Health reform fact check: Euthanasia of the elderly
By Cindy House 
| August 10, 2009 | 9:01 AM
This is the first in a series of fact checks examining allegations that have been made on both sides of the aisle about the health care reform plan heading through Congress. Read the complete text of the America’s Affordable Health Choices Act of 2009 here.
THE ALLEGATION: The bill promotes the euthanasia of the elderly by encouraging them to cut their lives short when they have fallen ill and have become a burden to society.
WHAT THE BILL SAYS: This allegation appears to refer to provisions in Title II, Sec. 1233 “Advance Care Planning Consultation.” Sec. 1233 amends the Social Security Act and affects Medicare recipients, most of whom are elderly. It adds to the list of Medicare-covered services a doctor’s consultation every five years about advance health care planning. Medicare would pay for more frequent consultations if a patient is diagnosed with a chronic or terminal illness or if a patient moves into long-term care.
The bill does not make these consultations mandatory; it instead says that Medicare would pay doctors, nurse practitioners and physicians’ assistants for providing this service, similar to how they would be paid for an office visit.
“Advance health care planning” refers to a variety of topics, including the role of health proxies, durable powers of attorney, living wills, life-sustaining treatment, and the “continuum of end-of-life services and supports” such as hospice care.
As part of an advance care consultation, a patient would work with his or her doctor to develop specific orders for what life-sustaining treatments he or she would choose, and under what conditions he or she would choose them. These treatments could include hospital stays, the use of antibiotics or the use of feeding tubes. But a patient may also order full treatment.
For instance, a patient may decide that he would not want to be placed on a feeding tube if he falls seriously ill. She may decide that if she is considered brain dead that machines not be used to keep her heart beating. He may also decide that he wants the full spectrum of medical treatment available to keep him alive.
Sec. 1233 requires that consultations about these treatment orders include the reasons why such orders are beneficial to an individual and to his or her family, what resources are available to communicate patients’ wishes if they are unable, and what information a legal proxy would need to make decisions that conform to a patient’s wishes.
To help train medical personnel and standardize the process for developing and distributing treatment orders, Sec. 1233 calls for the creation of a “coalition of stakeholders” in each state. This coalition would include medical staffers as well as advocates for the elderly. No language in this section charges the coalition with making decisions for patients or gives it the power to determine what orders patients should or should not make.
THE VERDICT: The health care reform bill is not advocating or promoting euthanasia of the elderly or telling them to cut their lives short. Instead, it appears to be supportive of individuals making their own decisions about their own health care. It also addresses a problem many of us do not want to think about but likely will have to face at some point in our lives: how to choose a course of treatment for a loved one who has fallen seriously ill but never communicated their wishes.
FACT CHECK 2: Keeping your insurance
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