Friday, August 21, 2009

LTG 08/19/09 - Living wills and Logan's Run

From the Omaha CityWeekly, 08/19/09-08/25/09 issue

Did you hear? The new health care reform proposal has “death panels” that will decide whether people live or die based on their value to society. And those “death panels” will be made up of big Red Sox fans, so people from New York are way more likely to get put out to pasture. OMG!

All of the facts in the above paragraph are false. Some of them were made up by yours truly. Some of them were made up by Sarah Palin, former Alaska governor. I’ll leave it to you to figure out who is makin’ up what.

The whole kerfuffel revolves around a provision in some proposals encouraging the use of living wills. So let's get into some detail about what these scary things are.

In the United States, you do not have the right to have someone help you kill yourself. But there is a difference between actively killing yourself, such as taking poison or other means, and passively allowing yourself to die by withholding medical and physical care. That's where living wills come in.

When you execute (an unfortunate, but accurate, word in the current "death panel" climate) a living will, you tell your doctors under what circumstances you want medical care discontinued. For many people, their wish is to discontinue care if they are going to die in short period of time and there is no reasonable likelihood of recovery. That’s the basis for hospice care, a means to provide dignity and comfort at the end of a long struggle with a debilitating disease like cancer.

If you do not want "heroic" measures used to extend life, a living will is critical. Doctors, wanting to err on the side of life, will assume that you want every possible care used, up to and including putting your brain in a Futurama-style jar. If you don't want that, you'd better have a living will or a strong group of loved ones with a big budget for legal bills.

Another common use for a living will is to give direction in the event of a persistent vegitative state (PVS). That's the Terri Schiavo scenario, where the brain has died but the body is hanging on.

Remember Terri Schiavo? She was in a PVS and her husband believed she wouldn't want to linger on that way. Terri's parents fought her husband, and the Republican-led Congress tried to pass legislation to specifically stop Terri's husband from fulfilling what he thought were Terri's wishes.

Because, you know, Republicans believe in keeping government out of people's lives, right?

The whole reason Schiavo’s case became such a big fight was because Terri didn't have a living will, leaving it up to a judge to decide. As a judge, I can tell you that's a decision I want no part of.

But that's why having a living will is such a good idea. You, not your family or a judge, get to decide what to do in that most personal and private time.

To help people make these difficult decisions, someone had the crazy idea to let Medicaid pay for a doctor to talk with a family making those difficult decisions. One might think that having a medical professional offer advice to a struggling family trying to make the most difficult and painful of decisions would be universally supported.

One would be wrong about that. In a callous and transparent attempt to undermine any attempt at health care reform, conservatives like Palin have invented these “death panels” and social values tests to scare people away from making changes to a system that leaves 18 percent of the country without health insurance.

Palin has attempted to defend her “death panel” Facebook posting with another, longer post. This one has no text message abbreviation and uses footnotes, so either she’s taking it more seriously or had someone write it for her. Her basic premise in defending the “death panel” argument was that because the bill is intended to cut costs, there will be implicit pressure on the counselors to convince people to die sooner than they would otherwise.

Unfortunately, even with the footnotes, that’s a load of moose poop. Anyone giving counseling to people in end-of-life situations would have a financial incentive to provide more services, not less. That means, if we are implying selfish motivations upon the counselors, that people would be pushed to get more medical treatment, not less.

Palin’s attempt to defend her “social value” part of her Facebook posting was even less convincing. That may have something to do with the fact that there is nothing in any proposal that could even come close to putting into law any kind of determination of a person’s “social value” as criteria for medical care that Palin darkly warned her Facebook friends about.

Frankly, I was disappointed. I thought we’d get at least one footnote to the dystopian science fiction classic “Logan’s Run.”

Look, there’s plenty of room for reasonable debate. I’m not nuts about a number of things being proposed in the health care reform package, and I think more discussion about them would be healthy.

But it is despicable, indefensible, and evil to tell bald-faced lies to people who trust you in an attempt to scare them into actions that benefit you politically. Anyone who does so (I’m looking at you, Ms. Palin) should be simply ignored in any further policy discussions.

Or, perhaps more appropriately, un-friended.


Anonymous said...

Pat, you are a dear friend, but your logic is flawed.

You have a Medicare/Medicaid patient being advised about whether they should want further treatment or just die. As the Government would be paying for further treatment (remember it is a Medicare/Medicaod patient), it definitely has the incentive to decrease its costs by nudging Grandma (or parents of kids with severe diabilities) to "do the right thing".

Imagine this scenario under a "single payer" system, which is where many Democrats want to go, or the public option, where the Government is your insurer. [Then, spin it further out as the "public option" becomes more and more utilized because it can run at a deficit, like all other government programs, and runs private insurers out of the market.]

It is lready a complicated enough debate without people mis-stating and misconstruing arguments and statements.

Two lashes with a wet noodle for you. :)

Law-Talking Guy said...

Thanks for your comment, but I would suggest reading the column again. Think about it. Who is doing the counseling? Doctors. Doctors would be getting reimbursed from Medicare under the proposals. Doctors would also be getting reimbursed for medical services they provide. The more medical services they provide, the more money they make. It is in the doctor's financial interest to ensure the patient receives MORE end-of-life care, not less. If anything, having a doctor counsel a patient for end-of-life issues should be viewed with suspicion as to providing too MUCH care (and thus providing more money to the doctor) rather than too LITTLE care. Follow the money, baby, and you'll find that the whole "death panel" meme is nothing more than an effective lie to scare people into opposing a reform bill.

As for private insurers being run out of business by a public option, let's think about that in two ways. First, health insurers are doing fine. Since 2000, ten of the largest ones saw their profits increast 438 (!) percent. This is hardly an industry teetering on oblivion.

I would agree that the debate is complicated enough without mis-statement of fact. That's why Ms. Palin's tweet made me so angry.

As for the noodle, save that for how bad my fantasy baseball team is doing ...