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Senators eliminate end-of-life provision

Respond to charge of ‘death panels’

By Foon Rhee
Globe Staff / August 14, 2009

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A plan to provide hospice counseling and other end-of-life advice to patients and their families is being dropped by US Senate health care negotiators after critics charged that it would lead to the formation of federal “death panels,’’ a key GOP senator said yesterday.

The theory that encouraging doctors to discuss such sensitive topics would lead to euthanasia of the elderly was among the more inflammatory accusations floated against the health care overhaul in the last week, leading President Obama to complain in New Hampshire this week about “wild’’ misconceptions about the proposals. Among the leading proponents of the “death panels’’ criticism was former Alaska governor Sarah Palin.

The original sponsor of the provision and a variety of specialists all debunked the allegation and said end-of-life counseling can help families deal with difficult choices. Nonetheless, Senator Chuck Grassley, the Senate Finance Committee’s top Republican and one of six committee members trying to hash out a bipartisan bill, said yesterday that the provision could be misinterpreted and that it will not be contained in the committee’s proposed legislation.

The language is still in the House legislation, which would permit Medicare to pay doctors for voluntary counseling sessions on end-of-life issues, including living wills, making a close relative or friend a health care proxy, hospice care, and information about medications for chronic pain.

Under the proposal - supported by the American Medical Association and the National Hospice and Palliative Care Organization - counseling sessions would be covered by insurance every five years, and more frequently for the seriously ill.

The episode illustrates the intense passions in the health care debate. The phrase “death panels’’ proved to be a volatile buzzword, and it quickly caught on in talk radio, cable television, and at town hall meetings conducted by members of Congress on summer recess.

The provision was turned into a “horrific, totalitarian institution,’’ and deleting it should help ease the way for the health care overhaul, said Ross Baker, a political scientist at Rutgers University.

“It’s too tough to try to explain,’’ he said. “It’s better to just ditch it. At this point, they’re trying to get rid of anything with the least ability to frighten people. The message now is reassurance and a very light government hand.’’

Palin, the 2008 Republican vice presidential nominee, called the end-of-life counseling provision “downright evil,’’ contending that federal bureaucrats would decide whether ailing seniors or children with Down syndrome - like her son Trig, born last year - should receive treatment.

In a town hall meeting Tuesday in Portsmouth, N.H., President Obama tackled the issue head-on, saying he wanted to “clear the air’’ on a rumor that the House somehow “voted for death panels that will basically pull the plug on grandma because we’ve decided it’s too expensive to let her live anymore.’’ That view, the president said, came from a misreading of the legislation.

But in a Facebook posting late Wednesday night, Palin refused to back down. She argued that under the legislation, the elderly and ill could be coerced into accepting minimal care to reduce costs.

“With all due respect, it’s misleading for the president to describe this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients,’’ she wrote. “It’s all just more evidence that the Democratic legislative proposals will lead to health care rationing.’’

White House spokesman Robert Gibbs said yesterday that death panels are the biggest misconception about the overhaul.

“It does us no good to incite fear in people by saying that there’s these end-of-life provisions, these death panels,’’ he said. “Quite honestly, I’m so offended at that terminology because it absolutely isn’t in the bill.’’

As part of the White House counteroffensive, senior adviser David Axelrod included the claim among eight “common myths’’ about the health care overhaul in an e-mail to Obama supporters.

“It’s a malicious myth that reform would encourage or even require euthanasia for seniors. For seniors who want to consult with their family and physicians about end-of life decisions, reform will help to cover these voluntary, private consultations for those who want help with these personal and difficult family decisions,’’ Axelrod wrote.

Democrats have criticized Grassley for what they see as adding to the firestorm when he assailed the end-of-life provision himself during a town hall meeting Wednesday in Iowa.

“You have every right to fear’’ it, he said. “There are some people who think it is a terrible problem that grandma is laying in a bed with tubes in her . . . and that the government should intervene. I think that’s a family or religious thing that needs to be dealt with.’’

Yesterday, Grassley criticized the House bill, saying there was a difference between a “simple education campaign, as some advocates want,’’ and paying “physicians to advise patients about end-of-life care’’ and rating doctors “based on the creation of and adherence to orders for end-of-life care.’’

“We dropped end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly,’’ Grassley said. “Maybe others can defend a bill like the [House] bill that leaves major issues open to interpretation, but I can’t.’’

However, other Republicans, including Senators Lisa Murkowski of Alaska and Johnny Isakson of Georgia - who sponsored similar legislation - have said Palin’s claim was hurting the party’s attempts to influence the bill.

Portions of the Democratic health care bills “are bad enough that we don’t need to be making things up,’’ Murkowski said, repeating a phrase Palin used last month when announcing her resignation as Alaska’s governor, when she asked the news media to “quit making things up.’’

Isakson said it was “nuts’’ to claim the bill encourages euthanasia.

Representative Earl Blumenauer, an Oregon Democrat who wrote the provision in the House bill, called references to death panels or euthanasia “mind-numbing’’ because the bill would block funds for counseling that presents suicide or assisted suicide as an option.

“It’s a blatant lie, and everybody who has checked it agrees,’’ he said.

Material from The Associated Press was used in this report.