Tuesday, August 18, 2009

Sorting Out the Dem's "Advance Care Planning Consultation"

Congressman John Yarmuth asserted last night in his "tele town hall" that there is "no mandatory aspect" in the end of life consultation included in the House's draft health care legislation. According to Yarmuth, the new law merely would amend the Social Security Act to allow Medicare recipients to get reimbursed for such end of life consultations.

I am not convinced.

Yarmuth is correct that under the Democrats' plan, such consultations would be covered by Medicare.

However, there is language in H.R. 3200, Section 1233 "Advance Care Planning Consultation," that could be construed to mandate such consultations.

Take section (F) (i) (III) (ii), which provides that the "Secretary [of H.H.S.] shall limit the requirement for explanation" of advance care planning in certain circumstances depending on state law for advance directives. (Emphasis added.)

"Requirement for explanation"? A fair reading would be that an "explanation" is required. That explanation is the end of life talk.

Many of us have durable powers of attorney, health proxies and so forth. Personally, I think it's a good idea to have an end of life conversation. But many of us want that to be a private decision that we make after consulting not just with our physician but with our family and clergy. Some people may prefer never thinking about, talking about, or planning the end of life; that should be their right, even if it's not very wise. To the extent that the "explanation" is required, it infringes upon our liberty. Government compulsion always does.

Even assuming the end of life counseling is not mandatory, another problem with the section on "Advance Care Planning Consultation" is that it puts words in the mouths of our physicians.

Section 1233, (F) (i) provides that an "explanation of orders regarding life sustaining treatment or similar orders, which shall include [emphasis added] (I) the reason why the development of such an order is beneficial to the individual and the individual's family and the reason why such order should be updated periodically as the health of the individual changes."

Again, many of us may think that a "Do Not Resuscitate Order" -- or its opposite -- is a good idea in certain circumstances. That's not the issue.

The problem is the government compelling health care providers to "provide the reason why" such orders are a good idea. That's compulsory speech for the doctor and compulsory listening for the patient.

Liberals don't want physicians to "provide the reason why" an abortion might not be a good idea. Pro-abortion advocates argue that such "counseling" is an undue burden on the right to have an abortion. That's why liberals in Congress opposed legislation that would make physicians offer to show pregnant women sonograms of their unborn fetus before performing an abortion.

Yet when the person who might die is alive and breathing, as opposed to a fetus in the womb, the Democrats have no qualms about compelling doctors to give "reasons why" that person should agree to a health order about the end of his or her life.

The left fears that abortion counseling is an attempt to coerce women into forgoing the abortion and bearing the child. Depending upon who does the counseling, that fear may be well-founded. The same fear of coercion applies to "Advance Care Planning Consultation." Except that the debate is not about when life begins, but rather when it should end.

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