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August 14, 2009

‘End of Life’ in Health Care Proposal May be Dropped

Senators may drop the “end of life” provision tucked in the House’s health care reform bill being hotly debated, according to The Wall Street Journal. The provision stipulates that “planning consultations” should take place between senior citizens on Medicare and their physician at least every five years.

Opponents say the provision shows that architects of the health-care overhaul want to ration seniors' care. Democratic lawmakers say no part of the House bill calls for rationing care. Physician counseling would be voluntary.

But growing complaints over the provision are leading key lawmakers to conclude that the health overhaul should leave out any end-of-life counseling provisions. A group in the Senate Finance Committee that is attempting to craft Congress's only bipartisan health bill has decided to exclude such a measure, Senate aides said this week.

Former Alaska Governor Sarah Palin made comments on her Facebook page on August 7 criticizing the bill:

The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

The White House called it a “malicious myth” on the new Health Insurance Reform Reality Check website, launched as part of the White House’s campaign to stop “misinformation being spread by defenders of the status quo."

Cathy Lynn Grossman at USA Today wants to know if you think Palin’s style is ethical. What do you think?


How can you even ask if "bearing false witness" is unethical? You can disagree about a policy without lying about it. Palin in this case just lied about it. (Although CT reporting about it wasn't much better.)

CT yet again fails to demonstrate any integrity on this issue. It is patently false that the proposed health reform "Mandates Euthanasia" or that the disabled and elderly will face "Death Pannels".

Evanelical Christianity has completely lost its way by getting into bed with the GOP. There may be some good reasons to oppose this legislation, but these falsehoods aren't them. Sad to see such cowardly reporting from the entire media, no exception to CT.

Absolutely unethical. It's OK for her to say "I fear this could happen," but not to speak as if it's already a done deal. She's juxtaposing her own anguish for her child onto something else. Of course, Obama has been known to bear false witness as well, so I guess no one knows for sure what will or won't happen. It would have been better if they had just clarified that section instead of removing it.

We're arguing about what the House bill says when in reality we should be asking WHY IS THE HOUSE OF REPRESENTATIVES EVEN WRITING A BILL THAT SPELLS OUT HEALTH CARE TERMS???? Our federal government was never designed for, and therefore has no business, trying to take over any part of the nation's health care. Regardless of what the bill says in any of its parts, it's a horrible idea and will ruin most (if not all) of the decent health care that this nation has left. Doctors and pharmacists won't get paid (public aid in some states is behind on payments to doctors and pharmacists by several months as it is now). Eventually, there will be less incentive to take these positions, and our nation's health care professionals will have to jump ship and do something else to put food on the table. You're arguing about what the bill says? You ought to be terrified that this bill even exists. WAKE UP, PEOPLE!!

I don't get the complaints that the government should get out of health care. They are in health care. They fund medicaid, medicare, all the military doctors, the VA, WIC and a huge percentage of the children in the country. Yes there are problems but unless you want the government to stop funding all of those thing then Congress will still be involved in writing health care legislation. So the question is, what kind of health care legislation do we want them involved in.

A provision that authorizes doctors to talk to their patients about their values and how they want to be treated in serious situations is precisely the type of legislation that I want Congress to be writing. But because of straight up lies, it is likely to politically hot to be included.

Yes, the government needs to stay out of health care. I'm amazed that people are arguing about what's in this bill instead of looking at the bigger picture and realizing that a health care bill shouldn't even exist. Adam S makes a good point (even though this is obviously not the point he's trying to make), the government does fund medicaid, medicare, the VA, WIC, etc. They shouldn't even be doing any of this. Medicaid in some states is behind by several months on payments to doctors' offices and pharmacies. The elderly can get coverage from private insurances. The military and VA coverage ought to be provided by the government just like any other employer provides insurance to its employees and retired employees - through private payers. WIC ought to be done away with or at least drastically scaled back (States can't afford this kind of burden and people need more incentives to find jobs. Endless government handouts don't accomplish this.) Children will receive coverage when their parents get out and find jobs. Above all, out-of-wedlock pregnancies are driving a vast majority of the "necessity" for these handouts. People need to be responsible for the fact that they can't control themselves. So, to sum up, government health care will end up driving our even further into massive debt and will compete so much so with private insurance that private insurance will eventually seize to exist, and drive health care professionals out of their respective fields due to lack of timely payments from the government and lack of money coming from anywhere else (people aren't going to pay cash and the private payers will be out of business). So, the amazing QUALITY of health care that we have in this country will take a massive death blow. I understand that people may argue about accessibility of health care (even though health care isn't inaccessible, most people just don't want to work hard to gain the PRIVILEGE of health care), but the QUALITY of American health care is top tier. Did I miss anything?

