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More on End-of-Life Counseling

Friday, September 4, 2009

Regarding Linda Gouldrup's Aug. 26 letter and Charles Krauthammer's Aug. 21 op-ed, "The Truth About Death Counseling":

Putting the issue of health-care reform aside, I would just like to point out the basic flaw in the "death panel" scare, hopefully without sounding too mercenary about it. I, and the vast majority of my medical colleagues around the country, do not work for the government. We are in private practice, and we get paid to care for patients in those intensive-care units. Does anyone seriously think a token fee to discuss end-of-life issues outweighs what we would make were those patients kept alive? If we were so easily bought, as these misinformed people imply, you would think we would be firmly against these discussions. And yet we are some of the most vehement supporters of them, regardless of whether we would be paid for them. Why do you suppose that is?

Sarah Palin and other pundits have set us back 10 years with their rhetoric and scare tactics, simply for political gain.

RICHARD SWIFT

Warrenton

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Regarding Ingrid Komar's Sept. 1 Health commentary, "Nothing to Get Scared About":

Ms. Komar wrote that under H.R. 3200, Medicare will cover end-of-life counseling and "medical professionals you choose would provide advice and guidance; you would be free to follow or to ignore it or not consult them at all." Wrong. Simply providing coverage would have taken one or two lines in the bill, not six pages.

The bill lists what "shall" be covered in the consultations, a decision that should be left to the patient and doctor, not prescribed by government. The bill's partisans say the consultation sessions are voluntary. But if there is a penalty for noncompliance, then it is not voluntary, regardless of whether the word mandatory is used. The penalty is on page 432. Doctors' quality ratings will be determined in part by the percentage of doctors' patients who create living wills and the percentage who adhere to them -- and quality ratings affect a doctor's Medicare reimbursement.

The "adhere to" part is especially dangerous. Some people say they'd rather die than be on a ventilator, but when the time comes, they choose to live.

Doctors will incur penalties when situations change and a living will is not adhered to. As a patient advocate, I see these difficult situations and know that government should not be involved.

BETSY McCAUGHEY

New York

The writer is the chairman of the Committee to Reduce Infection Deaths and a former lieutenant governor of New York.

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