End of life care, resuscitated (editorial from The Oregonian, 12/29/10)

After the 'death panel' furor, Obama quietly orders payments for advance care planning

Maybe now, in this lull between pitched political battles over health care reform, Americans will see clearly the wisdom of encouraging more conversations on end-of-life care. We sure hope so.

President Obama has authorized a new Medicare rule, effective Jan. 1, allowing payments to doctors for time spent discussing "voluntary advance care planning" with their patients. This is more or less the same policy that Rep. Earl Blumenauer, D-Ore., sought to include in the broad health reform bill, which opponents seized on and twisted into "death panels" and government-sponsored euthanasia

That was fear-mongering by people like former Alaska Gov. Sarah Palin and talk-show host Rush Limbaugh, who saw an opportunity to turn Americans against health care reform. But it did real damage to the long, difficult and important movement to get people to talk about, plan for and control the end of their lives.

Oregon is a pioneer in this effort, far ahead of most states in the field of advance directives and palliative care. Oregonians, for the most part, understand that end of life planning is about keeping control of choices about life-sustaining treatment where it belongs -- with the individual, not with the government, physicians or hospitals.

It was infuriating to see end-of-life care, including advance directives, warped into an argument against health care reform. Even House Republican Leader John Boehner of Ohio sought to whip up the hysteria, claiming: "This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law."

That is flat-out untrue, as time and Obama's new Medicare rule will prove. There is nothing here to fear. Under health care reform, Medicare covers yearly physical exams, or wellness visits. The new rule allows physicians, as part of those annual visits, to discuss end-of-life treatment, including advance directives. That's all.

There are no government "panels," no power given to anyone else, no loss of control by patients. On the contrary, dying people with advance directives would retain far more control than they have now.

This simple truth has carried the day in the debate over end of life planning in Oregon. Ultimately it will everywhere else in this country, if leaders like Obama, Blumenauer and others continue to stand up to those who seek to twist the facts on advance directives.

A New York Times story on the new regulation reported that Blumenauer and others learned of the new policy in November, but urged other supporters to keep quiet about the change to avoid setting off another political backlash. Blumenauer's office said in an e-mail, "The longer this goes unnoticed, the better our chances of keeping it."

You can understand the concern, given the lies that were thrown around the proposal last year. But secrecy is the wrong strategy. Full sunlight, complete openness, ultimately will swing the debate over end of life care.

The debate will be won, as it has in Oregon, when Americans understand that it is about knowing their individual choices and asserting their control over their last days on earth.