A short while ago I wrote about a fear-mongering piece in the Wall Street Journal, written by Betsy McCaughey. It turns out that my imagination was insufficient to comprehend the scope of her audacious mendacity. McCaughey is one of the thugs pushing the lie that the health care reform bill would mandate euthanasia counseling. Her deceitful comments were picked up by Rush Limbaugh and others, and spread across the wackosphere. So what did she say?
The health care reform bill “would make it mandatory — absolutely require — that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner.”
The only thing correct about that statement is the spelling. The actual bill is far less sinister. It allows physicians to be paid for counseling regarding some of the problems of aging (emphasis mine):
..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 advance 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 unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).
I already provide my patients with counseling regarding these issues, but I can’t get paid for it. What the proposed bill would do is make it easier for me to talk to patients once in a while by actually paying me for my time and expertise. I’ve bolded some of the key points above. To think there is anything sinister about this is to be completely ignorant of the problems older people deal with every day.
As you become older, illness, infirmity, and death become more present concerns. Doctors can help guide older folks through this. For example, I encourage my patients (even before they are “old”) to have an advanced directive and to assign a health care proxy. Usually this will involve a written document that states their medical wishes and assigns a specific person to make decisions for them if they are unable to do so themselves. I also discuss various end-of-life issues, such as how to approach fatal illnesses. Hospice care is often covered by insurance, and offers great services. To get hospice care, you generally have to have a prognosis of less than six months. I’d rather refer someone and have them “flunk out” by living too long, then have them suffer and die without support.
I also talk to people about how to approach fatal illnesses in the hospital, including how to approach decisions about mechanical ventilation and CPR. These discussions are rather involved and time-consuming, but necessary for good care. I certainly wouldn’t mind being able to bill for it.
There’s a lot to be concerned about in the proposed health plan. An honest debate is good and necessary, but poisoning the waters with fear-mongering lies is anti-democratic and just plain evil.