The New York Times is reporting that the Obama administration has implemented end of life planning within Medicare through new Medicare regulations. During the health care reform debate this information was targeted as “death panels.”
However, I would characterize the process as common sense.
Patients do need to know options for themselves and their families. In fact, a prudent person will plan way ahead with the proper legal documents expressing their wishes well in advance of an emotional period during a serious and perhaps terminal illness.
Nevertheless, you can expect a significant backlash and the cry of death panels once again. Understand the facts before you draw conclusions. Some individuals will see this as government involvement in telling people how to end their life, but the fact is that doctors routinely advise patients about this topic. What is changing is that Medicare will reimburse for the time spent on such counseling. One must have a very cynical view of other human beings to believe that this process will result in doctors encouraging people to die sooner rather than later.
Related Articles
- Upcoming Obama Regulation Will Likely Revive “Death Panels” Rhetoric (themoderatevoice.com)
- Death Panels issue raised by Medicare Regulation-Your Funeral Guy (yourfuneralguy.wordpress.com)
- White House To Encourage End-Of-Life Planning; Expect RWNJ’s To Talk “Death Panels” Again (alan.com)
QUINNSCOMMENTARY 
If this is not targeted to those who we wish to discourage from heroic and other intensive health measures, why target older and disabled individuals by limiting this counseling to Medicare-eligibles? Why limit it to situations where taxpayer funds are at risk – where politicians have deliberately over-committed and deliberately underfunded/underdelivered?
Is this really an issue to be discussed solely between the patient and her physician without input from others?
Among other things, cognitive impairment is more common with advanced age, and can undermine an older patient’s ability to make decisions about medical care – and certainly, about advance directives.
While I don’t have a comparable study about medical decision-making, a recent study suggests your cognitive ability to make financial decisions reaches its peak, on average (and averages can be deceiving) at age 53!!! Which is more complex, more difficult, more stressful??? See…
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=973790
In terms of appropriate setting, not sure why we would have the discussion about advance directives, decisions that are as grounded as much in legal, moral and religious issues as in medical issues without consulting legal counsel and other family members. Of course, that would not be the situation if Health Reform had included advance directives as part of minimum essential benefits under ACA … where such advance directives are completed in advance of severe medical conditions, pain/suffering and cognitive impairment.
It is one thing to ask the simple question. It is another thing to ask the question among those who already have medical issues and to help shape the response such as by having the physician answer questions that would compare aggressive treatment of acute medical conditions with palliative treatment – perhaps designed to steer the individual in one direction or another?
I’m not Medicare-eligible, and I have advance directives (will, durable power of attorney for health care, living will, etc.) I’d bet you had them before becoming Medicare-eligible, too, right?
Anyway, I have major concerns when the government starts writing regulations that are deliberate, intentional overreach – particularly where specific sections of the new Health Reform law previously included authorization but Congress specifically removed those provisions as part of the Health Reform activity – essentially, it means these regulations are written out of thin air and inconsistent with the history and construction of the ACA – which lacks any such enabling provisions.
Finally, consider the ping pong of executive orders about the “gag” rule – implemented by Reagan, reversed by Clinton, implemented by Bush II, reversed by Obama (after 3 days in office in 2009)….
So, when the R’s take over the white house (as they someday will), will we see this dropped? Why not get it right?
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