Moving toward death as the default option

posted at 9:12 am on August 3, 2009 by Pundette
[ Healthcare ]   

For background you may read this post in which we discuss the reports that the end-of-life counseling provision in HR 3200 is mandatory, the charges that that claim is a lie being spread to scare the elderly, and ambiguity of the actual provision.

Now I find that much smarter people than I are looking at the bill and finding it dangerously ambiguous.

From Junkfood Science, the argument that HR 3200 could indeed mandate periodic end-of-life counseling. Please go there to read Sandy Szwarc’s well-researched piece.

She draws on the Bioethics Defense Fund for evidence from HR 3200:

The House version of the Obama Health Care Plan provides:

The term “requirement” on page 428, line 22 supports the interpretation that such consultations are mandatory;

Such an interpretation of this vague and overbroad bill would require that the consultation take place every 5 years or more frequently if there is a “significant change in the health condition of the individual”; (p. 428, lines 17-25)

That consultation by an undesignated physician, nurse practitioner or physician assistant “may include the formulation of an order regarding life sustaining treatment”; (p. 429, lines 1-3)

“Order regarding life sustaining treatment” is defined as an “actionable medical order” that “is in a form that stays with the individual and [is] followed by health care professionals and providers across the continuum of care.” (p. 429, line 4-16);

The order may indicate treatment ranging from “full treatment to an indication to limit some or all or specified interventions” including “the use of antibiotics” and “the use of artifically administered nutrition and hydration.” (p. 430, lines 4-17)

What the bill does NOT say:

The wording of the bill does not provide that the individual must consent to the “actionable medical order regarding life sustaining treatment.”

The bill does not clarify whether the end of life counseling is optional for the provider or the patient.

The bill is also silent on whether the physician or other health professional writing the order will be your personal health care provider.

The ambiguity of the bill leaves the door wide open:

SUMMARY: This broad and imprecise bill is wide open to be interpreted as mandating “advanced care planning consultations” — giving the government unprecedented power in shaping who makes the decisions regarding your personal healthcare decisions after the age of 65.

Szwarc’s conclusion concurs with Betsy McCaughey’s: Mandatory or not, the bill provides for coercion of the elderly to sign advance directives.

Szwarc quotes Wesley J. Smith, who agrees that the bill is ambiguous and suggests language that would close the door on interpretations that the counseling would be mandatory:

It sure isn’t clear from the face of the bill and would require exploring the referenced statues I quoted above. And then there is this provision on page 428:

The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State—‘‘(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings;

It shouldn’t be this hard to figure out.

Regardless, if mandatory counseling is not what the president and Congress really have in mind, it would be very easy to correct any confusion:

1. Add a provision stating that the counseling is entirely voluntary–both for the patient and the medical provider. In that way, the regulations–that will be thousands of more pages–promulgated by the agencies to further the purpose of the law won’t be able to require counseling.

2. Add a provision stating that the patient will not lose benefits if he/she refuses counseling or does not sign an advance directive.

3. Add a provision that no service provider will lose compensation for not providing counseling.

4. Add a provision prohibiting the counseling from being directed toward refusing or accepting care–along the same lines of the Kennedy/Brownback bill passed last year to prevent genetic counseling of pregnant women carrying a Down baby from being directed toward abortion.

But wait, there’s a lot more. In the second half of her article, Szwarc give us the history of the “lives not worth living” campaign. Please read. It will turn your blood to ice water. Social engineers are working like the devil to make death the default option. See Wesley Smith’s Obamacare: Example of Why Some Fear “Counseling” About End-of-Life Care Could Become “Persuasion”:

Here is an example of why I believe that the fear is realistic. The Center for Practical Bioethics has published a “Caring Conversations” workbook, in which intimate issues and details of life, death, and end of life options are raised.  Nothing wrong with that, in and of itself, of course.  It all depends on how it is done.

In this regard, it is worth nothing that workbook contains an advance medical directive that has a default position of refusing life-sustaining treatment and participating in medical experimentation when the person will not be restored to health.

Read the rest.

We’ve talked before about the power of the default option. It’s multiplied when applied to the elderly. Remember how vulnerable they are and how much they generally respect their doctors’ advice. Americans need to pay attention to this and take heed of that queasy feeling they’re getting.

Blowback