Swick said..."the elderly can get coverage from private insurances."..."Children will receive coverage when their parents get out and find jobs." I understand that people may argue about accessibility of health care (even though health care isn't inaccessible, most people just don't want to work hard to gain the PRIVILEGE of health care"

Swick, when you want to join the real world let us all know because you're living in some sort of nasty dreamworld right now.

"Swick, when you want to join the real world let us all know because you're living in some sort of nasty dreamworld right now."

I've explained myself. You make a vague statement like this with no rebuttal or explanation of WHY I'm living in a dreamworld. Explain further how I'm wrong. I work in a pharmacy and know plenty of elderly people who have foregone Medicare in favor of private insurance (even though even Medicare is partially private, but publically subsidized). And as far as children receiving insurance by their parents working and being covered...maybe I'm naive, but how many employers out there offer insurance plans without the option of covering children? I'm guessing very few if any offer no coverage for the children of their employees. Again, where am I wrong here? Maybe I'm just a dreamer (queue music and clouds) thinking people ought to be looking for jobs to support themselves and their families - call me old-fashioned.

Setting aside Sarah Palin's delusional post-fact nonsense -- and setting aside the irresponsible refusal of our host to call it that -- the primary issue here is not whether the final version of the bill will allow Medicare to fund consultations on end-of-life, living-will issues. The main point is that the health care reforms would change the current status quo.

That status quo, please note, is not that end-of-life decisions are a private matter to be decided between an individual or a family and their physicians. The status quo is that these decisions are to be dictated by fiat by the patients' insurance company.

The only exception to that, the only cases in which these decisions are actually left to the patients and doctors, are in the cases in which the patients are 65 or older and covered by Medicare. That federal program doesn't interfere with those decisions. Private insurance companies can interfere. They do interfere. They are, at this very moment, interfering. They may choose not to interfere, but if they do so, it is because that is their choice, not yours or your doctors. They're running the show.

You're free to defend insurer's rights to deny coverage, to use "rescission" to refuse payment, and to overrule patients and doctors routinely on the choice of care, but please don't pretend this argument arises from, or is congruent with, some kind of Christian principle.

You're free to argue against health care reform on libertarian grounds. Or on Hobbesian grounds. Or on the basis of an allegiance to social Darwinism. But to argue against it because you deem it "un-Christian" is utter blasphemy.

Palin's statement is hardly the kind of discourse that we need at this time in America. What makes it even worse is that this comes from someone who claims to be an "evangelical." This is embarassing for Christian people. It is fine to hold strong convicitions, but his kind of fear mongering and ideological posturing betrays a kind of faith that is anzious, insecure, and unreasonable. It is no wonder that anti - religious attacks are on the increase. Palin represents the kind of sterotypical "Christian" they love to caricature and apply to all of us who claim the Christian faith. She not only bears false witness, she IS a false witness when resorts to such tactics in God's name.

Has any of the participants in this discussion participated in an end of life conversation with a doctor?
When my mom was in a nursing home suffering from dementia, her doctor, the chief nurse, my wife and I had a valuable discussion about how to care for her as she neared the end of life. We discussed the limits of extraordinary care that might unnaturally prolong her life as well as the application of common sense medicine that would provide her with comfort and the ability to function to the best of her ability. My mother had previously stated her wishes via a DNR order and a living will. Her doctor wanted to make sure that I (with power of attorney) had seriously considered the issues.
This was, on an emotional level, an unnecessary discussion, but there were some practical parts of the discussion that enabled the nursing home staff and our family to confirm that we were all on the same page.
I see nothing wrong with Medicare or some other Federal funds being used to pay a doctor to have this kind of conversation with a terminally ill patient and his or her family as they together deal with end of life issues.
While I distrust the government's possibly acting like a super-HMO and dislike certain provisions of the 5 different health care reforms being considered in Congress, something has to be done for those who can't afford medical care, can't get insurance because of pre-existing conditions, or are at risk of being dropped by their insurance company because of their recent medical history. Is access to medical care a right or is it just something for those able to pay for it and fortunate enough not to get need it?
For me, this is not an abstract ethical issue. I had by-pass surgery 4 months ago. My wife has twice had surgery during the last decade. I am self-employed and pay for our (very expensive) insurance out of my own pocket. My wife and I, based on observation of what has happened to others, are sure that a late payment of an insurance premium, an incompletely or incorrectly filled out piece of paperwork, or some other minor technicality will be used to provide the grounds for our provider to dump us from their program.

