GOP Leaders: Preserve Pain, Oppose Dignity for the Dying?

An attempt last week by some Republicans to turn end-of-life counseling into a political football makes the case that they would rather have the elderly living ignorant and in pain rather than dying in their own time and with dignity.
An example of the argument is here at WorldNetDaily. The short version: A health care reform bill being sausaged in the U.S. House includes a provision at the moment that would require an end-of-life consultation. (Read the whole bill here.) The section creating the "controversy" is No. 1233.

It would require an "advance care planning consultation" at least once every five years for people on Medicare. Some on the political right are claiming the bill would promote euthanasia and push the elderly into dying prematurely.

[CORRECTION: Contrary to what the opponents imply, and which I foolishly assumed to be correct, the bill would not require a consultation. If you read Section 1861 of the Social Security Act (),subsection (s)(2, it's clear that this is all about allowable billing. The proposed new law sets forth the kind of end-of-life consultation that a doctor could charge Medicare for, but only if the patient wants the service. Which makes the tone of the opposition even less defensible.]

Here's a representative quote in a statement from U.S. Reps. John Boehner (the House minority leader) and Thaddeus McCotter (chairman of the Republican House Policy Committee):

"With three states having legalized physician-assisted suicide, this provision could create a slippery slope for a more permissive environment for euthanasia, mercy-killing and physician-assisted suicide because it does not clearly exclude counseling about the supposed benefits of killing oneself."

(The bill also does not "clearly exclude counseling about the supposed benefits" of heroin addiction, driving while drunk or robbing a bank. Obviously the sponsors of the bill are leaving those loopholes open intentionally, also.)

I have expertise by osmosis about end-of-life issues. My wife's career has been in long-term heath care, from nursing homes through hospice. I've seen her facilities, driven her to patient visits, heard her side of midnight phone calls. While I don't know if there are any good deaths, I know for a solid fact that there are better deaths.

And there are terrible, agonizing, prolonged, psychologically crippling deaths. Not all of those can be avoided. But some happen needlessly.

Do you want your spouse and children agonizing and fighting each other about what care your should receive if you can't speak for your self? Or do you want to engage in the battle with members of your family while ill, having never tried the discussion in healthier times? Those disputes can carve scars that last generations. And many are needless.

Do you want to suffer pain that could have been avoided -- without accelerating your death? Are you worried about addiction when you could accept an appropriate dependence on drugs that can eliminate needless pain?

Do you want to end up like Terri Schiavo, the unconscious Florida woman whose death became a legal and political battle about her feeding tube? Even young people should have a written advance directive expressing their wishes if they become incapacitated. Maybe she would have wanted the feeding tube removed and maybe she would not have. But I bet she would not have wanted the U.S. Congress imposing its will on the decision process. It was so needless.

These are all decisions you can make now – and change as often as you like. But most people do not know what their options are. Dying is not a topic most of us are comfortable talking about. Like sex education at the end of childhood, however, how we approach the end of life is a topic too important not to be addressed.

If you actually read the language in the bill (which is a looooong way from becoming law), the political scare tactics by opponents become even more bile-inducing. What does the bill require? Here's a chunk:

(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 (including those funded through the Older Americans Act of 1965).
(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.

Do you know what palliative and hospice care are, and what the difference is between the two? Do you know why you might want – or not want – either one? (Very short answer: Palliative care is mostly specialized pain management that allows for further treatment of underlying conditions. Hospice is all about comfort when death is relatively imminent and the patient is no longer searching for a cure. Both can be godsends at the proper time and place.)

What kinds of decisions would the bill require your health professional to raise? They include:

(i) the intensity of medical intervention if the patient is pulse-less, apneic [not breathing], or has serious cardiac or pulmonary problems;
(ii) the individual's desire regarding transfer to a hospital or remaining at the current care setting;
(iii) the use of antibiotics; and
(iv) the use of artificially administered nutrition and hydration.

That is where the scaremongers are really teeing off. Here's a quote from Deacon Keith Fournier on Catholic Online:

"In short, is Euthanasia included in this National 'Health Care' Reform? The more I have looked at the proposals the more it seems not only possible, but probable."

The argument is that discussing whether there are any conditions when you would choose not to have a feeding tube or CPR is tantamount to (or even precisely equivalent to) encouraging you to shorten their own life. This is, I'm sorry, crazy talk. As if suicide counseling encourages people to commit suicide. Or driver's education inevitably promotes car wrecks.

The entire corpus (so to speak) of health care law in America puts control in the hands of the patient or the patient's legally designated representative. You have an absolute right to refuse any treatment. Or to seek any legal treatment that insurance or income can avail you. This section of the bill would change not one jot or tittle of that.

If your pastor, your priest, your congressman or your next-door neighbor want to influence the choices you make, it's a free country for that, too. But you should make an informed decision, which means getting the information first.

Should you be having your first conversation about such issues during an emergency at a hospital bedside? Of course not. And should you really be worried that your doctors are going to push you or your loved ones into an early death? If so, I suggest you've had doctor problems a long time before that conversation.

I'm not saying that this particular bill is necessarily a great idea. Any law can be abused, from traffic codes to the death penalty. (But I don't hear these same partisans calling for elimination of all laws.)

And there is a reasonable philosophical argument as to whether the government should require discussions about end-of-life planning. [But see CORRECTION above. The bill doesn't do that.] America is a nation that believes people should generally be free to make their own smart or stupid decisions without forcing them to do the research that a prudent person will go through.

But to paint end-of-life counseling in a way that makes some people afraid of their doctors and afraid to engage in such discussions on their own is much worse than merely playing politics. It is a strategy that will increase the amount of pain in the world.

Needlessly.