Obamacare: End of Life Counseling Provisions Improved in Newest Version

The new House Obamacare bill is in and the criticisms about the end of life counseling issues appear to have been addressed seriously.  These are my initial impressions, subject to change.  But I must say, it’s better.  On page 129, the bill states (with my italics):

SEC. 240. DISSEMINATION OF ADVANCE CARE PLANNING INFORMATION.

(a) IN GENERAL.—The QHBP offering entity —4(1) shall provide for the dissemination of information related to end-of-life planning to individuals seeking enrollment in Exchange-participating health benefits plans offered through the Exchange; (2) shall present such individuals with—(A) the option to establish advanced directives and physician’s orders for life sustaining treatment according to the laws of the State in which the individual resides; and (B) information related to other planning tools; and (3) shall not promote suicide, assisted suicide,  euthanasia, or mercy killing.

The information presented under paragraph (2) shall not presume the withdrawal of treatment and shall include end-of-life planning information that includes options to maintain all or most medical interventions.

(b) CONSTRUCTION.— Nothing in this section shall be construed—(1) to require an individual to complete an advanced directive or a physician’s order for life sustaining treatment or other end-of-life planning document; (2) to require an individual to consent to restrictions on the amount, duration, or scope of medical benefits otherwise covered under a qualified health benefits plan; or (3) to promote suicide, assisted suicide, euthanasia, or mercy killing.

The new text blunts the criticisms about end of life counseling made here at SHS and elsewhere.  I am especially pleased that the counseling is not to be directed toward a particular result and that the option of receiving care is to be included in the directives. However, the bill does not, as far as I can tell, guarantee that the provider cannot be sanctioned for not pursuing the issue. Moreover, as Rita Marker told me in a conversation this morning, the language is far from air tight and regulators may interpret it in ways that take back what appears to have been gained. For example, the requirement not to “promote” assisted suicide certainly doesn’t preclude it from being brought up or discussed in the counseling sessions.  And let us not forget, there is still a pending Senate Bill that would deprive providers of payment if they did not offer the counseling.

So, here’s the bottom line as I see it: The House drafters clearly responded to valid criticism—no matter how invalid they claimed it was at the time.  Further improvement is warranted.  Credit Sarah Palin and Betsy McCaughey for bringing so much attention to this important issue that Obamacare pushers were forced to respond.

Don’t get me wrong: The bill still stinks on many levels––e.g., rationing boards.  It is a fiscal disaster. It would empower the bureaucrats to control lives across the breadth of society.  It should be soundly defeated.

There is also more to be said about assisted suicide.  But I’ll do that in a separate post.