Jon Stewart and Some Blonde Moron -- page 432

Jon Stewart had a very probing interview with Betsy McCaughey on The Daily Show yesterday about the House version of the Health Care Bill. He got her to admit that she believes the bill is specifically designed to deny health care benefits to seniors. It just goes to show you that having a PhD after your name doesn't mean that you're intelligent.

There is language in the bill, she claims, on page 432 of the legislation, which makes it mandatory for doctors to have a conversation with people about end-of-life issues. Not that this is anything new, but apparently counseling someone about stopping eating or drinking water as a way to peacefully end one's life is now what's being called a "death panel." Forget the fact that she never got around to actually reading the language on page 432 because she failed to mark the page in the thick binder that she brought with her. She didn't get around to reading it because she would have run across this, which actually begins on page 425:

A consultation between the individual and practitioner...

OK, so this is a one on one, is it? Doesn't sound like a panel to me.

Such consultation shall include the following: (A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to...

So the practitioner is going to have a discussion about end of life issues, such as living wills, advance directives, and durable powers of attorney. I had these discussions with my lawyer when Lisa and I planned our living trust. Nothing new here.

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...

Again, nothing new.

Now, on page 429, the bill goes on to describe "life-sustaining treatment":

The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items—

(i) the intensity of medical intervention if the patient is pulse less, apneic, 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.

OK, so now this is what has people up in arms, I guess. The bill actually says that doctors can discuss levels of treatment that artificially prolong life. Is it wrong to have this discussion with someone who's not in the heat of the moment,dying in an emergency room, but rather, in a rational space like the doctor's office, when one is fully cognizant of one's options? McCaughey says in the interview that people sometimes change their minds when push comes to shove. Well, I say, that should be a topic of discussion as well: "Mrs. Patient, these are very serious issues we're discussing here. Sometimes it's easier to make these decisions when you're not gravely ill, but once you get to that point you decide to change to your mind and opt for life-sustaining measures. If there is a possibility that you might do this, I strongly suggest you opt for life-sustaining measures now and avoid that decision later on."

See, to me this is no different than "abstinence only" sex education for teens: "Gee, if teenagers were to be educated that one could prevent pregnancy and/or STDs by wearing condoms during sex, or by engaging in sexual acts other than vaginal intercourse, it would encourage teens to be sexually promiscuous." This now becomes: "Gee, if seniors (or parents of gravely ill children) knew that they could plan in advance how their lives would end if they became unable to make decisions about it, that might encourage euthanasia or doctor-assisted suicide." It's so silly, and it reveals, as I see it, yet another moral issue that conservatives will hang their hats on, like abortion or gay marriage.

Another area where McCaughey gets worked up is, in fact, page 432, which reads:

For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.

This means that doctors receiving Medicare payments are going to be measured on whether they actually have this "advanced care planning" discussion with their patients when it's relevant. Again, I see nothing here that suggests to me that the government is going to insert itself in end-of-life care. It's merely saying that recipients of government money will adhere to a standard of care that includes having this very beneficial discussion. I see why McCaughey never got to this page, since I don't think she would have survived Stewart's withering take-down. As it is, for him to say, "I like you, but ... I don't understand how your brain works" is bad enough.