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End-of-Life Benefit Ignites Health-Care Rhetoric

When Representative Virginia Foxx (R-N.C.) promoted proposed Republican health-care legislation July 28 by proclaiming it was "pro-life because it will not put seniors in a position of being put to death by their government," it stoked a small but passionate fire already burning over a seemingly obscure provision of a House health-care proposal that, proponents say, would help seniors make educated end-of-life plans but, to some, is an opening wedge into something more sinister.

The provision in question is found on page 425 of the 1,000-plus-page H.R. 3200 bill currently being hashed out in Congress. It pertains to "advance care planning" for elderly or terminally ill Americans and calls for "an explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice," and allows Medicare to pay for such consultations every five years.

Obama Tries to Calm Fears But in the conservative blogosphere, there's a short distance between end-of-life planning and counseling euthanasia. A woman even asked President Barack Obama about the provision during an AARP-sponsored town-hall meeting on health care on July 28. "I have been told there is a clause in there that everyone that's Medicare age will be visited and told to decide how they wish to die," the woman told the President. "This bothers me greatly, and I'd like for you to promise me that this is not in this bill."

Obama replied that the intent of the amendment was mainly aimed at promoting advance planning and living wills. He said, "The intent here is to simply make sure that you've got more information, and that Medicare will pay for it."

Advocates of the measure say critics have misinterpreted the provision, while opponents are contending that their criticism of it has been misunderstood.

AARP Endorsement "We've been hearing concerns from our members that this is a step toward government-mandated euthanasia," says Jim Dau, a spokesman for the AARP, the advocacy group for people past age 50, which supports health-care reform to help older Americans. "These are baseless scare tactics put out by those who seek to derail health-care reform. The bill would help people find resources to help themselves and their doctors make important decisions about the end of their lives."

According to Dau, what's been lost in the small-scale hysteria is that these services are 100% optional: Medicare subscribers can ask for help with living wills if they like, but no end-of-life arrangement will ever be mandated or imposed upon them by doctors or government. "The only new thing about the bill is that Medicare will pay for end-of-life counseling every five years," Dau says. "If you decide to take one of these consultations, you don't have to sign any document before you leave—no advance directives, no living will. These are, as they should be, completely optional."

Abortion Connection? A spokesman for Foxx, however, says her concern is that the bill contains no specific clauses to thwart courts from misinterpreting it. "Two years down the road, she doesn't want it to turn out that euthanasia and abortions are paid for with tax dollars," says Aaron Groen, who works in Foxx's Washington office.

Another critic of the bill, former New York State Lieutenant Governor Betsy McCaughey, caused a stir when she said in a July 16 radio interview that the legislation means "every five years people in Medicare have a required counseling session that will tell them how to end their life sooner." McCaughey, who is a patient advocate and founder of the Committee to Reduce Infection Deaths, based in New York City, said in an interview this week that critics took her words out of context.

"The new benefit of end-of-life counseling is being provided in the midst of health-care cost-cutting," McCaughey says. "I worry cutbacks on health spending will jeopardize the health of elderly Americans, leaving some with no choice but to consider ending their lives. This end-of-life counseling specifically includes whether or not to forgo nutrition, hydration, and antibiotics, which many families would regard as inappropriate for their loved ones."

The bill itself makes no specific recommendations for end-of-life preparations.

A "Win-Win" Provision McCaughey also believes the provisions for advance care planning need alteration. "This new benefit is provided in the context of shared decision-making, but it's not shared by patient and family or routine caregiver," she says. "It's between a patient and physician or nurse, so it's shared with the wrong people."

The AARP's Dau feels that, despite the controversy, the advance care planning portion of the bill will survive and become law. "This is such a commonsense, win-win piece," he says. "I'm sure it's considered good sense by lawmakers of both political parties, and medical associations and nursing groups."
Rebecca Reisner is an editor at

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