Update: Is End Of Life Counseling Really a Republican Initiative?

I recently received a message on twitter from a liberal claiming that end of life counseling was actually a republican initiative.  I sent him a message asking him to cite his sources for this information but have yet to hear from him.  I have also searched the internet to try to get some information on his claim.  I would like to have a discussion on this topic.  If anyone out there has an option substantiated by facts on this topic please post your comments here.  I would love to hear from you.

UPDATE:  Well, I actually did get a reply back from the twitter who suggested that end of life counseling was actually a republican initiative.  The link he provided was for a press release for Senator Johnny Isakson of Georgia on heath care.  This press release and statement was released from his office on November 4, 2005.  I was anxious to see if indeed Senator Isakson had indeed proposed making end of life counseling mandatory for seniors every 5 years like the democrats’ proposal in house resolution 3200.

This press release actually stated nothing even remotely close to making end of life counseling a requirement by law.  It actually stated the following:

Isakson said the Terri Schiavo case is a wake-up call to how important it is to sort out end-of-life decisions I believe it is every person’s right and responsibility to make sure their loved ones are prepared to make decisions on their behalf by discussing and documenting their wishes,” he said. “It is my sincere hope that all Georgians will join me in following the lead of the Georgia General Assembly’s Resolution and make their final wishes known.

This statement merely encourages loved ones to be prepared to make decisions on their loved ones behalf in the event that they are incapable of doing so themselves due to a medical emergency.  This press release was centered around the controversial Terri Shiavo case.  Senator Isakson was merely making a statement reiterating the importance of sorting out end-of-life decisions.  He was NOT arguing that end-of-life counseling should be mandatory every 5 years and be giving by some random government assigned doctor or counselor.

If anyone would like to send me a link to some facts proving that government mandated end-of-life counseling is actually a Republican initiative I would appreciate it.


About Will Hucks

I am a systems analyst and do java development here in Jacksonville Florida.
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10 Responses to Update: Is End Of Life Counseling Really a Republican Initiative?

  1. Don says:

    Find the word mandatory .. find the term random .. it is a patience choice and it can only be paid for by Medicare every 5 years at most. Your choice

