Monday, August 10

Scared to Death by Section 1233? The Facts May Help

In July, Rep. John Dingell of Michigan and eight fellow Democrats (Rep. Robert Andrews [D, NJ-1], Rep. Dale Kildee [D, MI-5], Rep. Carolyn Maloney [D, NY-14], Rep. George Miller [D, CA-7], Rep. Frank Pallone [D, NJ-6], Rep. Charles Rangel [D, NY-15],Rep. Fortney Stark [D, CA-13], and Rep. Henry Waxman [D, CA-30]) introduced H.R. 3200, America's Affordable Health Choices Act of 2009--a.k.a "the health care reform bill", in the House. The bill includes Section 1233, "Advance Care Planning Consultation," which requires Medicare to pay for one session of end-of-life counseling every five years for the purpose of:

A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
D) The provision by the practitioner of a list 13 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 through the Older Americans Act of 1965).
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.

On July 18, Rep. John Boehner (R-Ohio) said that the House's health care reform bill could be "a slippery slope for a more permissive environment for euthanasia, mercy-killing and physician-assisted suicide because it does not clearly exclude counseling about the supposed benefits of killing oneself."

Last week, Sarah Palin wrote that she doesn't want her parents or her disabled son "to stand in front of Obama's 'death panel' so his bureaucrats can decide . . . whether they are worthy of health care. Such a system is downright evil."

Is this true, let the bill speak for itself:

In Section 1233 of the original version of the House bill, Congress requires Medicare to cover one session of "advance care planning consultation" every five years for Medicare patients to talk about living wills, hospice care, durable powers of attorney and more. Does the bill require Medicare patients get counseling? Nope. Does it prevent counselors from raising assisted suicide and euthanasia with patients as an option? Nope.

So with a legitimate gray area in the bill, Blue Dog Rep. Mike Ross (D-Ark.), who along with Baron Hill of Indiana, Jim Matheson of Utah, Zack Space of Ohio, John Barrow of Georgia, Bart Gordon of Tennessee, and Charlie Melancon of Louisiana, struck a deal with Rep. Henry Waxman to narrow the health care bill's scope and cost. Ross' amendment to the bill addresses the question of end-of-life care.

Ross' amendment makes it illegal for counselors to promote or list as an option suicide or assisted suicide. Ross also states that the counseling is entirely optional, and that seeking counseling on a living will, for example, will not be interpreted by a hospital as declining full and aggressive treatment. For more on states' stands on assisted suicide, see here.

In its current form, the health care reform bill does not push euthanasia or assisted suicide. Rather it prevents health care providers from discussing these options. If anything, people should be more concerned that a physician is unable to discuss all options to their patient, rather than being worried that the physician will force euthanasia on an unwilling patient.

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