End of Life Counseling in the Health Care System Transformation Bill

This issue has arisen in recent days. Supporters of H.R. 3200 claim that its end of life counseling provision, section 1233 , is merely voluntary for the patient. But a closer look shows that section 1233 includes conditions and financial incentives for physicians and other health care providers that create a setting in which an elderly patient’s decision to appropriate this option is likely to be less than voluntary.

Writes Charles Lane in this morning’s Washington Post (HT: Jim Gergahty at NRO’s Campaign Spot ):

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.

Patients may refuse without penalty, but many will bow to white-coated authority. 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.

. . . Ideally, the delicate decisions about how to manage life’s end would be made in a setting that is neutral in both appearance and fact. Yes, it’s good to have a doctor’s perspective. But Section 1233 goes beyond facilitating doctor input to preferring it. Indeed, 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.

Read Lane’s entire piece here .

It seems to me that one should be deeply concerned about this, especially if one has elderly parents. If, let’s say, H.R. 3200 or something close to it were to become law and the public option pushes private insurance into near non-existence (as would surely happen with all the incentives in place), then there will no neighboring state to which to run. You won’t be able to take your business elsewhere, since there will be no elsewhere. And to whom will you issue your grievance, a special “health court,” one likely informed by a youth-worshipping culture and a utilitarian bioethics philosophy that sees the elderly (not to mention, handicapped infants ) as burdens that are syphoning away valuable resources that could be put to better use in support of society’s “real persons” and more productive contributors?

If you think my reflections are “fishy,” you can report me to the White House, here . The email address is: flag@whitehouse.gov.

(Originally posted on What’s Wrong with the World )