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AUGUST 23, 2009 1:57PM

End of Life Issues, pgs 424-426

Rate: 11 Flag

Hi _____:
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,
Lisa Lucas

***************************************************************************************** Refuting a similar right-wing email campaign, please read this post by Mishima.

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Thanks for mapping out this argument clearly. The accusational approach that the conservatives take to this issue proves one thing for sure - they are in denial that death is a surety, and that we should acknowledge its approach and plan accordingly. My mother was in denial to her last day - and that was her choice - but my choice will be to map out the steps I want taken, or not taken, on my behalf. Why should the healthcare system we create ignore such an important rite of passage, by refusing to fund it?
Thank, Ardee and JK. Ardee, I feel like you do. After watching others fight until their last breath, I know that many people want that option. I am not sure that is for me, however.

I wrote this letter to a Christian but left out most religious references to God's will with regard to our end. As a society we are in denial of death regardless of religious outlook.

Even if everyone read the bill and understood its meaning, they would not react well to thinking that hard about their death. All perfectly human on that topic. In the end, let's not throw the baby out with the bath water for three pages in a thousand page bill?
Advanced directives are already part of our health care system. I do not know how a right to end of life decision -making (it is not killing) has become so controversial. Our family has had these provisions in place for yars so that the family member who will have proxy knows each of our wishes. This prevents abuse by the medical system. It does not allow carte blanche! If I am 85 years old (I may actually make it to that age), I do not think a trach or respirator is humane, especially given the fragility of an elder's body tissues. I do not want to be assaulted when I am dying! Just let me go! That is different than actively killing me. Assisted suicide is a different issue than advanced directives. Let's not confuse the two. One can favor both, only one or the other, or none of the above and include it in one's advanced directives. Sounds like it protects me, "doing no harm", so to speak. Thanks for the post
Good explanation and thanks for providing the real language of the bill. I am so sorry about your sister-in-law. It sounds like it is time for a TV reporter to learn about this.
Thanks, Rainee and Dorinda. As usual these days, the media is all about the drama and little about the truth. There is little to read into the words yet even Wolf Blitzer said the bill read mostly as gobblety gook...I was ashamed on his behalf that day.

I have to say I got the idea from Jon Stewart who tried to debunk a right-wing nutjob on this issue. In my heart, I knew there was nothing close to "death panels". There is very little in the language that is even "scary". Apparently discussing issues concerning end of life/death are too scary for poor Sarah Palin to wrap her mind around?

As far as the news, I cannot write too much but I know they would have a field day here if they dug into things...
Thank you for finding this and letting us get educated about it. It's one thing to have a dog in the fight, but it's another to know what we're talking about!

Now, I wish that we could get CNN and FOX to make this information available, but they won't make money that way.
it's absolutely asinine to twist the language into something sinister. if, as you say, any language dealing with end of life consultations is going to be twisted this way, maybe we should just leave it out. universal coverage is the most important issue here.
Thanks, Z and Cap'n. Yes, everything surely gets twisted and the media only talks about the hyperbole. Why not get to the bottom of these myths by comparing them to the actual bill?

Jon Stewart attempted it the other night, but his guest, in typical right-wing fashion just talked loudly on top of him and interrupted his every statement. Typical and not helpful...he kindof made his point, but I would have liked it to be made a little stronger. He would never get anywhere with this woman, however, whose didn't want her point to be confused by the facts....
It's people! Soylent green is made from people!!! Oh, wait, wrong post. Good explanation, thank you for posting this. I really was hoping to see the term "Death Panel" in there somewhere, but alas, my hopes are dashed once again. So much for crushing health care legislation based on scare tactics. Well, there's always the cry of "communist!" but ever since we've begun to feel safe from the threat of total nuclear annihlation, it lacks the power it used to.
If people were not so goofy, they would know that no one wanted to "pull the plug on Grandma" and surely that the government was not going to try to get anyway with Death Panels or any such nonsense. The media knows that if they lie long enough to the right wingers by repeating lies over and over they become "sticky". It doesn't take long because that base will believe ANYTHING negative they are told about the Obama administration..."he is black, you know... ".

Reminds me that I need to write a little more about a scene I witnessed in Office Max. There is more to the story, but in summary a little gnarled up old white man didn't want to stand in line near a tall good-looking black man. He made this known by saying that he didn't want to stand next to Obama...oh so sad...
After discussing these and other issues, I fear I get no where with those indoctrinated by Fox News. That station is a dangerously powerful vehicle in its ability to stir up hate and vitriole...
Nice post, Lisa. Thoughtful and intelligent. You might want to check out mishima's post too.
Thanks, Sandra -- going to Mishima now!
Grace, substance and the personal reason why it matters---that's you Lisa.

Thanks for the info---but mostly--prayers for you r sister in law. Roger
Thanks, Roger, you are sweet and nice to be concerned.

As it turns out, my sister-in-law was never seen by the specialist. Was sent to a treatment facility, seen there by a social worker, and promptly released for lack of health care insurance. Hopefully, she will be with us until a public option kicks in -- I am still optimistic in spite of all...
I trust you (and Mishima's) and how you parse what is actually in the proposals. It saddens and angers me that so many are willfully lying for personal politics instead of what our country should do for the greater good for most Americans. Keep fighting Lisa. I hope you are your SIL and all your loved ones will have what we need and deserve. I don't know how others view it, but I think decent, timely and effective health care is a basic human right. xoxo
You said: "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."

In my finite understanding, the problem with this debate is that the left refuses to acknowledge peoples real fear of the potential of the state rationing care and deciding not to treat certain diseases past certain points. This is one of those places in the bill that could be tweaked in the future to support that procedure.

The right seems to think that there is NO place for the government in end of life treatment. I agree. There are already programs in place that pay for burial & such for the indigent and the poor. At the least this is a bureaucratic provision that itemizes payment for a specific counseling "procedure" that seems odd to even have in the bill.

It smells fishy and shouldn't be in the bill.

If it is that much of an issue, why not quell their fears and remove it?
This portion of the bill deals with care that some people will face if they have prolonged illness at the end of their life. The bill intends to allow that a patient and his doctor may make end of life plans and that the doctor can bill for his time. That billing is not possible now so it was added by this bill. End of story.

"Sneaking things in" and government conspiracies can be attributed to bills governing every aspect of life by both sides depending on the bill. With regard to health care reform, the right wants to throw the baby out with the bath water because the baby "might" poop in it. The baby might also get clean in it, too.

If we used some common sense, as citizens we wouldn't try to squash a bill providing for a basic human need. Just because some group wants only to consider the worst case scenario for every potential, doesn't mean that they are correct. There would be no room for a positive outcome if everyone thought like you and others on the extreme right. We need health care reform -- I am not interested on bit in the extreme right's position on this.

On the other hand, if you want to assure me that you are willing to give up your Social Security benefits as well as Medicare and that you plan to fight to do so because you are convinced these entities are ALSO evils created by our government, I would be interested to listen to you tell me what you plan to do in YOUR old age...