Advanced Care Planning Provisions in Health Care Bill Could Pressure Patients

Bioethics   |   Steven Ertelt   |   Aug 12, 2009   |   9:00AM   |   WASHINGTON, DC

Advanced Care Planning Provisions in Health Care Bill Could Pressure Patients

by Steven Ertelt Editor
August 12
, 2009

Washington, DC ( — A leading pro-life group says there may not be "death panels" in the national health car restructuring bill that Congress is considering, but the language of the legislation is cause for concern. The National Right to Life Committee says the advanced care planning provisions are problematic enough to oppose them.

The cause of the controversy is Section 1233 of HR 3200, the government-run health care plan that the House will consider when it returns from its August recess.

The measure would pay physicians to give Medicare patients end-of-life counseling every five years or sooner if the patient has a terminal diagnosis.

NRLC executive director David O’Steen says the section of the bill could unduly influence patients to make decisions that would result in revoking lifesaving medical treatment or something as basic as food and water.

"I’m not aware of ‘death panels’ in the bill," O’Steen told the Associated Press. "I’m not aware of anything that says you will be hauled before a government bureaucrat."

"But we are concerned … it doesn’t take a lot to push a vulnerable person — perhaps unwittingly — to give up their right to life-sustaining treatment," he explained.

Jennifer Popik, a medical ethics attorney with National Right to Life, offers additional explanation of the concerns.

She says "the pro-life fear is that efforts to push patients and prospective patients to prepare advance directives may in practice become a means of persuading or pressuring them to agree to less treatment as a means of saving money."

Popik points to a 2008 JAMA study that concluded: "On the other hand, patients who reported having end-of-life discussions received less aggressive medical care."

"What is particularly disturbing about this ‘cost-savings’ provision of the bill is that it appears to follow President Obama’s call this past spring for ‘a very difficult democratic conversation’ about ‘those toward the end of their lives [who] are accounting for potentially 80 percent of the total health care bill out here,’" Popik says.

The pro-life attorney also notes that a pro-euthanasia group is responsible for some of the language that is causing controversy.

"It is also extremely troubling that Compassion and Choices, the principal group that promotes physician assisted suicide throughout the country is not only aggressively promoting these provisions, but claims responsibility for the inclusion of the main provision," she says.

She says the group is promoting it because the provision "allows assisted suicide and euthanasia to be promoted as an option in the places where it is legal (i.e. Washington, Oregon, and Montana)."

Popik says Section 1233 isn’t the only problem with the health care bill.

"There are also two other amendments, one requiring private and public health care plans to give potential enrollees the option to establish advance directive," she explains.

The other section, 1191, would, as Popik notes, "empower the Secretary to spearhead a public education campaign, toll-free telephone hotline, and clearinghouse to promote advance directives and other advance care planning."

The National Right to Life analysis is similar to that of Charles Lane, a member of the editorial board of the liberal Washington Post newspaper, who has written an analysis of the bill that makes it clear the advanced care planning provisions cause problems.

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