Health care end-of-life provision causing anxiety among elderly

Washington D.C., Aug 19, 2009 / 11:59 am

Members of the AARP are leaving by the thousands out of concern for the organization’s support for President Obama’s health care reform.  While several issues are to blame, many have expressed concern that Section 1233 of HR 3200 gives doctors an incentive to persuade ill patients that assisted suicide is their best option.

CBS reports that 50,000 – 60,000 have left the AARP since July 1, 2009 due to disagreements on Obama’s health care reform. Even though the AARP does not officially endorse the proposed health care changes, the association is generally seen to be in support of the reform- so much so that even President Obama mistakenly stated last week that the AARP is on board with the administration’s changes.

One section of the bill that has senior citizens as well as younger Americans concerned is section 1233 of HR 3200 which is titled, “Advance Care Planning Consultation.”

The text of the bill describes “advance care planning” as including a consultation between the patient and his or her doctor in which they would discuss and answer questions including future care, living wills, durable powers of attorney, information about a health care proxy and an explanation about end-of-life services that would be available. These services include, according to the text, “palliative care and hospice, and benefits for such services and supports that are available under this title.”

Pro-life organizations such as National Right to Life (NRLC) have spoken out specifically about this section of the bill.  LifeNews.com reports that the NRLC executive director David O. Steen expressed his concern that the bill could pressure ill patients into giving up treatment.

He noted that the bill makes him uneasy:  “it doesn't take a lot to push a vulnerable person — perhaps unwittingly — to give up their right to life-sustaining treatment," he explained.

Jennifer Popik, a medical ethics attorney with NRLC, also mentioned the fear that pushing patients to “prepare advance directives” could “become a means of persuading or pressuring them to agree to less treatment as a means of saving money."

She added that a 2008 JAMA study found that “patients who reported having end-of-life discussions received less aggressive medical care."

Attempting to win over those who oppose the bill, President Obama stated at the AARP town hall on July 28 that he believes the bill “is a good thing.”

The President explained that the section actually “makes it easier for people to fill out a living will” and noted that it puts the patient in control “so she can say whether or not she wants extraordinary measures to be taken to save her life.” 

Obama explained that right now, “most of us don’t give direction to our family members,” so when one becomes ill, “nobody is there to make the decisions” and then the doctor, who doesn’t know your preference, “is making the decisions.”

Obama said that contrary to many rumors, no one will be forcing anyone to fill out a living will, and “certainly nobody is going to be forcing you to make a set of decisions on end of life care based on some bureaucratic law in Washington.”

“It’s putting more power, more choice in the hands of the American people and,” he argued, “it strikes me as a reasonable thing to do.”

However, the President’s words have not assuaged everyone’s fears mainly because Section 1233 was written by two strong pro-euthanasia advocates: Rep. Earl Blumenauer (D-Ore.) and Compassion & Choices.

Oregon Congressman Earl Blumenauer wrote in the Huffington Post on July 28 that he knows “a little bit” about section 1233 “because it’s a bill that I wrote which was incorporated into the overall legislation.”

Blumenauer is also known for being a backer of his state’s “Death with Dignity” law.  Oregon was the first state to permit physician-assisted suicide.

Compassion & Choices, formerly known as the Hemlock Society, also had a hand in promoting section 1233.

On their website on Tuesday, Compassion & Choices noted that they have “worked tirelessly” to include “a provision requiring Medicare to cover patient consultation with their doctors about end-of-life choice.”

Popik, the ethics attorney with NRLC called it “extremely troubling that Compassion and Choices, the principal group that promotes physician assisted suicide throughout the country is not only aggressively promoting these provisions, but claims responsibility for the inclusion of the main provision.”

She added that “Section 1233 allows assisted suicide and euthanasia to be promoted as an option in the places where it is legal (i.e. Washington, Oregon, and Montana)."