Wednesday, September 09, 2009

Death Panels: True or False

President Obama has decried the term of "death panels" as being perjorative to his takeover of the American health care system. He especially chided "those politicians" who make these scurrillous charges, meaning the former Gov. of Alaska, Sarah Palin. But who is right? If you go to section 1233 of HR 3200, you find the following:


(a) Medicare-CommentsClose CommentsPermalink

(1) IN GENERAL- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended–CommentsClose CommentsPermalink

(A) in subsection (s)(2)–CommentsClose CommentsPermalink

(i) by striking ‘and’ at the end of subparagraph (DD);CommentsClose CommentsPermalink

(ii) by adding ‘and’ at the end of subparagraph (EE); andCommentsClose CommentsPermalink

(iii) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink

‘(FF) advance care planning consultation (as defined in subsection (hhh)(1));’; andCommentsClose CommentsPermalink

(B) by adding at the end the following new subsection:CommentsClose CommentsPermalink

‘Advance Care Planning Consultation

‘(hhh)(1) 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:CommentsClose CommentsPermalink

‘(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.CommentsClose CommentsPermalink

‘(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.CommentsClose CommentsPermalink

‘(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.CommentsClose CommentsPermalink

‘(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 service organizations (including those funded through the Older Americans Act of 1965).CommentsClose CommentsPermalink

‘(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

The ability to counsel someone carries a duty to offer advice that is in the best interest of the person being counseled. I know that when I present an offer of a plea agreement to a client, I try to remain fastidiously neutral, since as I explain to the client "at the end of the day, I go home either way, but you may not." This is to reinforce that they are the ones making the choice, after I have explained to them the ramifications of their choices.
But if there is a dual loyalty, as in to the patient and the payer of the bills, it is easy to slide into a onesided approach to the problem. i.e. You are too old to chew the leather, and there is this convenient ice floe that is just getting ready to take off. Wouldn't it be lovely to go for a sail away from it all? Especially if the counselor has a financial interest in helping you to make the decision, shouldn't you be concerned that they are not recommending what is in your best interests versus their own?
Maybe Gov. Palin is onto something. Plus, Obama says it's a lie. And we all know we can't trust him.


Unknown said...

True or False? False.

Steve, you point to your own integrity as a professional while willfully impugning the integrity of others, before those others have ever had a chance to act in the capacity you impugn them for. Surely you are aware of the caricature of public defense (clear the case at all costs)? That you act with integrity in that position should offer you evidence that others might as well; not the contrary.

Anonymous said...

The private sector and competitive market forces, not the federal government, are the best means to meeting our country’s rapidly expanding health care needs. One of the things I think we can do to help make that happen is support American businesses and the U.S. Chamber of Commerce ( They’re doing things to reach out and show people that they can get involved, too.

Steve said...

Wulfgar, it is the capacity to steer the client, especially if there is a personal interest in the outcome that is the difference. For me, there is no advantage personally to how a client decides.
But if someone is given an incentive to steer people one way, they lose their impartiality. Especially when dealing with emotionally charged issues such as the end of one's life.
I am not saying that it is automatic, but that it is rife with potential for abuse.