Thursday, August 13, 2009

Bad for you health?

Some previous thoughts on these alleged death panels, here. Now… the full Monty.

Executive summary: Although our review of Section 1233 does not turn up any “death panels”, the language in that section contains enough wiggle room for these “counseling” sessions to produce unsavory situations and outcomes because of the inevitable rationing that will come with government-managed healthcare.

There’s been a lot of buzz about these alleged death panels that will be part and parcel to Obamacare (side note: we need to find another term for Obamacare. The President keeps calling the healthcare reform bill that was cobbled together by 3 House committees, “my proposal” or “my plan” – he hasn’t proposed squat). In his wonderfully orchestrated townhall meeting a couple of days ago, the President said that any end-of-life counseling would be strictly voluntary.

Yahoo! Did their own fact-checking by… talking to a priest. Here’s the exchange.

Q: Does the health care legislation bill promote "mercy killing," or euthanasia?
A: No.

Q: Then what's all the fuss about?
A: A provision in the House bill written by Rep. Earl Blumenauer, D-Ore., would allow Medicare to pay doctors for voluntary counseling sessions that address end-of-life issues. The conversations between doctor and patient would include living wills, making a close relative or a trusted friend your health care proxy, learning about hospice as an option for the terminally ill, and information about pain medications for people suffering chronic discomfort.
The sessions would be covered every five years, more frequently if someone is gravely ill.

Q: Is anything required?

Monsignor Charles Fahey, 76, a Catholic priest who is chairman of the board of the National Council on Aging, a nonprofit service and advocacy group, says no.

"We have to make decisions that are deliberative about our health care at every moment," Fahey said. "What I have said is that if I cannot say another prayer, if I cannot give or get another hug, and if I cannot have another martini — then let me go."

Ladies and Gentlemen, the wit, wisdom and humor of Monsignor Charles Fahey. Let’s give it up for his Excellency… he’ll be here all week.

So, is the Monsignor correct? Yes and no. Let’s roll the tape. Here is the money paragraph from Sec. 1233 Advance Care Planning Consultation:

(For purposes of ease of reading and our own sanity in attempting to transcribe this .pdf file we took some liberties with respect to the construction of Sec. 1233. It is our heartfelt intent that the spirit of the bill is contained herein)

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…. (other bad stuff)…

A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.

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 –

Effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual.

The level of treatment indicated under (above paragraph) may range from an indication for a full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items –

The intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems.
The individuals desire regarding transfer to a hospital or remaining at the current care setting.
The use of antibiotics; and
The use of artificially administered nutrition and hydration.

(italics and emphasis, ours)

Conclusion: First and foremost, this legislation, because of the Byzantine fashion in which it is written should be opposed on principle alone. Well, all legislation is written in that manner. Perhaps, but we all reserve the right to be smarter than we used to be and nothing this important should give someone a headache while trying to read it, let alone interpret it.

So while there does not appear to be a death panel, per se, the vague manner in which the language is crafted leaves plenty of wiggle room for physicians to steer patients towards decisions that would lead to a lessening of treatment(s), malnourishment, dehydration and a cutback on anti-biotics.

And if you believe, as we do, that government-managed healthcare will lead to shortages and thus the eventuality of rationing, one can connect the dots to see where this is all going.

Benefit of the doubt: Denied. We’ve heard too much already with respect to what the President himself has related as to the potential of rationing end-of-life care and the immutable laws of economics when it comes to who’s paying for what to let this slide.

The current healthcare reform bill as written, will indeed impose pressure on physicians and thus their patients into decisions that will not have their personal-health best interests at heart with specific respect to end-of-life decisions.

At the end of the day: Keep your politics off my body.


Foxfier said...

Short version:
Compassion and Choices, formerly the Hemlock Society, is claiming credit for section 1233.

Should we thus believe it has no use at all for getting folks to off themselves?

B-Daddy said...

I agree with denying the benefit of the doubt after what we see in Oregon, where the state will pay for for the drugs to kill you but not the one's to keep you alive. See my earlier post on Oregon and state funded and encouraged assisted suicide.