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End-of-Life Planning To Be Covered By Medicare in 2011

End-of-Life Planning To Be Covered By Medicare in 2011

A new health regulation issued early in December revives voluntary end-of-life planning for elderly Medicare health care recipients, as reported in today’s New York Times. Democrats had dropped such planning from last year’s massive overhaul to health care legislation after heavy criticism by former Alaska Gov. Sarah Palin and some Republicans about ‘death panels.’ 

Actually, Palin went even further and personalized the issue by posting on her Facebook page that the President’s ‘death panel’ could ‘kill’ her ‘Down Syndrome baby.’ You can still read excerpts via Talking Points Memo such as:

The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

I’m speaking here as the mother of a severely autistic 13 1/2 year old who, with my husband, Jim Fisher, spent a good part of 2010 putting together a Special Needs Trust for our son, not to mention our wills and living wills. A Special Needs Trust is ‘way to provide for the needs of [a] disabled child without making him or her ineligible for SSI (Supplemental Security Income) and other programs that require their users to have a limited income’—it’s just one of the legal and financial planning Jim and I, and parents of disabled children, have to undertake. If we don’t plan ahead now for our son’s care as an adult, and also when we are gone and when he himself is elderly, no one will.  
Regarding the new Medicare regulation: The health care legislation that President Obama signed into law back in March authorizes Medicare coverage for ‘wellness visits’ or yearly physical examinations, during which doctors are to discuss end-of-life treatment as part of voluntary advance care planning. Individuals and their families can devise advance directives about having, or not having, aggressive life-sustaining treatments administered, should a person become too ill to express their wishes.

The Obama administration cited research by Dr. Stacy M. Fischer, an assistant professor at the University of Colorado School of Medicine, according to which “end-of-life discussions between doctor and patient help ensure that one gets the care one wants” and thus “protect patient autonomy” (go here for a PDF file of an article by Dr. Fischer).

 

Aside from revising the ‘death panel’ rhetoric, critics may argue that the new regulation is a thinly-veiled rewording of Section 1233 of the bill passed by the House in November 2009. Under Section 1233, Medicare was to pay for ‘consultations’ about advance care planning every five years. The new rule makes ‘annual discussions’ part of the wellness visit.  The New York Times quotes Elizabeth D. Wickham, executive director of  LifeTree, a ‘pro-life Christian educational ministry. She expresses concerns that ‘end-of-life counseling would encourage patients to forgo or curtail care, thus hastening death. Patients, she states, will ‘lose the ability to control treatments at the end of life.”

 

But without any end-of-life planning, patients are left to the mercy of others their care when they are no longer to speak up for themselves. They have no control at all about what happens to them, with health care decisions left to whoever has power of attorney.

 

Representative Earl Blumenauer of Oregon was one of the Democratic members of Congress who had urged the Obama administration to cover end-of-life planning. While ‘very happy’ about the new regulation, he also noted via a November e-mail that ‘”this regulation could be modified or reversed, especially if Republican leaders try to use this small provision to perpetuate the ‘death panel’ myth.”’ 

Somehow, I have a feeling we will be hearing more about the ‘death panel’ myth by the likes of Sarah Palin.

Back in 2009, Palin completely missed the point by simplifying end-of-life and advance care planning into a catchy sound byte (‘death panel’—hell yes, that works!) crafted to stir people’s passions. She thereby did a real disservice to children likes her son and mine, not to mention scores of elderly Americans and their families. She and others will probably be upping ‘death panel’ talk and how ironic, as the whole point of end-of-life planning is to ensure the dignity and quality of individuals who are ill, who are disabled.

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101 comments

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4:22AM PDT on Sep 5, 2011

Im In the UK.and believe 100% in deciding when I want to leave this earth.How do I go about getting this done.Iv retired and in good health.but their is no way I want to be kept going with medication and tubes,Im no ones guinea pig.

10:54PM PST on Feb 9, 2011

thank goodness, sense returns to politics!

The FIRST question we ask people when they enter the hospital, is: do you have Advanced Directives? It is the most sensible question, one should ask, because we don't want to go against anyone's wishes. This "death panel" nonsense was so patently phony, just to obstruct the health reform bill!

In fact, all of us should have a Living Will, no matter your age, because one never knows when a bad driver will take you out on the freeway. Living on a vent, is not life.

4:24PM PST on Jan 30, 2011

What happens if you have a living will now, then years later become ill and want to change your mind? It could be too late to state your wishes then. Right now you may not want to be put on life support, later after you become ill, you decide that you do! You may not be able to change it in time.

11:35PM PST on Jan 3, 2011

Good!

3:15PM PST on Dec 31, 2010

I would like to know how one would become an end of life counselor. I believe this service would lend comfort and a feeling of respect at the end of life. I work as a nurses aide and have seen many families struggle at the end with decisions that should have already been determined.

6:57PM PST on Dec 30, 2010

Marie Marindy--I hope you have a Living Will. And I am not saying that because you have a disability. I was disabled nearly 3 years ago by a stroke, which ended my nursing career. But prior to that I spent 32 years convincing as many patients, friends and family as possible to make Living Wills. If you want everything possible done, no matter what, you put that in. The point to having this document is so YOUR desires will be known in a situation where you can't speak for yourself. Most people don't think of what they might want because they are uncomfertable talking with family, so an outside mediator helps.
I forced every member of my family to make one by pointing out that if they didn't, I would do what I wanted if they didn't!

2:47PM PST on Dec 30, 2010

Thank you.

9:40AM PST on Dec 30, 2010

The whole idea of "end-of-life" planning is to discuss the matter while the person is still mentally alert and aware of how things might turn out if s/he becomes so incapacitated as to be unable to express his/her last wishes.
It seems to me that most people have a justified horror of being "hooked up" to various mechanisms which take over their failed bodily functions. Most "living will" documents deal with making decisions, where the patient's condition is beyond healing or saving.
My mother was put on life support for several days and then went on to live 3 or 4 more years, which included witnessing the wedding of one of her granddaughters. It was a case, where the medical personnel in charge could see that it was not a terminal situation.
Medical practitioners are well-equipped to distinguish between cases where the patient may survive and can't without mechanized assistence. However, because of their Hippocratic oath, they must accede to the wishes of the spokespeople of the patient --even if the doctors know that the situation is terminal.
Every person should be given the right to decide for him/herself about how they wish to pass their final moments. That is what end-of-life counseling does.

10:32AM PST on Dec 29, 2010

There's nothing like it where I live and it leads to terrible abuse. I'm all for people having options.

10:01AM PST on Dec 29, 2010

Thanks for sharing.

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