I’m reading through the Dingell, et. al. Health Care reform bill (House 111) because I feel that someone ought to.
Many things are standing out to me, but the part that is ringing through my brain and setting my ire alight right now is found in Subtitle C, Section 1233. Advance Care Planning Consultation (p.425 of PDF)
I would encourage every single one of you to download the PDF and wade through the legalese yourself. Because I don’t want this to be just one long game of telephone where someone says they heard something somewhere and there is nothing to back up their claim. I assure you I’ve read through the legalese three times now and am beyond appalled.
Summing it up as succintly as possible, the ACPC is a mandatory counseling session, required every 5 years for anyone receiving Medicare. This counselling session is for state-sponsored personnel to meet with the elderly and/or infirm. In these meetings they are to discuss living wills, powers of attorney, health care proxies and “the formation of an order regarding life-sustaining treatment.”
That sounds positive, right? “the formation of an order regarding life-sustaining treatment….”
You do understand what that means, yes? In case you don’t, let me clear it up for you.
The government is making sure that everyone who is really old or really sick understands that they would be better off to sign a Do Not Recuscitate order, thus saving the state piles and piles of money that would be wasted keeping their useless body alive.
They’ll advise you of all of your options, “from an indication for full treat-ment to an indication to limit some or all or specified interventions.”
I’ve seen my friends who are pro-choice be up in arms for years against counselling requirements for pregnant women. They seem to believe, among other things (and correct me, folks, if I’ve got it in any way wrong) that those counselling sessions are designed to advance one point of view–that of keeping the baby–and downplaying the other–having an abortion. Every one I’ve ever known to support such a counselling requirement has favoured it for much the same reason. It’s designed to force a desired behaviour. The force may be gentle, but it is a push in one direction.
This counselling session is no different. It’s how we tell our mothers that they should just opt to starve to death when they have a stroke because it saves “their kids” (i.e. the government of we the people) money. It’s how we tell our fathers that if they have multiple heart attacks they should just hang it up and not waste the state’s money on feeding tubes. It’s how we tell parents with seriously ill children that prolonging the life of their child with expensive chemo is too expensive and probably a dumb idea anyway.
It’s eugenics. It’s a society that values money above humanity. And it’s poised to become law, just in time for people my age to watch their parents turned into Soylent Green.
Just Another Pretty Farce 
“I would encourage every single one of you to download the PDF and wade through the legalese yourself.” – Why do you want me to do something my Congressional rep isn’t going to do?
Okay, that’s not really funny.
I have to disagree about the abortion counseling requirement. I think it’s important to discuss the procedure beforehand, to make sure the woman knows how it will happen, to make sure she is sure of her decision and not being coerced, etc. Informed consent is a good thing for all medical/surgical procedures. I have a problem with the counseling requirement when it turns into a mandatory waiting period or includes scripted information that is not accurate given the existing medical evidence (such as regarding breast cancer or mental health effects).
Regarding the specifics of your post, I’ll have to give it more than a cursory glance, but based on my cursory glance, I don’t read it the same way you do. I read it as saying it should be explained that having *an* advance care plan order regarding end of life care is beneficial, not that said order should be a DNR or that the individual must elect to refuse certain care under certain circumstances. Granted, the counseling would have to be unbiased (no encouraging/manipulating people to DNR) in practice, and I think how it’s carried out in practice is an important issue. But I don’t see anything in the language of the bill (again, from a cursory read) that specifically encourages refusal of care, just that people should have advance plans.
Well, of course it won’t say so explicitly “oh, we will encourage people to die gracefully”. I see Kat’s point, the gov’t system would have little interest in keeping people alive, in fact, it would have the opposite motivation. Sounds a little paranoid, maybe. But I prefer viewing the gov’t with suspicion rather than believing bureaucrats will usually do the right thing.
Um, holy crap…downloading the PDF as we speak and getting it to the disability community asap.
I’d agree with Rachel. There’s certainly a VERY valid concern about HOW such “counseling” is done in practice, but frankly, I think it’s a fantastic idea to try and help the average person to ensure the proper preparations are being made as we near the end of our lives.
My parents have only recently been through that with my step-grandfather and it’s very overwhelming to get those sorts of things in order, and unfortunately, for those who don’t have the money to hire various attorneys and other guides, even knowing what steps should be taken is difficult, let alone how to take them.
It’s called a living will. Most people don’t have them and should. After my father died, we sat down with my mom to find out just exactly what she wanted us to do if she ever became incapacitated – not with the intent of pushing her into the grave so I could inherit, but just to know. In doing so, you do have to discuss all sorts of possibilities, but the end result is that you can take into consideration the way they want these aspects of illness handled. Do they want to live on a ventilator if that’s the only way they can live? If so, how long? Weeks? A few days? Overnight? These aren’t easy questions to deal with from either side.
Less than a year later we had to face those exact issues. The pain, though still present, was lessened because we knew what she wanted.
It’s a good idea, I concede that. But the fact that it is mandatory AND to be done every five years (or more often if you are sick or infirm) is where it crosses the line from end-of-life management to ‘you owe your country a death’.
I gotta say that it sounds to me more like “you owe your country to have this decided.” I helped my MBD uncle deal with health care and nursing homes towards the end of his life, and most of the mandatory meetings had the social worker/counselor running through checklists of “have you done this?” items. They asked the questions again at each meeting, but if the answer was “yes,” they didn’t hassle you about what your decision was. In fact, they were grateful that it had been made. Now, that was dealing with Medicaid, and maybe Medicare is wildly different, but I doubt it.
I think it’s already mandatory to offer counseling whenever you are admitted to a hospital. I’ve been offered counseling for a living will or durable power of attorney so many times now I’ve lost count, and I’m only 36. I actually looked into it about 18 months ago when I had a really major open-heart procedure, in which I would be clinically dead (no heart-lung bypass even) for half an hour, and had a decent chance of not waking up. I never felt any pressure to make any particular decision, and didn’t even write a living will. I discussed my wishes with my family, and fortunately they didn’t have to act upon them.
I don’t trust the government much, but I would actually trust them not to pressure folks into DNR orders more than I would insurance companies. I don’t expect insurance companies would do that either 9I don’t think they’re patently evil), and of course they don’t usually make such counseling mandatory, but they have a bottom-line to worry about. BC/BS is doing just fine, but if I kicked the bucket they would save enough money to put someone’s kid through college, perhaps even Ivy League.
I found these surveys of rare disease patients in Europe very telling: http://www.eurordis.org/article.php3?id_article=1960
… and that video with Obama and Jane Strum angered me.
Know this is any old post, but came across this which says that page 425 doesn’t make the counseling mandatory, just makes it covered by medicare should the patient want it. Frankly, I”m more comfortable with that.
http://factcheck.org/2009/07/false-euthanasia-claims/