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Proposed Counseling for Seniors in Health Plan Spurs New Battle

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By Ceci Connolly
Washington Post Staff Writer
Saturday, August 1, 2009

A campaign on conservative talk radio, fueled by President Obama's calls to control exorbitant medical bills, has sparked fear among senior citizens that the health-care bill moving through Congress will lead to end-of-life "rationing" and even "euthanasia."

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The controversy stems from a proposal to pay physicians who counsel elderly or terminally ill patients about what medical interventions they would prefer near the end of life and how to prepare instructions such as living wills. Under the plan, Medicare would reimburse doctors for one session every five years to confer with a patient about his or her wishes and how to ensure those preferences are followed. The counseling sessions would be voluntary.

But on right-leaning radio programs, religious e-mail lists and Internet blogs, the proposal has been described as "guiding you in how to die," "an ORDER from the Government to end your life," promoting "death care" and, in the words of antiabortion leader Randall Terry, an attempt to "kill Granny."

Though the counseling provision is a tiny part of a behemoth bill, the skirmish over end-of-life care, like arguments about abortion coverage, has become a distraction and provided an opening for opponents of the president's broader health-care agenda. At a forum sponsored by the seniors group AARP that was intended to pitch comprehensive reform, Obama was asked about the "rumors." He used the question to promote living wills, noting that he and the first lady have them.

Democratic strategists privately acknowledged that they were hesitant to give extra attention to the issue by refuting the inaccuracies, but they worry that it will further agitate already-skeptical seniors.

The side battle also undercuts what many say is the more fundamental challenge of discussing sensitive, costly societal questions about how to align patient wishes at the end of life with financial realities, for both the family and taxpayers.

"I don't think it's about cutting costs; it's about quality," said Tia Powell, director of the Montefiore-Einstein Center for Bioethics. Pointing to extensive research, she said: "The good news is if you get people in an environment that is of their choosing, where there is support and they have good pain control, it is very likely to extend their life."

Not since 2003, when Congress and President George W. Bush became involved in the case of Terri Schiavo, who lay in a vegetative state in a hospice in Florida, have lawmakers waded into the highly charged subject, said Howard Brody, director of an ethics institute at the University of Texas Medical Branch at Galveston.

The attacks on talk radio began when Betsy McCaughey, who helped defeat President Bill Clinton's health-care overhaul 16 years ago, told former senator Fred D. Thompson (R-Tenn.) that mandatory counseling sessions with Medicare beneficiaries would "tell them how to end their life sooner" and would teach the elderly how to "decline nutrition . . . and cut your life short."

House Minority Leader John A. Boehner (R-Ohio) and Republican Policy Committee Chairman Thaddeus McCotter (Mich.) said they object to the idea because it "may start us down a treacherous path toward government-encouraged euthanasia."

Brody says the proposal to reimburse counseling sessions "is an excellent idea," because too few doctors or adult children know what an elderly person wants, even sometimes when the patient has signed a medical directive.

About one-third of Americans have living wills or a document designating a health-care proxy who would make decisions if they become incapacitated, said Barbara Coombs Lee, president of Compassion & Choices, a nonprofit group that focuses on the rights of the terminally ill. "But it's alarming how rarely they actually get honored because often doctors haven't familiarized themselves with the patient's wishes," she said.


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