DURING THE health reform debate in 2009, Republican alarmists decried a provision to pay doctors to discuss end-of-life treatment options with Medicare patients as tantamount to “death panels.’’ The bill as finally approved lacked that clause, but late last year Obama administration officials authorized such counseling in a Medicare regulation on annual physical examinations. Now they have withdrawn that provision in a cave-in to expected opposition. The retreat is lamentable.
All too few such discussions between doctors and patients occur now, with the result that many patients end their lives tethered to mechanical feeding and respiratory devices in hospitals — not peacefully at home, where many people would prefer to die. Both doctors and patients often shy away from talking about end-of-life “what ifs’’ because of fear or awkwardness. The regulation initially put forth by the Obama administration would not have required such conversations but at least would have eliminated one excuse for not conducting them — that doctors will not be reimbursed for their time. In the past, proposals for support of end-of-life discussions enjoyed bipartisan support, including from such Republican senators as John Isakson of Georgia, Richard Lugar of Indiana, and Susan Collins of Maine.
Conversations about a patient’s preferences for or against heroic, life-extending measures have nothing to do with death panels denying care to elderly or disabled patients, the red herring raised by former Alaska Governor Sarah Palin, then-House minority leader John Boehner, and others. Those leaders weren’t mistaken; they were deliberately disingenuous, going to any extreme to defeat health reform. Instead, they blocked what had been one of the most widely accepted, and least controversial, parts of the bill.
After the dust cleared, a national organization of hospice-care providers and members of Congress asked the Obama administration to establish counseling reimbursement in a new regulation. Far from depriving patients of the right to make decisions about their own care, the regulation would have increased their autonomy by encouraging discussions about care options during routine exams and not in the midst of a medical crisis. The administration should have stuck by its convictions.