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Friday, November 20, 2009


Rationing Issues with the Reid Senate Bill:
With the various concerns related to rationing and euthanasia, we will post a series of concerns - the following analysis being one among several.

“Shared Decisionmaking” – Advance Care Planning By Another Name?

The Reid bill does not include provisions paralleling those in the House bill designed to create incentives for “advance care planning.”[1] But, Section 936 [2] provides funding to develop “patient decision aids” that are supposed to help “patients, caregivers or authorized representatives . . . to decide with their health care provider what treatments are best for them based on their treatment options, scientific evidence, circumstances, beliefs, and preferences.”

Under the Reid bill, the Department of Health and Human Services would contract with an “entity” that is to “develop and identify consensus-based standards to evaluate patient decision aids for preference sensitive care . . . and develop a certification process” for these “patient decision aids.” [3] Additional grants and contracts would be awarded to develop such “patient decision aids” which are to include “relative cost of treatment or, where appropriate, palliative care options” and to “educate providers on the use of such materials, including through academic curricula.”[4] Money would be awarded to establish “Shared Decisionmaking Resource Centers . . . to provide technical assistance to providers and to develop and disseminate best practices . . .”[5]

Furthermore, there is also language in this section about ensuring the materials are “balanced” to help patients and their representatives “understand and communicate their beliefs and preferences related to their treatment options.”[6]

The concern, however, is the same as that with the promotion of advance care planning. Given the stong views many in the medical community have about poor quality of life and the considerable emphasis on saving costs, these measures will in fact subtly or otherwise “nudge” in the direction of rejecting costly life-saving treatment.

[1] Note: The Reid bill provides for encouraging minors in foster care to prepare advance directives- in the same manner as the house bill.
[2] Sec. 936(b)(1), p. 1106
[3] At p. 1108
[4] At p. 1110
[5] At p. 1110
[6] At p. 1109

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