

THIS STATEMENT SPOKEN LIKE A TRUE IDIOT:

“This didn’t start with Obama. It started decades ago. Your family member may very well have voted for Congressholes her entire life who promised him or her a lifetime of ease. If she didn’t, enough of her friends and fellow family members obviously did. That’s my whole point”.

So I guess I can judge you by your family and friends too. Idiot. She never took a dime, that I know of, from the government or anyone else. You are pathetic.

A lot of the elderly no longer actually see a doctor but once a year, their care is transferred to Physician Assistants or Nurse Practitioners....who have scams with local attorneys to find dementia patients, who have money and can be fleeced....one county I know has a whole group doing the lifting of family inheritances via their system. I was amazed at the amount of money they could get from anyone who has a sizable bank account.

Makes you want to take all your savings out in nickels and dump it in the ocean.

Prayer for Those Who Are Terminally Ill

Lord Jesus, you healed so many people during your public ministry. I bring before you now, in prayer, all those who are terminally ill -- those afflicted with cancer, AIDS, and other illnesses.

Look lovingly and compassionately upon them. Let them feel the strength of your consolation. Help them and their families to accept this cross they are asked to carry. Protect them from euthanasia, Lord.

Let them see you carrying their cross with them, at their side, as you once carried yours to Calvary. May Mary be there, too, to comfort them.

Lord Jesus, I know and believe that, if it is your will, you can cure those I pray for (especially N.). I place my trust in you. I pray with faith, but I also pray as you did in Gethsemane: your will be done.

Bless us, Lord, and hear my prayer. Amen.

Reprinted from "Queen of Apostles Prayerbook" with permission of copyright holder, Pauline Books & Media,

If you have any money to give your children, be careful who helps you plan what to do, and even a house in my state would have to be in the child’s name more than 5 years or the state will take it once DSS is involved (and the person does not need to be destitute for them to take over).....DSS looks for ways to pay for their care, after the cash money runs out. They now turn everything into cash for easy access in my state.

The Will no longer means anything, if a disgruntled family member gets an attorney, and has a separate Guardian of the Estate appointed. At that point they will take all furniture, antiques, and personal property...sell it (cheap auctions attended by their friends/family) and put money in the elder persons account for their care, but remember this guardian is getting paid for all this, so it will soon be gone. Check your state and changes made in past couple of years since Obama became President. You will be surprised.

There is some info in this article about another petition at Care.com regarding how parents and children are separated.

http://ezinearticles.com/?Do-Not-Be-Deceived-By-Elder-Abuse-Attorneys-And-Their-Agendas&id=6108256

“After former Alaska governor and vice-presidential candidate Sarah Palin dubbed the planning sessions “death panels,” the provision was dropped from the law ultimately enacted.”

There are now non profits who handle the elderly person’s guardianship ( of the person not the estate) where the state department of social services places them, when all their money runs out for ‘end of life planning’.

Believe me they may have deleted one place that was in the O care act, but it was somewhere else in some language because I know it’s here. Those agencies are fancy names like “HOPE ? or things you would not think of as ‘end of life planning’ groups. This is so the state gets what money there is, then transfers them to that group for guardianship of the person...then ???.

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