HCR -- Advance Directives Again

By John Ballard

Heads up.  The provision excised from PPACA thanks to the "death panels" furor has been reinstated via an executive rule change. And yes, the noise machine is back in action as a quick check at Memeorandum will attest.

Here is a link to the story.

When a proposal to encourage end-of-life planning touched off a political storm over �death panels,� Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1.

Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.

Congressional supporters of the new policy, though pleased, have kept quiet. They fear provoking another furor like the one in 2009 when Republicans seized on the idea of end-of-life counseling to argue that the Democrats� bill would allow the government to cut off care for the critically ill.

And here is a comment I left at a couple of places with paneezinawad.

I�m stepping out of my element to leave a comment here but someone needs to start waving a flag of reason.

Advance directives are so much a part of good medical care these days that they are included in the admission packets of many hospitals. My post retirement work for the last seven years has been among seniors in a variety of circumstances. Whether in independent living arrangements, assisted living, CCRT, or long-term care environments the need and importance of advance directives is as recognized as the need for durable medical equipment, handicapped access and proper nutrition.

I have no illusions that anything I leave in a comments thread will change anyone�s already made up mind, but I urge readers to do a little homework of your own. Yellow pages, local senior centers, hospitals, community colleges, CCRT or assisted living facilities are all good places to start. Consult with directors, chaplains, teachers, and any other resource people you wish and ask them about advance directives. How are they different from DNRs? What is the meaning of �living will� and what are your state�s laws regarding end-of-life issues (and yes, they are regulated by the states, not the federal government). Talk with a few people from various hospice providers, a growing enterprise which has been a part of Medicare benefits for years.

I have watched many families in denial cause dying relatives weeks and months of unnecessary protracted suffering when palliative care was available. Does anyone know, for example, that some people get discharged from hospice because they improve to the point that they no longer can be considered �terminal�? And who has given thought to questions like �If you have a terminal condition and are unable to communicate your wishes, do you have a designated individual with power of attorney for medical care who can make medical decisions on your in accordance with your wishes?� What if that person has died or is no longer available� is there a backup? What if you�re in another state (or another country) and have a life-threatening medical problem? What assurance do you have that you will never lose consciousness or be among the growing number of people with senile dementia or Alzheimers?

Don�t want to ruin you day before the New Year starts, but someone needs to get your attention. Thanks for reading. I won�t trouble you further.

(And before I forget� this inflammatory regulation simply insures that if and when a physician takes valuable professional time to answer questions asked by a patient or family member about the fine points of a final directive, he or she will be paid for their time instead of having to work pro bono. Seems reasonable to me.)

This is so tiresome. Saying the same stuff over and over.
I'm getting a soft spot in my heart for day-care workers.