End-of-Life Planning Scare Resurfaces

From the rest of this story: http://www.politicsdaily.com/2011/01/01 ... -planning/

The only opponent quoted in the story was this:

Elizabeth D. Wickham, executive director of LifeTree, which describes itself as "a pro-life Christian educational ministry," said she was concerned that end-of-life counseling would encourage patients to forgo or curtail care, thus hastening death. "The infamous Section 1233 is still alive and kicking," Ms. Wickham said. "Patients will lose the ability to control treatments at the end of life."

Which, with all due respect, was no more accurate a summary of "Section 1233" or the new regulation than "death mallets" would be to describe hammers.

Jump to the new regulation. The relevant passage is a lot shorter than the killed section of reform legislation. It adds "voluntary advance planning upon agreement with the individual" to the items that Medicare will pay for during an annual physical.

That's it. No panels, death or knotty pine. Just a conversation with your doctor if you want it. No loss of patient control unless the patient is in a condition where conscious control is impossible -- in which case the whole point of the planning is to ensure that the patient's wishes be followed.

http://www.factcheck.org/2010/12/let-th ... ons-begin/
Let the Distortions Begin: A sneak preview of what to expect as 2012 comes into focus.
December 23, 2010
‘Death Panels,’ Revisited

In a Dec. 10 Wall Street Journal opinion piece, Palin misstated the role, makeup and authority of the new Independent Payments Advisory Board — a panel created under the new health care law to slow the growth of Medicare spending. The purpose of her article was to criticize a recent report issued by the National Commission on Fiscal Responsibility and Reform, a bipartisan commission created by President Barack Obama. But, in doing so, Palin also took a swipe at the new Medicare advisory board.

Palin, Dec. 10: It also implicitly endorses the use of "death panel"-like rationing by way of the new Independent Payments Advisory Board — making bureaucrats, not medical professionals, the ultimate arbiters of what types of treatment will (and especially will not) be reimbursed under Medicare.

Her description of the health care panel is wrong on three counts:

* the board doesn’t have the power to ration health care;
* board members won’t be all "bureaucrats," since the law requires that it include medical professionals and other health care providers, as well as medical researchers, experts in health care finance and actuarial science, and representatives of employers and the elderly;
* board members will not be the “ultimate arbiters,” since Congress has the authority to change or block their recommendations, although special legislative procedures make it more difficult than usual for Congress to act.
But the board cannot propose any " ‘death panel’-like rationing," as falsely claimed by Palin. (Yes, it was Palin who popularized the term "death panel" during the health care debate last year. At that time, she used the phrase in reference to another health care proposal — although she was wrong then, too, as we wrote http://www.factcheck.org/2009/08/palin- ... th-panels/ .)

CinnamonGirl wrote: How are you supposed to figure that out ahead of time? It depends on what is happening. I just want my family to decide according to what is happening.
Agonizing is part of it, I don't see how deciding ahead of time makes sense or save grief. What if you decide on something and it is written in stone and they wish they could do something else. That seems more agonizing to me. I say let my kids and family decide. I trust them.

CG - that's why living will's ask very detailed questions on many types of situations - permanent vegetative state, coma with possibility of recovering, dementia, pain management, hospice care, etc. Here's an example: http://www.docstoc.com/docs/9655572/Liv ... -Checklist
You can specify what you'd like done in each specific situation, or leave that up to you family as you wish, but getting that directive down in writing eliminates any guesswork on the part of doctors who are charged with your care. The more information you put down, the easier you make it on your family members who are already trying to deal with their own emotional state due to your situation and the last thing they want to think about is whether you'd want to stop the feeding tube or not. These are not the easiest of things to think about (it took me and EM 3 hours to fill out both of ours, but that included our will and estate planning as well), and certainly you may change your mind a decade down the road, which is why it's good to revisit a living will every few years, especially if major life changes occur (ie, terminal disease diagnosis, accident that disables you physically in some manner, etc), and change it accordingly - they are set in stone only once a situation arises, but can be changed anytime before then. It's helpful to have decided on funeral and burial/cremation arrangements - if it's chosen and paid for ahead of time, it saves your loved ones the time and grief of having to make those arrangements on top of dealing with their grief of losing you (my parents live out of state and have done this already - I'm grateful that I'll only have to deal with clearing out their house and putting it on the market - my mom's a packrat and my Dad's apologized to me already if he goes first and I have to deal with it!). It's also important to have your financials documented and distributed legally how you'd like so there are no legal hoops that your family has to jump through, and critically, pay for unnecessarily. My cousins had attorney fees to cover when my uncle died just so they could be named executors of his estate, as he had no will, and they were living with friends and boyfriends at the time so they had no money, were practically homeless, trying to raise newborns out of wedlock, and ill-equipped to deal with anything.

Here's some other sites with good checklists/things to consider:
http://www.wiserwomen.org/index.php?id=155
http://ag.ca.gov/consumers/general/care.htm