The Return Of Death Panel

It is a new year and a new Congress, but the changing of the calendar has served only to usher in new controversy on a settled subject; health care reform. The Affordable Care Act, passed by majorities in both houses, consolidated into one measure according to congressional rules, and signed by the President, is under attack by revisionist conservatives. Lacking any real, democratic basis for repealing the measure, the conservative mainstream media revived the original law’s biggest boogieman; the Death Panel.

You remember the Death Panel, don’t you? A relic from the battle over Clinton’s health care initiative, Betsy McCaughey, went on the Fred Thompson radio show and blew the debate over health reform wide open. She used an increasingly common (and embarrassingly bipartisan) technique for accomplishing her goal; she took a clause out of the bill and lied her ass off about it. Once she let the false cat out of the bag, Governor Palin and others fanned the flames into an inferno. What once was a debate about various market-based fixes to a broken health care delivery system, degenerated quickly into shouting matches and shrill accusations.

The real tragedy of this event goes far beyond the politics or economics of health care reform. Death panel or “end-of-life counseling”, whatever label one uses to describe the rule, don’t relate to a liberal versus conservative issue; this is a Terri Schiavo issue. You might remember the young women who fell into a vegetative state and became the subject of national attention? Her husband made the decision to remove her feeding tubes, believing that is what his wife would have wanted. Her parents filed suit to stop the action, and a court had to make the final decision. In our country, the Schiavo story is repeated on some level every day; terrible decisions and arguments over the desires of loved ones whose wishes can never be known, tear apart thousands of families.

Most American don’t understand the legal options available to them regarding this reality; the fact is we will all die, and many of us will be unable to make decisions regarding how we are cared for as our death approaches. What is more shocking than our own lack of knowledge, is that many practicing physicians share the ignorance. Living wills, medical power of attorney orders, do not resuscitate (DNR’s), and orders for palliative care are all concepts we should understand. If you want to be kept alive along as there is a glimmer of hope, you say so in your living will. If you don’t want to be subject to 90 minutes of chest compressions and other interventions if you have a major heart attack at 90, then you have a DNR. These objects cover the gamut of options for us at the end of our lives, from fighting at all cost to sliding quietly away.

Politically, providing seniors with information about these options, via their general practitioner, seemed like an excellent choice. The first steps to this counseling were taken in the Medicare legislation of 2004, which was a Republican-sponsored law. When Democratic staffers inserted the same essential clause into the structure of the proposed public option, they undoubtedly thought it would be the least controversial measure in the bill. And why not, this is how the infamous Death Panel clause read:

H.R. 3200, page 425: Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:

(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 of national and State-specific resources to assist consumers and their families with advance care planning … .

(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.

(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders …

Not exactly the stuff of rampant government gone crazy is it? As the public option did not survive the process, the rewritten version of this clause (which was substantially longer to crowd out the potential for controversy), did not appear in the final bill. President Obama sought to rectify this by writing the rule directly into Medicare and providing the funding necessary to compensate doctors for these services. The political nonsense referred to above made this move impossible, and more is the pity. Contrast the clause above and the intent of the rules, with new Speaker of the House John Boehner’s interpretation:

This provision may start us down a treacherous path toward government-encouraged euthanasia.

This is politics with integrity and the Speaker’s attempt to “restore civility” to the House? This is the political straw man all over again. This is the same old dysfunctional politics, built on the premise that one does not need to prove that a measure is wrong, one only needs to scare the public. The lack of public knowledge about the medico-legal realities at the end of our lives costs money for sure; more importantly, it is a destructive force on American families that is easily remedied. The Obama Administration was forced to pull back from this measure despite the fact that some conservative stalwarts, pro-life groups to name one, are starting to consider the rules on their merits rather than the politics.

Political branding and the label wars are a part of the process now, as distressingly normal for our democracy as voting. But we the people can take small steps towards the restoration of sanity in our government by calling the politicians and the pundits on the carpet when they use tactics like these. This is an issue worth a real, honest, all-encompassing discussion in our nation, and the John Boehner’s of the world have consigned it to target drone status. Some things, I believe, are too important to be political footballs.

The Rational Middle is listening…

3 thoughts on “The Return Of Death Panel

  1. Scott, thanks for your comments. They illustrate clearly the need for counseling on advanced directives of every type. Your example is another reason why Republicans and Democrats brought the issue to the front in the Medicare discussions of 2004, and why the use of this mythology was so blatantly hypocritical and mean-spirited during the health care debate. It is a real issue, with a simple solution: Medicare funds should be allocated so that doctors, the trusted advocates for their patients, can consult with their clients before the confusing and stressful issues become acute.

  2. I got another call yesterday from Mike Huckabee. He is raising money to fight the Death Panels. That same day, I had sent a patient to face the “death panels” already in existence. My patient is a 85 year old, demented, poorly mobile kind woman who is a full time residence of a nursing home. I have known her for 5 years. She is always accompanied by her attentive husband of 60 years who is quite deaf. His hearing aids no longer work, the problem is his auditory nerve, the nerve which transmits the sound waves to his brain, that nerve no longer works. There is no hope for him to hear. This kind woman has bladder cancer and I am required by standard of care to look within her bladder every three months. This procedure is intrusive when a patient is compliant, it is downright cruel when the patient has no idea of what I am doing nor why I am doing it and who must be held down to do the procedure. The nurses feel uncomfortable helping me. How does one explain the options to this patient or her husband? It does not involve chest compressions nor breathing tubes, rather how to treat someone with dignity at the end of their lives. There are middle ground options. The present day “death panels” helped define. This patient willl not be subject to scheduled survelliance rather we will wait for symptoms. She will not bleed to death nor be euthanized but we will not look for signs in their earliest state. I will actually make less money and she will be treated better. She will be allowed to die as she lived, with dignity.

  3. Well said, I think both sides (however, the GOP is doing a great job of making it a one party show right now) love to take issues they don’t agree with and instead of explaining in a calm, rational manner to the public why they don’t agree, they turn it into the end of days and scare everyone into a mob (Tea Party?) bent on irrational though and action.

    I feel it is ok to disagree, but let’s make sure we disagree based on facts and clear thoughts and less on “the sky is falling” crap that we seem to get.

    On another subject, I agree with the fact that while I have not really heard much of her name when it comes to the Health Care Law, but the ghost of Terri Schiavo defiantly plays a big role in the politics of it. Good call.

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