Pro-Life Professor: Concerns About Death Panels Overhyped

Bioethics   |   Steven Ertelt   |   Dec 31, 2010   |   2:30PM   |   Washington, DC

Not everyone in the pro-life movement is on board with the concerns about the “death panels” the Obama administration recently instituted, as one professor says they are overhyped.

Warren Throckmorton is an associate professor of psychology at Grove City College in Pennsylvania and fellow for psychology and public policy with the Center for Vision & Values.

As has reported, the Obama administration recently instituted new regulations in the implementation of the ObamaCare law that were removed when Congress debated them because of an outpouring of opposition led, in part, by Sarah Palin.

The regulations offer financial incentives for doctors to hold annual discussions with patients about end-of-life decisions. Specifically, the discussions are to be centered on advanced care planning where doctors discuss treatment options and decisions with patients, who would be encouraged to complete an advanced directive to ensure their future treatment is consistent with their wishes and values should be become unable to make their own treatment decisions.

The idea has some merit as it, for example, could have helped prevent the painful euthanasia death of Terri Schiavo at her former husband’s hands. But pro-life groups say they worry doctors would be incentivized to pressure patients into making treatment decisions that would ultimately ration their health care.

“The danger is that subsidized advance care planning will not just discover and implement patient treatment preferences but rather be used to nudge or pressure older people to agree to less treatment because that is less expensive,” warns Burke Balch, director of Natioanl Right to Life’s Robert Powell Center for Medical Ethics.

Throckmorton says the regulations don’t constitute a “death panel” because the meetings with physicians are voluntary, the patient makes his or her own treatment decisions, and helping patients with advanced directives — which could ultimately ensure they do receive lifesaving medical treatment and are not denied care — is generally a good thing.

“No death panel there, just the patient, perhaps family, and the physician,” he says. “Since the conversation is voluntary, a patient can avoid the whole thing.”

“Physicians are allowed to provide written information about how to construct an advanced directive and what individual physicians will do under certain conditions. Physicians must provide informed consent to care and letting patients know what they will do is good practice. If a patient doesn’t like the approach of that doctor, then another doctor can be pursued. I like this approach much better than just waiting around for something to happen and then trying to figure out what the patient would have wanted,” he adds. “These are important and necessary conversations, even though they can be emotionally difficult.”

While Throckmorton is sensitive to the rationing concerns, he says calling the discussions death panels is going too far.

“If you want to talk about rationing of care, then talk about rationing of care. Voluntarily discussing advanced directives with a personal physician is not a ”death panel” nor is it of necessity rationing of care,” he says.

The professor also responded to concerns of pro-life advocates who want to see the new regulations overturned.

“I am pro-life and I hope the new Congress does not overturn the regulation. I believe physicians should be reimbursed for bringing up the difficult topic and making adequate preparations for the inevitable,” he says. “Conversations about end-of-life care will happen with or without the regulation. The question is: Will they happen with the patient’s wishes known or not? There is nothing in the Medicare regulations which requires patients to accept a physician’s views if at odds with the patient’s views.”

The truth is likely somewhere in the middle — as there are positive ways in which advanced directives can help people preserve medical care. Yet, governments in places like England and Canada ration care when the government begins taking over or influencing the health care system.

Ultimately, the question about the potential problems with death panels centers on the question of whether doctors work with patients to help them design directives that promote care or ration it. That’s why the National Right to Life Committee, among other groups, has promoted the Will to Live project designed to promote care that is life-affirming without revoking lifesaving medical treatment. [related]

Balch, of the National Right to Life Committee, says the Will to Live form allows patients to clearly express the kinds of treatment they want should they be unable to make their own health care decisions down the road.

Balch says the form is vitally important because an NRLC study shows the laws of all but ten states may allow doctors and hospitals to disregard advance directives when the directives call for treatment, food, or fluids. The form is designed to make it clear that a patient wants food and fluids continued.

Following Terri Schiavo’s death, many groups and the media focused on Americans to complete living will forms. However, NRLC reports that, increasingly, health care providers who consider a patient’s “quality of life” too low are defying these directives in order to deny treatment against patient and family wishes.

“We believe most Americans will be frightened to learn that four-fifths of the states do not clearly protect their right to choose food, fluids, or life-preserving medical treatment,” Dorothy Timbs, legislative counsel for NRLC’s medical ethics center, told previously.

“Americans should fill out an advance directive like the Will to Live available on NRLC’s website to make clear your wish not to be denied food or treatment clear,” Timbs added. “However, it is equally important to work for legal reform so that your choice for life will be honored.”