    16 (a) MEDICARE.—
    17 (1) IN GENERAL.—Section 1861 of the Social
    18 Security Act (42 U.S.C. 1395x) is amended—
    19 (A) in subsection (s)(2)—
    20 (i) by striking ‘‘and’’ at the end of
    21 subparagraph (DD);
    22 (ii) by adding ‘‘and’’ at the end of
    23 subparagraph (EE); and
    24 (iii) by adding at the end the fol25
    lowing new subparagraph:
    VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00424 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
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    f:\VHLC7140971409.140.xml (444390|2)
    1 ‘‘(FF) advance care planning consultation (as
    2 defined in subsection (hhh)(1));’’; and
    3 (B) by adding at the end the following new
    4 subsection:
    5 ‘‘Advance Care Planning Consultation
    6 ‘‘(hhh)(1) Subject to paragraphs (3) and (4), the
    7 term ‘advance care planning consultation’ means a con8
    sultation between the individual and a practitioner de9
    scribed in paragraph (2) regarding advance care planning,
    10 if, subject to paragraph (3), the individual involved has
    11 not had such a consultation within the last 5 years. Such
    12 consultation shall include the following:
    13 ‘‘(A) An explanation by the practitioner of ad14
    vance care planning, including key questions and
    15 considerations, important steps, and suggested peo16
    ple to talk to.
    17 ‘‘(B) An explanation by the practitioner of ad18
    vance directives, including living wills and durable
    19 powers of attorney, and their uses.
    20 ‘‘(C) An explanation by the practitioner of the
    21 role and responsibilities of a health care proxy.
    22 ‘‘(D) The provision by the practitioner of a list
    23 of national and State-specific resources to assist con24
    sumers and their families with advance care plan25
    ning, including the national toll-free hotline, the ad-
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    f:\VHLC7140971409.140.xml (444390|2)
    1 vance care planning clearinghouses, and State legal
    2 service organizations (including those funded
    3 through the Older Americans Act of 1965).
    4 ‘‘(E) An explanation by the practitioner of the
    5 continuum of end-of-life services and supports avail6
    able, including palliative care and hospice, and bene7
    fits for such services and supports that are available
    8 under this title.
    9 ‘‘(F)(i) Subject to clause (ii), an explanation of
    10 orders regarding life sustaining treatment or similar
    11 orders, which shall include—
    12 ‘‘(I) the reasons why the development of
    13 such an order is beneficial to the individual and
    14 the individual’s family and the reasons why
    15 such an order should be updated periodically as
    16 the health of the individual changes;
    17 ‘‘(II) the information needed for an indi18
    vidual or legal surrogate to make informed deci19
    sions regarding the completion of such an
    20 order; and
    21 ‘‘(III) the identification of resources that
    22 an individual may use to determine the require23
    ments of the State in which such individual re24
    sides so that the treatment wishes of that indi25
    vidual will be carried out if the individual is un-
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    f:\VHLC7140971409.140.xml (444390|2)
    1 able to communicate those wishes, including re2
    quirements regarding the designation of a sur3
    rogate decisionmaker (also known as a health
    4 care proxy).
    5 ‘‘(ii) The Secretary shall limit the requirement
    6 for explanations under clause (i) to consultations
    7 furnished in a State—
    8 ‘‘(I) in which all legal barriers have been
    9 addressed for enabling orders for life sustaining
    10 treatment to constitute a set of medical orders
    11 respected across all care settings; and
    12 ‘‘(II) that has in effect a program for or13
    ders for life sustaining treatment described in
    14 clause (iii).
    15 ‘‘(iii) A program for orders for life sustaining
    16 treatment for a States described in this clause is a
    17 program that—
    18 ‘‘(I) ensures such orders are standardized
    19 and uniquely identifiable throughout the State;
    20 ‘‘(II) distributes or makes accessible such
    21 orders to physicians and other health profes22
    sionals that (acting within the scope of the pro23
    fessional’s authority under State law) may sign
    24 orders for life sustaining treatment;
    VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00427 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
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    f:\VHLC7140971409.140.xml (444390|2)
    1 ‘‘(III) provides training for health care
    2 professionals across the continuum of care
    3 about the goals and use of orders for life sus4
    taining treatment; and
    5 ‘‘(IV) is guided by a coalition of stake6
    holders includes representatives from emergency
    7 medical services, emergency department physi8
    cians or nurses, state long-term care associa9
    tion, state medical association, state surveyors,
    10 agency responsible for senior services, state de11
    partment of health, state hospital association,
    12 home health association, state bar association,
    13 and state hospice association.
    14 ‘‘(2) A practitioner described in this paragraph is—
    15 ‘‘(A) a physician (as defined in subsection
    16 (r)(1)); and
    17 ‘‘(B) a nurse practitioner or physician’s assist18
    ant who has the authority under State law to sign
    19 orders for life sustaining treatments.
    20 ‘‘(3)(A) An initial preventive physical examination
    21 under subsection (WW), including any related discussion
    22 during such examination, shall not be considered an ad23
    vance care planning consultation for purposes of applying
    24 the 5-year limitation under paragraph (1).
    VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00428 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
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    f:\VHLC7140971409.140.xml (444390|2)
    1 ‘‘(B) An advance care planning consultation with re2
    spect to an individual may be conducted more frequently
    3 than provided under paragraph (1) if there is a significant
    4 change in the health condition of the individual, including
    5 diagnosis of a chronic, progressive, life-limiting disease, a
    6 life-threatening or terminal diagnosis or life-threatening
    7 injury, or upon admission to a skilled nursing facility, a
    8 long-term care facility (as defined by the Secretary), or
    9 a hospice program.
    10 ‘‘(4) A consultation under this subsection may in11
    clude the formulation of an order regarding life sustaining
    12 treatment or a similar order.
    13 ‘‘(5)(A) For purposes of this section, the term ‘order
    14 regarding life sustaining treatment’ means, with respect
    15 to an individual, an actionable medical order relating to
    16 the treatment of that individual that—
    17 ‘‘(i) is signed and dated by a physician (as de18
    fined in subsection (r)(1)) or another health care
    19 professional (as specified by the Secretary and who
    20 is acting within the scope of the professional’s au21
    thority under State law in signing such an order, in22
    cluding a nurse practitioner or physician assistant)
    23 and is in a form that permits it to stay with the in24
    dividual and be followed by health care professionals
    25 and providers across the continuum of care;
    VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00429 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
    July 14, 2009 (12:51 p.m.)
    f:\VHLC7140971409.140.xml (444390|2)
    1 ‘‘(ii) effectively communicates the individual’s
    2 preferences regarding life sustaining treatment, in3
    cluding an indication of the treatment and care de4
    sired by the individual;
    5 ‘‘(iii) is uniquely identifiable and standardized
    6 within a given locality, region, or State (as identified
    7 by the Secretary); and
    8 ‘‘(iv) may incorporate any advance directive (as
    9 defined in section 1866(f)(3)) if executed by the in10
    11 ‘‘(B) The level of treatment indicated under subpara12
    graph (A)(ii) may range from an indication for full treat13
    ment to an indication to limit some or all or specified
    14 interventions. Such indicated levels of treatment may in15
    clude indications respecting, among other items—
    16 ‘‘(i) the intensity of medical intervention if the
    17 patient is pulse less, apneic, or has serious cardiac
    18 or pulmonary problems;
    19 ‘‘(ii) the individual’s desire regarding transfer
    20 to a hospital or remaining at the current care set21
    22 ‘‘(iii) the use of antibiotics; and
    23 ‘‘(iv) the use of artificially administered nutri24
    tion and hydration.’’.

