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8/10/2009
Should docs be discussing end-of-life decision-making?
FoxPolitics News erringly included (July 22) mention of Betsy McCaughey’s warning that end-of-life counseling was mandated by HR 3200.
We also included refutation of the errant McCaughey claim. No, end-of-life counseling sessions are not required, but rather payment for them is allowed. Below is a portion of Section 1233 of HR 3200. Read the whole thing here (pp. 424 – 434) and decide for yourself:
‘Advance Care Planning Consultation
… 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, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations
(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. And on and on, detail after detail.
Charles Lane, editorial staff at the Washington Post, says that thought McCaughey’s warnings were off-base, there’s still reason to be concerned.
Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren't quite "purely voluntary," as Rep. Sander M. Levin (D-Mich.) asserts. To me, "purely voluntary" means "not unless the patient requests one." Section 1233, however, lets doctors initiate the chat and gives them an incentive -- money -- to do so. Indeed, that's an incentive to insist. The solution, as Lane reminds us, is to for all of us to take responsibility and be sure we have a living will and durable power of attorney for health care drawn up, kept current and easily available. “No authority figure got paid by federal bean-counters to influence me. I have a hunch I'm not the only one who would rather do it that way.”
Jo Egelhoff, FoxPolitics.net
COMMENTS
I also was suspect of the "terminal" treatment options and spent some time looking at it.
I bow to the Washington Post, as I am sure they have more Legal knowledge than I.
However, can someone explain what this is: ???
page 429
an actionable medical order relating to
16 the treatment of that individual that—
17 ‘‘(i) is signed and dated by a physician (as de18
fined in subsection (r)(1)) or another health care
19 professional (as specified by the Secretary....... nurse...
Cont pg 430
11 ‘‘(B) The level of treatment indicated under subpara12
graph (A)(ii) may range from an indication for full treat13
ment to an indication to limit some OR ALL specified
14 interventions.
What I read is the Czar can appoint anyone with health care credentials ( sic!)to determine what you get or don't get. ( my caps above )
it also means a nurse can decide whether you get treated OR not
(It says "appoint")
Thats what I read.
Then we get to whether everyone gets the 5 year death review
The dems say "No" but read this:
"IF" old folks do not have to have a manditory 5 year evaluation as we are told, why then use page 429 line 1 to 9 ?
They cover the individual WHEN HE HAS A CHANGE (like developing a Terminal condition or Life threatening injury)
Since his LAST 5 year review(!)
That would imply logically that you get the review whether you have a terminal illness or not. !
This is contradicted by the Democrats,
but hey, just read what I posted.
Rich Carlstedt (Mon Aug 10 18:39:07 2009)
It's really hard to follow this stuff because of the layers upon layers of instructions and definitions. I read pp. 424 to 430 to be defining what an advanced care planning consultation should consist of, if Medicare is going to pay for it. The sections on p. 429 of which you speak are to insure a medical professional (as defined in the law) is on hand to discuss the life sustaining treatments that may or may not be used. My dad and I went through this discussion that is much more complicated than I would have thought. We did it with guidance from the attorney who was helping us put the Power of Health Care Attorney in place. The attorney forced us to think about whether or not dad would want tube feedings, for example, and if so, in what instances. These paragraphs are not suggesting whether or not to pay for different life sustaining treatments.
Jo (Mon Aug 10 21:40:15 2009)
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