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."
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.
Wesley Smith, an attorney for the International Task Force on Euthanasia and Assisted Suicide, said Obama's focus on controlling costs and the legalese in the bill have contributed to the confusion. "People fear these counseling sessions will push toward less care because the point is to cut costs," he said. The average cost of care for a chronically ill Medicare patient in the final six months of life is $46,400, according to Dartmouth University data.
The emphasis on cost containment means "you'll end up with denial of care for the elderly," said Charmaine Yoest, president of Americans United for Life, who also testified against the Supreme Court nomination of Sonia Sotomayor. Possible abortion coverage and end-of-life care in the health bill will be "a watershed battle for the life community."
In the past two weeks, AARP has fielded a few thousand calls from people who mistakenly think the legislation would require every Medicare recipient to "choose how they want to die," said James Dau, a spokesman for the organization.
Though he is "willing to give the benefit of the doubt" to some who may be confused, Dau complained that the effort to "intentionally distort" the proposal "is just plain cruel to anyone who is forced to make one of these difficult decisions at the end of life."
The American Medical Association, which supports the provision, has received similar inquiries and protests from patients who fear doctors will begin denying care late in life.
"These are important discussions everyone should have when they are healthy and not entering a hospital, so they are fully informed and can make their wishes known," said association President J. James Rohack. "That's not controversial; it's plain, old-fashioned patient-centered care."
After letting the controversy simmer on talk radio and the blogosphere, expecting that it might blow over, Democrats have begun to respond.
The allegations of mandatory counseling and euthanasia "are blatantly false," Reps. Earl Blumenauer (D-Ore.) and Sander M. Levin (D-Mich.) wrote colleagues. The accusations are "as offensive as they are untrue."