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Friday, December 18, 2009


Sen. Rockefeller (D -Wv.) has filed an amendment that would incorporate the House's controversial 1233 Advance Planning Provisions. Although time is running out for this amendment to be considered on the floor, there is the very real possibility that this dangerous language appears in the "manager's amendment"(this will serve as one large amendment meant to address all outstanding Democratic concerns).

During the summer there was considerable criticism of provisions in the House health care bill that would reimburse Medicare physicians to discuss "advance care planning" with their senior citizen patients, in the express expectation that many would complete advance directives rejecting life-preserving medical treatment and thus save substantial sums of money, as well as other sections promoting such advance directives. More on how these dangerous provisions would work is available here.

In reaction, neither the bill reported in July from the Senate Health, Education, Labor and Pensions Committee nor that reported in October from the Senate Finance Committee contained similar provisions. The Reid bill did incorporate advance planning language (explained here), but did not mirror the dangerous House language.

During the Senate Finance Committee deliberations, Senator Rockefeller spoke out strongly in favor of including House-style advance planning provisions. More recently, a speech from a long-time advocate reveals that his strategy is to do so "at the llth hour."[1]

Presumably, that 11th hour has arrived, and there is a very great possibility that Sen. Rockefeller may be successful in having these Advance Planning provisions inserted into the "manager's amendment."

Author and blogger Lee Siegel, a strong advocate of universal health care coverage, points out an important danger in these provisions:
The shading in of human particulars is what makes [House Bill section 1233] so unsettling. A doctor guided by a panel of experts who have decided that some treatments are futile will, in subtle ways, advance that point of view. Cass Sunstein [who is the Obama Administration’s regulatory czar] calls this “nudging,” which he characterizes as using various types of reinforcement techniques to “nudge” people’s behavior in one direction or another. An elderly or sick person would be especially vulnerable to the sophisticated nudging of an authority figure like a doctor. Bad enough for such people who are lucky enough to be supported by family and friends. But what about the dying person who is all alone in the world and who has only the “consultant” to turn to and rely on? The heartlessness of such a scene is chilling. [2]

[1] "Senator [Jay] Rockefeller [(D-WV)] . . . has had legislation in place to promote advance care planning . . . [;] his staff has said that he plans to, at the 11th hour, to step in and try to use his influence to put it back into the legislation as an amendment."

Myra Christopher, President, Center for Practical Bioethics, in October 1, 2009 Kansas City Rotary Club speech


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