August 2, 2009 in Nation/World

Health reform opponents put scare in seniors

Counseling provision fanned into talk of euthanasia
Ceci Connolly Washington Post
 
Associated Press photo

President Barack Obama participates in an AARP tele-town hall meeting on health care on Tuesday in Washington.
(Full-size photo)

WASHINGTON – A campaign on conservative talk radio – fueled unintentionally by President Barack Obama’s calls to control exorbitant medical bills – has sparked fear among senior citizens that the massive health reform bill moving through Congress will lead to end-of-life “rationing” and even “euthanasia.”

The controversy stems from a proposal to pay physicians who counsel elderly or terminally ill patients about what medical interventions they would prefer near the end of life and how to prepare instructions such as living wills. Under the plan, Medicare would reimburse doctors for one session every five years to confer with a patient about his or her wishes and how to ensure those preferences are followed. The counseling sessions would be voluntary.

But on right-leaning radio programs, religious e-mail lists and Internet blogs, the proposal has been described as “guiding you in how to die,” “an ORDER from the Government to end your life,” promoting “death care,” and, in the words of anti-abortion leader Randall Terry, an attempt to “kill granny.”

Although the counseling provision is a tiny sliver in a behemoth bill, the skirmish over end-of-life care, like arguments about abortion coverage, has provided ammunition to Obama’s opponents and threatened to derail the president’s broader health care agenda. At a forum sponsored by the seniors group AARP intended to pitch comprehensive reform, Obama was asked about the frightening “rumors.” He used the question to promote living wills, noting that he and the first lady both have them.

The side battle also undercuts what many say is the more fundamental challenge of discussing sensitive, costly societal questions about how to align patient wishes at the end of life with financial realities, for both the family and taxpayers.

“I don’t think it’s about cutting costs; it’s about quality,” said Tia Powell, director of the Montefiore-Einstein Center for Bioethics. Pointing to extensive research, she said: “The good news is if you get people in an environment that is of their choosing, where there is support and they have good pain control, it is very likely to extend their life.”

Not since 2003 when Congress and President George W. Bush became involved in the death of Terry Schiavo, who lay in a vegetative state in a hospice in Florida, have lawmakers waded into the highly charged subject, said Howard Brody, director of an ethics institute at the University of Texas Medical Branch at Galveston.

Betsy McCaughey, who helped defeat President Bill Clinton’s health care overhaul 16 years ago, appears to have initiated the attacks on talk radio, telling former GOP Sen. Fred Thompson that mandatory counseling sessions with Medicare beneficiaries would “tell them how to end their life sooner” and would teach the elderly how to “decline nutrition … and cut your life short.”

House Minority Leader John Boehner, R-Ohio, and Republican Policy Committee Chairman Thaddeus McCotter, R-Mich., said they object to the idea because it “may start us down a treacherous path toward government-encouraged euthanasia.”

Brody, however, says the proposal to reimburse counseling sessions “is an excellent idea,” because too few doctors or adult children know what an elderly person wants, even sometimes when the patient has signed a medical directive.

About one-third of Americans have living wills or a document designating a health care proxy who would make decisions if they become incapacitated, said Barbara Coombs Lee, president of Compassion & Choices, a nonprofit organization that focuses the rights of the terminally ill. “But it’s alarming how rarely they actually get honored because often doctors haven’t familiarized themselves with the patient’s wishes,” she said.

In the past two weeks, AARP has fielded a few thousand calls from people who mistakenly believe that the legislation would require every Medicare recipient to “choose how they want to die,” said James Dau, a spokesman for the seniors group.

Though he is “willing to give the benefit of the doubt” to some who might be confused by the discussion, Dau complained that the effort to “intentionally distort” the proposal “is just plain cruel to anyone who is forced to make one of these difficult decisions at the end of life.”

The American Medical Association, which supports the provision, has received similar inquiries and protests from patients who fear doctors will begin denying care late in life.

“These are important discussions everyone should have when they are healthy and not entering a hospital so they are fully informed and can make their wishes known,” said association President James Rohack. “That’s not controversial; it’s plain, old-fashioned, patient-centered care.”

After letting the controversy simmer on talk radio and the blogosphere, expecting that it might blow over, Democrats have begun to fight back.

The claims of mandatory counseling and euthanasia “are blatantly false,” Reps. Earl Blumenauer, D-Ore., and Sander Levin, D-Mich., wrote colleagues. The accusations are “as offensive as they are untrue.”


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