After enacting a Medicare regulation on Jan. 1 that would reimburse
doctors for holding end-of-life planning consults with patients, the
Obama administration swiftly reversed the move just three days later,
after intense controversy swirled around the issue.
Although critics of the regulation argued that it was a push towards
assisted suicide or advising elderly patients to forgo costly
life-sustaining treatments, some Catholic experts held that end-of-life
planning could instead be viewed as pro-life and consistent with Church
teaching.
Uproar over the regulation began when the New York Times reported on
Dec. 25 that the Obama administration quietly endorsed a policy that
would reimburse doctors who give consultations to patients on
end-of-life care as part of an annual wellness examination created by
the new healthcare reform law.
Though similar language was stripped from
the final Senate health care bill which passed last March, the
administration worked to achieve the same goal on Jan. 1 through a
Medicare regulation.
The Times observed that regulation writing could be
an effective process for the administration to enact health care
policies despite increasing Republican opposition in Congress.
Under the new regulation, Medicare would have covered “voluntary
advance care planning,” to discuss end-of-life treatment, as part of an
annual visit.
During the visit, doctors would have provided information
to patients on how to prepare an “advance directive” which would detail
how aggressively they wish to be treated if they are incapacitated to
make their own decisions in the future.
The regulation was published in
the Federal Register last November and was issued by Dr. Donald M.
Berwick, administrator of the Centers for Medicare and Medicaid
Services.
But in an interesting twist, the Obama administration reversed its
decision, just three days after the regulation was enacted on Jan. 1,
according to the New York Times.
Administration officials told the
newspaper that the reason behind the decision was that the public did
not have a chance to weigh in on the regulation.
“We realize that this should have been included in the proposed rule,
so more people could have commented on it specifically,” an unnamed
administration official said.
End-of-life planning provisions have been staunchly opposed by
political conservatives since the drafting of the health care
legislation in 2009.
Republican figures, such as 2008 vice presidential candidate Sarah
Palin and current House Majority Leader Rep. John Boehner (R-Ohio) led
the opposition, with Palin coining the term “Obama's death panels” and
Rep. Boehner warning against what he considered to be a step towards
“government-encouraged euthanasia.”
Elizabeth Price Foley, a professor of law at Florida International
University who is politically unaffiliated, offered a more nuanced view
in remarks to CNA on Jan. 4.
Although Foley said the term end-of-life planning “sounds innocuous
enough,” she feared that elderly patients could be pressured into making
decisions they don't understand.
Foley also said that advanced
directives in some states are slanted towards having patients refuse
life-sustaining treatments and that redrafting one's own directive
involves hiring an attorney, which can be costly and time consuming.
“If we coerce seniors into executing advanced directives we may
intentionally or unintentionally coerce some of them into signing
documents in which they express a desire to decline life-sustaining care
when that's not really what they want,” Foley said.
Richard Doerflinger, associate director of the Secretariat for
Pro-Life Activities for the U.S. Catholic bishops' conference, said he
shared concerns with conservatives over the issue but told CNA Jan. 4
that he didn't believe the Medicare regulation posed an “assisted
suicide problem.”
“There is a good deal of polarization and exaggeration on many issues
relating to health care reform; that's not confined to one party,”
Doerflinger said. “I do think the 'death panels' charge spreads more
heat than light.”
Doerflinger said the reportedly defunct Medicare regulation didn't
include a “panel” of any sort – “only a doctor and a patient who agree
to talk about what treatments the patient may want in the future.”
He noted Foley's concerns about elderly patients signing advance
directives without proper knowledge, but said “I don't think that's
sufficient reason for opposition in principle to offering people the
opportunity to sign a form they do feel comfortable with.”
“For many patients the alternative to this – for example, expressing
no wishes and so being left entirely to the mercy of insurers and
medical personnel who have their own 'bottom line' to worry about – may
be worse.”
He went on to say that advance directives can be utilized in accord
with Church teachings, noting that in “cases where the patient may
become unconscious or unable to communicate, it can be helpful for that
patient to put in writing what his or her general preferences are.”
Doerflinger stressed caution when approaching the issue, however,
saying that "Catholic teaching urges patients to accept life-sustaining
treatment whose benefits outweigh the burdens, but there is much room
for prudential decisionmaking within that principle."
Fr. Tadeusz Pacholczyk, who serves as director of education for the
National Catholic Bioethics Center, agreed that caution is necessary,
saying that patients “should never be offered immoral choices, such as
euthanasia or assisted suicide, and end of life planning sessions should
never become a fulcrum or pressure point to coerce individuals towards
unethical treatment options.”
“All patient care and end of life planning must be patient-centered,
seeking to assure that reasonable treatments options are available and
utilized, while unreasonable or unduly burdensome treatment options are
avoided,” he said.
“Generally speaking, end of life discussions are very important and
need to be encouraged, but encouraged in the right way,” he added.
Fr. Pacholczyk said that, regrettably, many families never talk about
these issues “until they are forced into them by urgent, unavoidable
circumstances.”
“Designating a health care proxy, someone who loves us and who we
trust, and who can make decisions for us if we become incapacitated, is
an important step that every person should take to assist in proper
management of end of life situations,” Fr. Pacholczyk said.
SIC: CNA/USA