Blogging nurse Sandy Szwarc of Junkfood Science (h/t: Dr. Rich’s Covert Rationing Blog) has read the language in HR 3200 concerning government-subsidized “end-of-life counseling” for old people, and she’s got it posted on her blog.
For anyone who still thinks that Sarah Palin is a moose-murdering dimwit who can’t tell the difference between a deathbed and a tanning bed, here’s some evidence to the contrary culled by Szwarc from the health-care bill’s Section 1233, euphemistically titled Advance Care Planning Consultation:
“(hhh)(1) Subject to paragraphs (3) and (4), the term `advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:….
“(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).
“(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title…
“(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include—
“(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;:
“(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).`(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.
“(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.
“(5)(A) For purposes of this section, the term `order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that—
“(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;
“(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;
“`(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary)…”
If you manage to plow through all the legalese, you’ll notice the following:
1. There is no provision for the patient to indicate that he or she has actually consented to the “order regarding life sustaining treatment.”
2. The order is supposed to be “standardized”–that is, there’s no room for a patient to craft an indidualized plan for end-of-life care (or its withdrawal) that fits the patient’s own moral and ethical stance on life and death.
3. There’s no requirement, or even suggestion, that the patient might want to consult a lawyer–that is, someone who is in a position to act as the patient’s advocate, to draft a living will or similar document that would reflect the patient’s true wishes and also have binding legal effect.
4. Worst of all, while the end-of-life consultation may not be exactly mandatory, it is mandatory for the physician (or nurse-practitioner or whoever) to keep bringing up the subject at every doctor visit until the patient finally gives in (note all the “shall”s). That will give the patient a five-year reprieve….unless the patient develops a “chronic, progressive, life-limiting disease” (what could that be? high blood pressure? type 2 diabetes?), at which point the relentless badgering will promptly begin again. Throw in the increasing frailty and mental vulnerability of many elderly people, especiallly those in nursing homes (who are also to be badgered relentlessly).
Furthermore, as Szwarc writes:
“Claims that it is not mandatory are most obviously not supported by the bill’s language. It directs healthcare providers that they ’shall’ ensure every Medicare patient receives such counseling every five years. ‘Shall’ means must. Those directives are to become part of the patient’s medical records. The most telling evidence that it will be mandatory is the Expansion of Physician Quality Reporting Initiative provision that makes advance care planning a reportable Pay for Performance measure for every professional providing services to Medicare patients. “Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.” Worse, those measures reportable to the government will be defined and determined by the Secretary of Health and Human Services. Electronic medical records will enable governmental oversight of physicians’ and patients’ adherence and identify those who are noncompliant.”
In other words, your doctor won’t get a “pay for performance” bonus unless he or she can deliver enough advance directives to satisfy the Department of Health and Human Services. Plus your medical records will rat you out as “noncompliant.” Sounds like coercion of the elderly to me.
No death panels? Really?