End-of-Life Choice, Death with Dignity, Palliative Care and Counseling

Posts TaggedObama Administration

Politics trump policy on ‘death panels’

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By: Brett Coughlin
January 5, 2011 06:34 PM EST

A federal regulation to pay for end-of-life counseling — dubbed “death panels” by critics — has been pulled by the White House . . . .

Barbara Coombs Lee, president of Denver-based Compassion and Choices – an organization that works to improve end-of-life care – said she is disappointed with the decision to pull the reg.

“Including advance planning in the wellness visit was the right thing to do. The volume of data and every respected, knowledgeable expert in the country confirmed that it was the right thing to do. We hope that what the White House has said is true and that this is some minor procedural clean up and that advance planning will be back in the wellness visit,” Coombs Lee said.

A lie, plain and simple

Now we’re talking.  Wednesday night, speaking to the nation and before a joint session of Congress, President Obama very publicly contradicted the outrageous claim that reimbursement for advance directive counseling would encourage seniors to end their lives.

An important step in advancing patient choice, Compassion & Choices has launched a petition drive to urge Congress to include the provision in the final health insurance reform bill. More importantly, the President made two things clear: the people who continue to spread this false rumor do so with malicious intent and their doing so is reprehensible and extraordinary, even in the rough and tumble arena of political speech.

Some of people’s concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim made not just by radio and cable talk show hosts, but by prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Now, such a charge would be laughable if it weren’t so cynical and irresponsible. It is a lie, plain and simple.

Denying the rumor is almost beside the point, after well over a month of proving it false. Back on July 23rd, the non-partisan Politifact project of the St. Petersburg Times, wrote that the “claim that the sessions would ‘tell [seniors] how to end their life sooner’ is an outright distortion,” and that former New York Lt. Governor Betsey McCaughey,  making the statement, “isn’t just wrong, she’s spreading a ridiculous falsehood. That’s a Pants on Fire.” The AARP, a group not usually inclined to dismiss the interests of seniors, called McCaughey’s statement “rife with gross, cruel distortions.” By mid-August, media outlets had already debunked this ridiculous claim over 40 times.

But the lie wouldn’t die. Every time somebody denied, it came back twice as strong, like the heads of the mythological hydra. Even an outrageous claim can frame the debate, as in the apocryphal story about Lyndon Johnson. Even if no one believes the smear you spread, if you can “make him deny it,” you’ve put your opponent on the defensive. In the recess this August, many Senators and members of Congress, instead of discussing the benefits of the bill they were working on, spent their time clarifying their position on legislation that didn’t exist.

When the lies about death counseling in pending legislation began to lose steam, a fresh falsehood surfaced. This time the claim – and those who made it knew that it was just as false – was that our government is providing veterans with a handbook encouraging them to take an early exit from life. The Vietnam Veterans of America called these ‘Death Book’ scare tactics “inexcusable.”

Wednesday, the President denied the claims one more time, but took the further step, more important and long overdue, of calling out the rumor-mongers, and warning them to stop spreading the lies. The Administration, the media and the public should continue to be clear: a lie is a lie.

The silver lining behind this cloud of propaganda is increasingly frequent discussions of real information about end-of-life discussions. Experts on the importance of talking with loved ones and preparing advance directives are getting a wider audience than ever before. The Washington Post last week hosted an online discussion with executives from Gundersen Lutheran Hospital of LaCross, Wis., to discuss end-of-life care. A pioneer in the field, Gundersen has urged Congress to have Medicare compensate physicians for consulting with patients on end-of-life planning.

If we want more people to engage in these discussions so crucial to the quality of their last days, we must support a measure that will make it more likely. As Muriel Gillick wrote last month in the Boston Globe,

Survey after survey indicates that most patients want to have end-of-life discussions but most do not have them.

When physicians are asked why they do not regularly engage in advance care planning with their patients, they report that they do not have the time for such conversations. The legislation under consideration in Congress that would allow physicians to be reimbursed for an advance care planning discussion with their patients is simply an attempt to correct the imbalance between what patients want and clinical reality.

