Posts
August 8, 2009
Blog for Arizona
NEVER underestimate the depths to which Republicans will sink in employing their time-tested fear mongering to win at all costs. The PR firms which do their dirty work are bottom feeding sewer dwellers. (I have met many of them over the years). Frightening the elderly with death is as low as they can go.
Rachel Maddow follows up on my previous post about this GOP Astroturf campaign. Maddow addresses specifically the "living will" being perverted into "Obama death panels" by moon-bat in chief Sarah Palin and a plan to euthanize Grandma by conservative talk radio and Faux News, and even Republican members of Congress. (at 3:35 of the video)
A "living will" is a durable power of attorney authorizing advance health care directives. You get to direct how the attorney-in-fact that you designate is to carry out health care decisions in accordance with your advance directives in the event that you are unable to make or communicate your decisions due to incapacity. Your attorney-in-fact is bound by your advance health care directives. "Living wills" are provided for by statute in Arizona.
I have drafted living wills for many clients over the years. There is nothing controversial about living wills -- everyone should have one. Without a living will, it is the hospital, doctors, and insurance company risk managers who will decide for you. This is critical to some individuals who want to direct a "do not resuscitate" order (provided for by Arizona statute). If that is your wish, you must comply with the statute. Otherwise, medical providers may keep you alive in a non-responsive state indefinitely. Think Terry Schiavo.
The living will provision that the right-wing fear mongers have perverted into "euthanasia for Grandma" is actually a bill sponsored by Republican Senators Johnny Isaacson (Ga) and Susan Collins (ME). It provides that medical providers will be reimbursed for their time in discussing living will and advance medical directives with you (currently, medical providers have an ethical obligation to discuss this with you at your initiative, but Medicare does not reimburse them for their time).
In 1990, Congress required health-care institutions (not individual doctors) to give new patients written notice of their rights to make living wills and advance directives -- but also required them to treat patients regardless of whether they have such documents.
The 1997 ban on assisted-suicide support specifically allowed doctors to honor advance directives. And last year, Congress told doctors to offer a brief chat on end-of-life documents to consenting patients during their initial "Welcome to Medicare" physical exam. That mandate took effect this year.
Section 1233 of the America's Affordable Health Choices Act of 2009 would pay doctors to give Medicare patients end-of-life counseling every five years -- or sooner if the patient gets a terminal diagnosis.
Right-wing fear mongers have portrayed this as a plan to force everyone over 65 to sign his or her own death warrant. That's total bullshit. As noted above, Federal law already bars Medicare from paying for services "the purpose of which is to cause, or assist in causing," suicide, euthanasia or mercy killing. Nothing in Section 1233 would change that.
The objection from some on the right is that this is not purely voluntary, that the doctor may now initiate the discussion, and the doctor will now have a financial incentive "to pressure" patients into a living will and advanced medical directives. They also object that Section 1233 dictates the content of the consultation. Charles Lane - House Health-Care Reform Bill Oversteps on End-of-Life Issues I find these objections overstated and not realistic.
As an attorney, I have had this discussion with many clients after advising them to first consult their physician. My clients have been very definite about what they want. There have been other occasions when family members have had a conflict with the hospital and its insurance risk manager over end of life care that family members have argued was not in accordance with the wishes of their loved one, but because the patient did not have a living will and advanced medical directives the family was at the mercy of the hospital and its insurance risk manager, forcing them to hire an attorney and go to court. You and your family members do not want to be in this highly charged emotional situation for end of life decisions. Discuss this with your physician and then go see your atttorney for a living will.