  2. Don says:

    I am sure this won’t turn on a light-bulb but what the heck

    Senator Richard Lugar (R-IN), Johnny Isakson, a Republican Senator from Georgia. co-sponsored 2007’s Medicare End-of-Life Planning Act.



  3. javabeanwill says:

    Ok, that has to be the longest comment ever on this blog. LOL.

  4. Don says:

    Very long yes .. but this is something that is a good thing and if it wasn’t for politics it should be something both Dems/Reps want. Since no one ever reads the darn section .. there it is 424-430

  5. javabeanwill says:

    This end-of-life planning act seems to be directly related to the Terri Schiavo case. The language of the Bill also seems to indicate the patients always have the option to decide what plan of action to take concerning end-of-life decisions. i.e.,

    `(E) whether or not the physician is willing to follow the individual’s wishes as expressed in an advance directive.’.

    The Democrats Bill seems to require individuals to attend end-of-life counseling every 5 years as mandated by law. The bill sponsored by Johnny Isakson seems to merely encourage people to decide on a plan of action in case of injury or another medical emergency. i.e.,

    `(A) the importance of preparing advance directives in case an injury or illness causes the individual to be unable to make health care decisions;

    Note how the Bill states “the importance of preparing advance directives”. It does not state that it is mandatory by law to “prepare advance directives”. Thanks for sharing this info though.

  6. javabeanwill says:

    It actually wasn’t necessary to post entire provisions of HR3200 here. I have my own copy which I have read. Thanks though. 🙂

  7. Don says:

    I’m confused … in one place you state .. “The Democrats Bill seems to require individuals to attend end-of-life counseling every 5 years as mandated by law. ” It says you can only get it paid for once every 5 years (i.e. not year after year). and it doesn’t mandate?

    Then you say “It does not state that it is madatory by law.

    I’m not sure if you think it is mandatory by law are not. Any hoot .. feel free to delete the long blog .. have a good one

  8. javabeanwill says:

    I’m sorry if you are confused but I was referring to your posting of a link to Senator Isakson’s Bill which I mentioned in my comment. I have read other news articles mentioning this provision of the health care bill and even though it doesn’t mandate this end-of-life counseling many journalists, liberal jounrnalists I might add, are having serious problems with it. Take for instance Charles Lane of the Washington Post who states the following about Section 1233:

    “…addresses compassionate goals in disconcerting proximity to fiscal ones…. If it’s all about obviating suffering, emotional or physical, what’s it doing in a measure to “bend the curve” on health-care costs?” He also points out:

    “Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive — money — to do so. Indeed, that’s an incentive to insist. ”

    He continues…

    “Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit “formulation” of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would “place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,” I don’t think he’s being realistic. ”

    Even Democratic New york State Senator Ruben Diaz, Chairman of the New York Sate Aging Committee wrote the following:

    “Section 1233 of House Resolution 3200 puts our senior citizens on a slippery slope and may diminish respect for the inherent dignity of each of their lives…. It is egregious to consider that any senior citizen … should be placed in a situation where he or she would feel pressured to save the government money by dying a little sooner than he or she otherwise would, be required to be counseled about the supposed benefits of killing oneself, or be encouraged to sign any end of life directives that they would not otherwise sign. “

  9. javabeanwill says:

    Also, Dr. Ezekiel Emanuel, a health policy advisor to President Obama and the brother of the President’s chief of staff has written that some medical services should not be guaranteed to those, and I quote, “who are irreversibly prevented from being or becoming participating citizens…An obvious example is not guaranteeing health services to patients with dementia.” See http://www.ncpa.org/pdfs/Where_Civic_Republicanism_and_Deliberative_Democracy_Meet.pdf

    Dr. Emanuel has also advocated basing medical decisions on a system which “produces a priority curve on which individuals aged between 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.” See http://www.scribd.com/doc/18280675/Principles-for-Allocation-of-Scarce-Medical-Interventions.

  10. Don says:

    You have to put the arguemet in full context .. for Diaz .. Just keep in mind .. it would be your “Doctor” that who is advising you and yes a larger pannel would put forth guidlines so he wouldn’t give you half the arguement either way. In other statements Diaz has held the position that the gov’t shouldn’t come between you and your doctor – and its this person holding the consultation. On one hand the doctor is the good guy but for end-of life he’s not. These conversations happen to day but Medicare doesn’t pay for them. There is a lot of stretch .. doctors and healthcare pannels will start trying to kill the old .. you can assume the worst or think about why its a smart thing to do.
    Also, today it is a recommend service by AARP – they tell seniors to do it – doctors are free to recommend it today (AMA recommends). And doctors get paid for a ton of services .. does that fact a service is paid for by medicare mean it is an incentive .. common .. they get paid to remove cateracts .. etc… by this logic …..

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