Opinion on advance planning distorts bill's intent

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It’s not often that I read something that’s so wildly off the mark I feel the need to comment on it. Thursday, however, I came across an opinion piece in the Wall Street Journal written by former New York State Lieutenant Governor Betsy McCaughey that I believe mischaracterizes an issue in a potentially dangerous way.

In her piece, “Government Care’s Assault on Seniors,” McCaughey argues that one provision of the House healthcare reform bill, the Advance Care Planning Consultation measure, is designed to counsel seniors on “cutting life short” in order to save the system money. The bill will “pressure the elderly to end their lives prematurely,” she opines in her opening paragraph.

This is a distortion of the intent of the measure. Here’s the text of the section in question (found on page 425 of the 1,000-page+ bill):

Advance Care Planning Consultation

[A]dvance care planning consultation means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:

• An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to

• An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses

• An explanation by the practitioner of the role and responsibilities of a health care proxy

• The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations

• An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title

• Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include:

-The reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes

-The information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order

-The identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decision-maker (also known as a healthcare proxy)

In essence, the bill proposes that, every five years or so, a Medicare beneficiary meets with a counselor to discuss advance directives and end-of-life care planning. The later sections of this measure are clearly designed to make sure every available option is at least considered. It is not, as McCaughey suggests, geared toward pressuring seniors to kill themselves for the greater good.

We at McKnight’s sift through various studies about senior care and related issues when preparing our daily news, and we’ve come across quite a few over the years that deal with this subject. Most demonstrate the advantages, to patients, families and physicians alike, of having an advance directive. One study found that even simply discussing all the options available improves a patient’s overall quality of life. (McKnight’s, 10/9/08)

Other studies showing the advantages of discussing, preparing and implementing an advance directive (also known as a “living will”) can be found here:

Archives of Internal Medicine, May 25 2009
http://archinte.ama-assn.org/cgi/content/abstract/169/10/954

Journal of the American Medical Association, October 8, 2008
http://jama.ama-assn.org/cgi/content/abstract/300/14/1665

Journal of the American Geriatrics Society, February 2007
http://www3.interscience.wiley.com/journal/117995713/abstract

Journal of the American Medical Association, July 13, 2005
http://jama.ama-assn.org/cgi/content/abstract/294/2/211

Study - Center for Demography and Ecology University of Wisconsin-Madison
http://www.ssc.wisc.edu/cde/cdewp/2007-05.pdf

When McCaughey argues that the measure is really just an excuse for the government to encourage the deaths of seniors who aren’t cost-effective enough to care for, that is an irresponsible twisting of its purpose.

Helping seniors plan for end-of-life care is an important part of long-term care, whether it’s comfortable to discuss or not. Everybody dies, and planning for the end needs to be part of a comprehensive approach to healthcare. This measure seeks to ensure that all options are at least discussed, and there’s nothing sinister about that.

Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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