How End of Life Medicare Counseling Could Become Persuasion to Refuse Treatment

The controvers over the end of life counseling section of the House health care reform bill has raised fears that such counseling could become persuasion to refuse care—particularly since the point of the agenda is to cut costs.  Over at Secondhand Smoke , I illustrate the potential problem by quoting from a model advance health care directive, published by a major bioethics institute, that has boilerplate language both refusing care and authorizing the signer to be a participant in medical experimentation. Patients who want treatment have to scratch out the boilerplate.

If this provision remains in the reform bill, amendments are needed to ensure that any counseling is not outcome directed.  I offer a few suggestions here .