With regard to Dr. James A Grillo III's letter:
There are moral, ethical, religious and political assertions being made in his letter and others like his that have been interpreted according to the author's personal beliefs and professional desires.
For example he writes:
Page 425 Lines 22-25, 426 Lines 1-3: Govt provides approved list of end of life resources, guiding you in death. (assisted suicide)
He interprets the language of Pg 425 and 426 as "assisted suicide". That is his analysis of the language regarding end of life consultations. Here is the actual language, taken directly from the HR 3200 bill:
Page 424 - 426
Advance Care Planning Consultation
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 a 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, including the national toll-free hotline, the advance care planning clearinghouses, and State legal 17 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.
(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include—
(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;
II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decision-maker (also known as a health care proxy).
Apparently, Dr Grillo is attributing to this language a slightly sinister slant (assisted suicide) based on his personal beliefs about end of life actions and decisions. His take seems to align with the "keep Terry Schiavo alive forever" judgment of end of life decisions.
Apparently, his belief is that anything short of keeping a patient alive at all costs is assisted suicide. This opinion reflects one side of the coin in the partisan debate that surrounded the Terry Schiavo case. I have mixed feelings about her case to this day as do many people. These decisions are never easy nor made lightly without a lot of thought and soul-searching.
The bill's language was intended to fill a gap in Medicare procedures. Should a patient want to consult with their doctor about end of life procedures, that consult will be paid for by Medicare. The Bush Administration tried to get the exact same language into another bill but failed.
Bill HR 3200 is written to change guidelines and standards of care. Naturally, moral questions result from interpretation of the language. The issues surrounding the questions of , "Should our lives be prolonged indefinitely, or should we be allowed to die without medical intervention?" continues to be a hard fought moral battle fron both perspectives.
In result, there is going to be some opposition to any bill's language that allows doctors to be paid for these consultations. The effort is being attempted by Congress so that the Medicare patient does not have to pay should they chose to have this consultation. That is the issue in a nutshell -- who pays for an end of life consultation.
The above listed paragraphs are the exact language from the bill, therefore it should be easy to read that these consultations are NOT mandatory. They would constitute a new covered benefit within Medicare for those that choose to be kept alive at all costs as well as those that do not want to be kept alive artificially.
If a doctor and patient want to talk about these things, surely this is a valuable benefit for the dying patient. Everyone will not agree that these consultations are a benefit-- evidence Sarah Palin's take on this language.
In the end, the right wing's fight against this aspect of patient care has fomented yet another divisive partisan moral/religious issue. Unfortunately, for the public, this issue has been couched in an outright lie. Every American that is concerned about end of life issues should read the actual language of pages 424 through 426 so that this propaganda about "death panels" can be silenced immediately.
Unfortunately for the masses, this discussion of this portion of the bill has devolved into partisan hyperbole focused around "pulling the plug on grandma". This is a falsehood that has been perpetuated at the expense of the elderly and is doing grievous harm to them. End of life issues might remain forever a hot button topic but putting fear in the hearts and minds of the elderly is not the way to have meaningful discussion concerning the moral aspects of the issue.
This country is divided on so many issues that it is hard not to be scared. One of my customers said that she is afraid we are going to have another civil war. I believe Fox News and the media are working overtime to keep the masses stirred up about everything. You and I try to talk one-on-one, and in our hearts and conversations we are left trying to bridge the huge divide that is obvious to both of us.
In the end, we have to find national solutions that are moral but also fair and reasonable. To use an easily understandable analagoy, health care reform is much like agreeing to "treat all parties honestly and fairly" in a real estate transaction. We have to walk a fine line to get things done in an ethical manner. Issues involving this level of human interaction are not easy and chosen methods open to interpretation. Just as homes continue to be bought and sold, people get sick and die. There need be humane rules governing these transitions in our lives. We need to support humane treatment of others.
I don't know what the answer is, but as I wrote yesterday, my sister-in-law remains unattended by the needed specialist for three days now apparently due to lack of health care insurance. I can tell you with certainty that the health care system is failing her as it does so many of us who cannot have health care insurance coverage for lack of funds or due to pre-existing conditions. Americans truly need health care and insurance reform whether they understand it fully or not. In the end, we all pay too much for care or lack of it within our current system.
All the Best,