The death panel thing was largely drummed up by political commentators' misreading or deliberate misinterpretation of an article coauthored by Pres. Obama's chief medical advisor, Ezekiel Emanuel, in the January 31st LANCET. The article dealt with the ethical problem facing health care professionals when there are not enough medical resources (such as a flu vaccine or organs for transplant) available to meet everyone's needs. The question is: on what basis do medical professionals decide whose needs have priority? After rejecting the idea that scarce medical resources should be made available only to those able to pay for them, Dr. Emanuel and his coauthors came up with the "Complete Lives System" as a contribution to this continuing ethical debate. Somehow, this became understood as a mechanism for evil government bureaucrats to determine who has to die or gets to live past the age of 74. I believe Dr. Emanuel was deliberately slandered.
The LANCET article is available online for free. One popular
TV political commentator suggested that the article was too technical for his viewers to understand. In my opinion, he was just trying to discourage them from reading it for themselves. It's not difficult at all. I encourage others to read it.

Christianity Today discredits itself by running a blog and allowing it to be run by trolls and anti-Christian posters. They are not representative of Christians at large in the US. It would be better to disable comments altogether if this is how it's going to turn out. These guys can post all day at Kos, Huff, etc.

As a writer, I covered a symposium on "Ethical Alternatives to Assisted Suicide" back when Jack Kevorkian brought assisted suicide into the news. Geoffrey Fieger, attourney to Jack Kevorkian, was part of this. In his opening speech, Fieger dismissed the Hypocratic Oath, said assisted suicide was not a slippery slope, and Defended Dr.Kevorkian as a -compassionate- physician. I remember Judy Gentile's speech too. As director of office programs for handicapper students at MSU she addressed the audience from her wheelchair.Gasping for breaths she addressed the audience, "I would like to rid society of the assumption that my life is of less value than someone else's." Judy suffered from Polio and cancer.

If any President of any nationality suggested government control of healthcare specifying a provision hinting at the E-word...as Christ- followers it would be our duty as American citizens to oppose them -with gentleness and respect. Although healthcare for all seems -compassionate- we cannot, we must not sacrifice the long term on the altar of the immediate. Christian tolerance is defined by God's biblical kind of love, not by worldly compassion or fiscal concerns.

What about those who would like to choose death over an empty or vegetative life? Current laws require that we live until we die of some natural cause. Now is the time to reconsider the whole matter of active euthanasia. Such a decision should be made only by the patient or his previously chosen healthcare power of attorney.

Isn't it a good thing that they don't Manual ali bllomberg, because if they did your comment would not have seen the light of day.

Are you glad now that there's freedom!

This is the last straw. When a magazine that uses the name "Christian" propagates lies and does not correct them (I'm tired of hearing the word "misinformation;" they are LIES), I don't have any need of them. I would remind you of ONE thing and that is what our Lord and Savior Jesus Christ has said about health care and every other kind of care: "Inasmuch as you have done it to the least of these, my brethren, you have done it unto me."

So much for Christian principals that many claim this nation was founded on and which this magazine would claim they represent. You've come a long way, baby!

Why does the government want to involve itself in end-of-life concerns in the first place? Do they wish to teach a market driven morality (limited recources = rationing of medical services)? Or do they hope that seniors will do the right thing and for the sake of society go out quietly into the night and die?(Thank you Joel Stein) Planning for the future is a wise step, but let seniors make their own decisions rather than being corralled by politicians not invested in their(seniors) future.