With Good Reason Death Panels?

Dec 1, 2009

Earl Blumenauer is a Democratic member of the House of Representatives from Oregon. He took credit recently in the New York Times for authoring the now infamous end-of-life provisions which, in varying forms, are still alive in both House and Senate healthcare reform bills.  Most notorious among these was the 'death panels' provision as coined by Governor Sarah Palin.  

While over the top, the term 'death panel' has stuck, and the burden has been on legislators to convince America that their future health decisions will not be dictated by a panel of Washington bureaucrats. Blumenauer maintains that his intention sprung from a legitimate concern for end-of-life planning which he noted even Sarah Palin endorsed once upon a time. Wrote Blumenauer:

I found it perverse that Medicare would pay for almost any medical procedure, yet not reimburse doctors for having a thoughtful conversation to prepare patients and families for the delicate, complex and emotionally demanding decisions surrounding the end of life. So when I was working on the health care bill, I included language directing Medicare to cover a voluntary discussion with a doctor once every five years about living wills, power of attorney and end-of-life treatment preferences.

Yet, through all the hype about the hype, for the past four months of debate, there has lingered a sense of concern in more measured voices in the debate. The editors of the Washington Times did not back away from using the term (editorial "Death Panels by Proxy," September 25), noting that the Baucus bill (the then current Senate version of the bill) created punitive incentives for doctors to provide less care for patients and, logically, to ration that care among elderly patients. 

The National Right to Life Committee reported last week that while the incentive language is now absent from the current Senate version of the bill (authored by majority leader Harry Reid), the bill remains highly problematic regarding end-of-life issues.  Chief among the problems is the pro-foreshortening of life mentality which it fosters. As NRLC explained in their press release:

Section 936 [of the Reid bill]... provides funding to develop and disseminate "patient decision aids" which are to include "relative cost of treatment or, where appropriate, palliative care options" and to "educate providers on the use of such materials, including through academic curricula" (p. 1110). Money is to be awarded to establish "Shared Decision-making Resource Centers . . . to provide technical assistance to providers and to develop and disseminate best practices . . ." (p. 1112).The concern with this section is the same as that with the promotion of advance care planning. Given the strong views many in the medical community have about poor quality of life and the considerable emphasis on saving costs (along with the Reid bills defective process for selecting the materials the patients receive), the danger is great these measures will in fact subtly or otherwise "nudge" patients in the direction of rejecting life-saving treatment to save costs.

And as my colleague Dorinda Bordlee of Bioethics Defense Fund has observed:

While the rhetoric of "death panels" has been hyped, it should not overshadow the fact that the language in current drafts of healthcare legislation raise legitimate questions about whether "advance care planning consultations" as they are called create a subtle yet effective means of pushing Medicare recipients to "self-ration" - that is, to sign documents or be subject to doctor's orders declining life-sustaining medical treatments years before they may be needed.

  
Elderly and ailing Americans, especially those with diminished means, do not need more "nudging."  Our culture is rife with a radically anti-life, cost-efficient, "get-it-over-with-and-die-and save-us-all-the-money-and-hassle" mentality.  So while it remains prudent to discuss our end-of-life preferences with family and healthcare providers, the dangers of government-regulated or even government-motivated consultations on such matters are glaring and obvious.  
  
These and other pro-life concerns are what might well upend the Reid bill now the focus of debate on the Senate floor. The ultraliberal Huffington Post was quick to concede on Sunday, a day before Senate debate was set to begin, that the crucial 60 member Democratic coalition needed for passage of the bill in the Senate was already breaking apart. So be it. Such putative reform of healthcare is something all Americans are safer without.