Advance-directives section fueling concern and, hospice officials say, misunderstanding

A provision in the health-care bill that has some people talking about making older people appear before "death panels" wouldn't force people to do anything they don't want to, local hospice officials said yesterday.

"I just think it doesn't say anything like what you hear in the news from various sources," said Dr. Richard Stephenson, the senior vice president of medical services at Hospice & Palliative CareCenter of Winston-Salem. "There is a lot of misinformation and conjecture."

"It hurts when a lot of bad information is out there," said JoAnn Davis, Hospice's executive director.

Sarah Palin, the former governor of Alaska and Republican candidate for vice president, has said that a provision of a health-care-overhaul bill that would authorize Medicare to pay doctors for a consultation about end-of-life care would set up a "death panel."

And last month, U.S. Rep Virginia Foxx, a Republican who represents North Carolina's 5th District, said that unlike the Democratic health-care proposal, the Republican version is "pro-life because it will not put seniors in a position of being put to death by their government."

A message left at Foxx's office was not immediately returned yesterday.

As the economy has become less of a topic for public debate, talk about revamping health care has heated up. Some people say they think that the steps that President Obama has taken to give the federal government a more active role in the economy may make it difficult to pass a health-care bill because some people see it as yet another intrusion by the government.

And no matter what else is going on, changes to the health-care system have been a difficult sell, going back to President Theodore Roosevelt in 1912. Presidents that followed -- including Franklin D. Roosevelt, Dwight D. Eisenhower, John F. Kennedy and Bill Clinton -- were unable to get their proposals passed either.

Although some people say that the provision about advance directives in the Democratic bill is relatively innocuous, some Republicans have used it as a way to rally opposition to the entire proposal.

But the provision has been misrepresented, Stephenson said. It would not create "death panels."

"It doesn't tell you what to plan," he said. "It just gives you the option to set out what your wishes are." If people want to, he said, they can make it clear that they want all available measures to be taken to prolong their life.

The provision about advance directives, which include living wills and durable powers of attorney, is quite simple, he said. "You have a right to a consultation, and Medicare will pay for it."

The American Medical Association supports this provision of the bill as does the National Hospice and Palliative Care Organization.

"Folks at the AMA have carefully scrutinized the document," Stephenson said.

The government already requires hospitals to ask adult patients whether they have a living will or advance directive. If the patient doesn't have one and wants one, the hospital has to offer assistance.

Although Medicare doesn't pay for a free-standing consultation with a doctor now, Stephenson said, it already covers such conversations when they come in the context of a visit to a doctor for another matter.

"It can be part of your regular checkup," he said.

In no way does the provision support euthanasia, Stephenson said. "Not one word."

Nor does it force anyone or the doctor to talk about end-of-life issues if they don't want to.

"It's totally voluntary," said Ann Gauthreaux, hospice's director of public relations.

Hospice supports people talking about what sort of life-prolonging care they do or don't want, he and Davis said, and, if this leads more people to talk about the issues, it's a good thing.

"Advanced-care planning is a good thing for everyone," Davis said.

Advanced-care planning can be a good thing not only for a person facing end-of-life care but also for the person's family, Stephenson said. "They are so often relieved that their loved one has done the advanced-care planning. It relieves them of the burden of making some difficult decisions."

Conversations with a doctor can be helpful, in part, because they can provide valuable information that enable people to make sound decisions. Someone may say he doesn't want to starve to death but once he fully understands the consequences of being put on a feeding tube when he is brain dead, he may decide otherwise.

"Most people are concerned that they are going to get life-prolonging care that they don't want," Stephenson said.

He reiterated, though, that, if life-prolonging care is what people want, they can get it.

And people can always change their minds about what they want, Davis said.

The heated debate has surprised John Moskop, a professor of internal medicine and a biomedical-ethics chairman at Wake Forest University School of Medicine.

"I believe that it's a fairly innocuous part of the health-care reform package, because most people want to talk with their physician about their end-of-life options and want their wishes to be known," Moskop said. "Advance-care planning is a totally voluntary process. People can choose the option of having less treatment or lots of treatment as they approach the end of their life, depending on their own personal goals and values."

Moskop said that such patient-physician counseling sessions about end-of-life options are taking place in our current health-care system.

"It's just that making the meetings reimbursable under Medicare makes it more likely they will happen," Moskop said.

"Ultimately, it's about making the decision that they think is the best for their life."

■ Kim Underwood can be reached at 727-7389 or at kunderwood@wsjournal.com.

■ Richard Craver can be reached at 727-7376 or rcraver@wsjournal.com.

■ The Associated Press contributed to this report.

Myth and Facts

Myth: The proposed health-care bill promotes mercy killings or euthanasia.

Fact: No, it doesn't. A provision in the House bill written by Rep. Earl Blumenauer, D-Ore., would allow Medicare to pay doctors for voluntary counseling sessions that deal with end-of-life issues. The conversations between doctor and patient would include living wills, making a close relative or a trusted friend a health care proxy, learning about hospice as an option for the terminally ill, and information about pain medications for people suffering chronic discomfort.
The sessions would be covered every five years, more frequently if someone is gravely ill.

Myth: The bill would create death panels that would decide whether a senior received medical care.

Fact: It would not, though some social conservatives say that stronger language is needed to protect seniors from being pressured into signing away their rights to medical treatment in a moment of depression or despair.
The National Right to Life Committee opposes the provision as written.
"I'm not aware of 'death panels' in the bill," said David O'Steen, the executive director of the group. "I'm not aware of anything that says you will be hauled before a government bureaucrat. But we are concerned ... it doesn't take a lot to push a vulnerable person — perhaps unwittingly — to give up their right to life-sustaining treatment."

Myth: The bill advocates assisted suicide.

Fact: No. It would block money for counseling that presents suicide or assisted suicide as an option. The bill's stance is supported by the American Medical Association, the National Hospice and Palliative Care Organization and Consumers Union. AARP, the seniors' lobby, is taking out print advertisements that label as false the claim that the legislation will empower the government to take over life-and-death decisions from individuals.

Myth: The government is currently not involved in end-of-life issues.

Fact: The government already requires hospitals to ask adult patients if they have a living will, or "advance directive." If the patient doesn't have one, and wants one, the hospital has to provide assistance to create one. The mandate on hospitals was instituted during a Republican administration, in 1992, under President George H.W. Bush.

Source: The Associated Press