Many hands working together can correct that imbalance. Many voices speaking in unison can drown out the lies. Understanding the importance of making choices for the ends of our lives, we want all Americans to have those choices. Near the end of his address, the President said,

That large-heartedness — that concern and regard for the plight of others — is not a partisan feeling. It’s not a Republican or a Democratic feeling. It, too, is part of the American character — our ability to stand in other people’s shoes; a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand; a belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgment that sometimes government has to step in to help deliver on that promise.

There are two ways you can help raise the voice of truth above the noise of lies.

Sign our petition and ask your friends to do the same. Ask Congress to help us extend that helping hand so that all of us can understand our options and express our choices for how we spend our final days.

Then, join us in Washington, D.C. October and register for Dignity & Choices, a symposium on end-of-life advocacy. Help move our nation’s health care debate beyond angry town halls. Hear from prominent legal, medical, cultural, religious and political leaders. Join a serious exchange of ideas to help craft better policies for end-of-life care. Register today.

HHS “Conscience” Regulation Still in Place

That meddlesome regulation encouraging healthcare workers to obstruct needed treatment considered offensive to their personal beliefs, went into effect January 19. It’s still in place. I’m determined to continue blogging about this issue until it is repealed.

Congress, the administration, or both must act to restore the needs of patients to their rightful priority over the morality of providers. Click here to urge the administration and your representatives to scrub this bad rule from the books.

Understandably, the battle over economic stimulus is occupying everyone’s attention. Fiscal conservatives insist the package contain more tax cuts. Compromising with them has so far had no effect on their votes. The belief system of the many conservatives just won’t allow an “aye” vote to spend public money directly for job creation. Their belief that government just doesn’t do this trumps the current need.

My point is this “conscience” rule is essentially the same issue. We’re in a clash between ideologues and pragmatists — people who place their own dogmatic beliefs above all, and people inclined to rely on pragmatic solutions in times of need or crisis.

Pragmatists definitely follow a moral compass and hold strong beliefs and values. But when confronted with solid evidence that acting on their beliefs will not solve a crisis, pragmatists tend to ask, “What else could work?” and move in a new direction. Ideologues refuse to move on.

This is why the Refusal Rule — called “Conscience Rule” by its proponents — is so dangerous. It’s like a big doggy treat for healthcare bulldogs who would love to sink their teeth into other people’s healthcare decisions.

Many people responded to my first two blogs on this rule commenting that divergent beliefs are an infrequent problem. These people say it’s unlikely that people with strong objections to certain medical treatments would choose to work in a hospital or clinic where the treatments occur.

Before this rule went into effect, that was probably true. But the stated purpose of this rule is to urge ideologues into action. It encourages them to go to work where they can impose their beliefs on the maximum number of medical patients.

It’s right there in the original language of the proposed rule. It seems a New England Journal of Medicine article caught the eye of the people at HHS looking out for the nation’s morality. The study reported on physicians who object on moral grounds to such things as contraception and an end-of-life emergency procedure known as terminal sedation.

Most physicians believe that even if they object to a legal treatment, they still have a duty to tell the patient it is available.. After all, how can patients make informed decisions about their various treatment options if their doctors refuse to disclose all treatment options? But a good number of morality-driven doctors said they don’t tell patients about the treatments they find morally objectionable. The HHS authorities clearly wanted to protect them by establishing a provider’s right to withhold crucial information.

A New York Times editorial enraged the HHS folk by stating that, “Any doctors who cannot talk to patients about legally permitted care because it conflicts with their values should give up the practice of medicine.”

The HHS rule intends to change this by encouraging moral ideologues in every healthcare category to seek employment in the medical system and protect them when they refuse to provide treatments they don’t like. The great “benefit” the rule makers cite is a newly “diverse” and “inclusive” workforce, “in which individuals from many different faiths and philosophical backgrounds are encouraged to participate.”

These dogmatists want to fill our hospitals and clinics with workers who place their beliefs over the needs of their patients. The pragmatist in me says this won’t work well for patients and I intend to keep hammering on Congress until the problem is fixed. Please join me.