First, Do No Harm. THEN Kill Your Patients?

August 4, 2009  
Filed under General Interest

A lot of people are seriously misconstruing a provision in the America’s Affordable Health Choices Act (H.R. 3200), which enjoys broad support in Congress. The provision provides coverage under Medicare for people to TALK TO THEIR OWN DOCTOR (read: Consultation with your primary care physician – not some government employee) about their wishes and health care preferences (i.e. Living Will).

The provision in the bill speaks to the fact that the Government will pay the CONSULTATION FEES that doctors (and other professionals) often charge just to talk to you. As someone who had to pay an attorney to discuss these matters when I had my Living Will, Power of Attorney for Health Care, Durable Power of Attorney, etc. done, I can tell you that I did not get this consultation for free. I can also tell you that I would much rather have all this done now, while I am “of sound mind and body” (OK, so maybe the “sound mind” part is subjective), then to put my family through the ordeal of having to make these decisions for me. Furthermore, I would never want to have to put my loved ones in the position of having to live with their decisions for the rest of their lives, always wondering if they “did the right thing.” Bottom line is, if you can get this extremely important CONSULTATION done, and the Government (i.e. Medicare) is willing to pay for it, then why not get it done?

There are a lot of bogus rumors being spread by those who are anti-health reform. The vast majority of people engaged in fear mongering have not actually read the bill, or if they did, they’re interpreting it based on their own financial interests — lobbyists, insurance companies, pharmaceutical companies and politicians who have been getting fatty contributions from those who are paying millions of dollars to save their multi-million dollar salaries. However, there is absolutely nothing in this provision that says the Government is going to send someone out to your house every 5 years and ask, “How do you want to die?” There’s absolutely nothing in this provision that says the Government is going to start killing off old people OR pay for abortions. There’s absolutely nothing “Kevorkian” in this provision.

It does, however, clearly state that your decisions are between YOU and YOUR DOCTOR OF CHOICE; not between you and some DMV clerk, or Postal Employee, or any some other randomly selected Government employee. Presumably, you will discuss these matters with a doctor you’ve already been seeing, who knows you personally, knows your health concerns, and will – no matter what – adhere to the The Hippocratic Oath that includes the promise “to abstain from doing harm.” That means your doctor is not going to try to talk you into taking your own life.

If you truly care about this provision, and Health Care Reform in general, you will take a few minutes to read the bill for yourself, and do your own homework. A copy of this PROPOSED bill can be found all over “The Internets.” To make it even easier for you, here’s a snippet of what’s in this piece of legislation. For anyone who would actually like to read more of it, click here for a PDF copy.

5 ‘‘Advance Care Planning Consultation
6 ‘‘(hhh)(1) Subject to paragraphs (3) and (4), the
7 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:
13 ‘‘(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
17 ‘‘(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
20 ‘‘(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
22 ‘‘(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
3 through the Older Americans Act of 1965).
4 ‘‘(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.

The House health care legislation includes a provision (Sec. 1233) that provides seniors with better care as they grapple with these hard questions. This provision extends Medicare coverage to cover the cost of patients voluntarily speaking with their doctors about their values and preferences regarding end-of-life care. These are deeply personal decisions that take thoughtful consideration, and it is only appropriate that doctors be compensated for their time. And, oh by the way, the Government, under this provision, will pay for that consultation.

Health “Scare” Reform Myths:

Myth: Patients will be forced to have this consultation once every five years.
Fact: Advance-planning consultations are not mandatory; this benefit is completely voluntary. The provision merely provides coverage under Medicare to have a conversation once every five years if – and only if – a patient wants to make his or her wishes known to a doctor. If desired, patients may have consultations more frequently if they are chronically ill or if their health status changes.

Myth: Patients will be forced to sign an advance care directive (or living will).
Fact: There is no mandate in the bill to complete an advance care directive or living will. If a patient chooses to complete an advance directive or order for life sustaining treatment, these documents will help articulate a full range of treatment preferences, from full and aggressive treatment to limited, comfort care only. Patients that choose to have these documents can customize them so that their wishes are appropriately reflected.

Myth: Patients will have to see a health care professional chosen by the government.
Fact: There are no government-chosen professionals involved. The legislation simply allows Medicare to pay for a conversation between patient and their doctors if patients wish to talk with their doctor about end of life care preferences.

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