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Clarity for End-of-Life Planning

Not least, the bill is an enabling document that leaves great discretion to the secretary of health and human services to develop guidelines that ultimately could change the character of what seems to be offered. In just one of dozens of examples, the bill leaves it to the secretary to develop "quality measures" on end-of-life care and advance care planning.

What might such quality measures look like? Who knows? But other documents floating around hint at what the secretary might consider.

One is a 2008 Rand Corp. report, "Advance Directives and Advance Care Planning: Report to Congress," which suggests mechanisms by which poor "advance care planning" could be viewed as "medical error," otherwise known as malpractice. While it's unclear what direction "quality measures" might take, the bill could allow the government to require Medicare providers to encourage end-of-life consultations -- or risk being penalized in their compensation or in their ability to participate in the Medicare program.

Beyond the jargon, of course, the real issue is that people instinctively (and correctly) fear bureaucracy -- especially in matters of life and death. When it takes 1,017 pages of mostly incomprehensible language to MapQuest the way we live (and die), people have a right to demand clarity.

A simple amendment to H.R. 3200 would do much to cool tempers. All that's needed is specific language saying that these end-of-life consultations are not mandatory -- either for physicians or patients -- and that there would be no penalty, either in coverage or compensation, for declining to participate.

In the absence of such language, one may reasonably assume otherwise.

kathleenparker@washpost.com


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