Saturday, July 18, 2009

Advance Care Planning

I just read an interesting section of the proposed health care bill that refers to Advance Care Planning Consultation. Now what the h e double toothpicks is that? Go to page 425 and read a ways and you come to:

4 ‘‘(E) An explanation by the practitioner of the
5 continuum of end-of-life services and supports avail
6 able, including palliative care and hospice, and bene
7 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 indi
18 vidual or legal surrogate to make informed deci
19 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 require
23 ments of the State in which such individual re
24 sides so that the treatment wishes of that indi
25 vidual will be carried out if the individual is un
1 able to communicate those wishes, including re
2 quirements regarding the designation of a sur
3 rogate decisionmaker (also known as a health
4 care proxy).
Translation: you will be encouraged to give it up (DNR - do not resuscitate) fur da grater god duvall. i.e. "you are going to die - would you care to speed things along?" And now you know where the cost savings will come from. No doubt Obama's Science Adviser John Holdren had some inputs on that section.

Cross Posted at Classical Values


linearthinker said...

I'm no fan of Obama, ObamaCare, or Holdren. Having said that, and without reading in full the section and context you quote, there has to be the consultation involving DNR decisions that you imply is a cynical provision to "speed things up." That it appears codified in the body of the proposed bill is surprising, but the protocol should be in place in every hospital offering critical care services in any setting where a terminal prognosis is a possible outcome. This comments thread is not the place where I'll discuss how I've recently become aware of this issue. Just know it's a period of incredible stress for the patient, family, and the potential surrogate decision maker. Improperly handled by the responsible medical staff, it can lead to disasterous consequences through confusion and bad decisions by the patient and next of kin. Perhaps you're right in assuming it's greasing the skids for "speeding things up," but the protocols and training must be dealt with somewhere.

linearthinker said...

An after thought is that the appropriate place for the protocol development and related training is within the medical establishment, not Congressional legislation. We already have too many laws and regulations clogging the system.

M. Simon said...

As you point out LT it is between a man, his family, his doctor, and his Maker.

John said...

This bill is about how best to spend tax money, not whether or not you want to spend a bleeding fortune staying alive or keeping your family member alive in a persistent vegetative state as long as science can achieve.

Does the bill forbid that?

I think not. In fact, the vision of a health care environment in which providers and insurers can ply their trade with the well-heeled without having to bother with the great unwashed is making the private sector salivate. Why do you think the AMA is on board?

M. Simon said...


It does not forbid that. The plan is to slowly squeeze it out.

Fortunately I do not think it will pass.