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Human Exceptionalism

Life and dignity with Wesley J. Smith.

Legislated Advance Directives to Live Could Be Ignored



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Politico is reporting that the proposal to explicitly pay doctors for end-of-life care discussions with patients has again been put in the Congressional hopper. Some called this a “death panel” aspect of Obamacare, as a consequence of which, it never made it into law.

As I noted back then, that wasn’t true. The potential death panels are the yet to be instituted cost/benefit boards of “experts” that could act like the NHS’s rationing board. Indeed, powerful voices have called for such a panel as part of the cost containment aspects of Obamacare.

Of course, I believe doctors should discuss these issues with patients–and I am a bit stunned that there should be extra pay for what should be a normal part of the physician/patient relationship. Be that as it may, despite the clear impetus for end of life discussions to save money on the assumption that people will refuse care, Politico reports accurately that such patient decisions can go either way. But that and two bucks will buy you a cup of Starbuck’s coffee. From the story:

But he’s [Republican co-author Phil Roe of TN) been reaching out to colleagues, trying to explain that this end-of-life medical consult legislation isn’t Obamacare. It’s about getting people the care they want and helping document their wishes, which may change over time. Both lawmakers noted that an advanced directive doesn’t mean a do-not-resuscitate order. People can and do opt for very aggressive do-everything care.

Talk about naive! You see, the prevailing opinion among the medical intelligentsia views patient “choice” as a one-way street. Choose to die, and the decision is sacrosanct. Ask to live and–well, it depends on what the “experts” think.

For example, Futile Care Theory seeks to grant hospital bioethics committees and physicians the right to veto such patient decisions. So, in a different way, would health care rationing–surely on deck if Obamacare sinks its teeth into the country’s bone marrow. Laws have already been passed allowing doctors to fill out POLST orders that impose a DNR order on a patient’s chart without consent. Heads we win, tails you lose.

It is also worth noting that the assisted suicide advocacy group Compassion and Choices bragged that it was a key player in creating the original proposal. That doesn’t make it bad, per se. But it sure does make it suspect–meaning that the details of the proposal need going over with a very fine toothed comb.



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