We’re all going to die. Many of us will leave this world connected to machines while doctors make aggressive—and futile—attempts to resuscitate us. This will happen even though many of us would rather slip away peacefully because we won’t spell out in advance what we want—or don’t want—our caregivers to do when the inevitable comes.
It doesn’t have to be this way. And if Rep. Earl Blumenauer of Oregon can push through his top legislative priority, it won’t be. Blumenauer, a Democrat, introduced a bill in Congress earlier this year that would pay doctors, through Medicare, to have conversations with their patients about end-of-life directives. The effort is likely to face fierce resistance and even Blumenauer admits that success could be years away, if it happens at all.
The legislation is intended to encourage patients to specify their preferences, ranging from do-not-resuscitate orders to do-everything-possible orders, while they are mentally and physically able. The hope is that these conversations with doctors will prompt patients to relay their wishes to family members and draw up living wills. Such documents can help ensure patient wishes are carried out and relieve family members of the stress that comes from making decisions about when to stop extraordinary life-saving measures that have little chance of success.
End-of-life care directives that forgo extraordinary measures have the added benefit of saving money. “The default mode for health care in this country is for pulling out all the stops and that’s what people do,” says Blumenauer. Living wills can prevent expensive hospital care in cases in which patients would prefer less, not more, medical intervention at the end of their lives.
Blumenauer’s proposal is similar to a provision included in an early House version of what became the Affordable Care Act, President Obama’s health care law. The provision was left out of the final bill after an insidious campaign by Republican health reform critics who tried to equate the consultations with “death panels” that would allow the federal government to make life and death decisions for seniors against their will.
The death panels meme, which Politifact rated its Lie of the Year in 2009, caught fire after Sarah Palin and former New York State lieutenant governor Betsy McCaughey implied that these panels, which never existed, would encourage or force Americans to end their lives early to cut costs for the government.
Blumenauer is hoping that the heated political climate that developed during the health care reform debate of 2009, and which spawned the death panels lie, has cooled enough that he can push end-of-life Medicare funding through the current Congress. “People shouldn’t be nervous, they should embrace this,” he says. Blumenauer has the support of a long list of doctor and palliative care organizations, but knows he’s still facing long odds.
In December 2010, months after the Affordable Care Act became law, the Obama Administration, at Blumenauer’s urging, quietly included end-of-life consultations in a set of Medicare regulations. After the provision was disclosed by the New York Times, the Administration, worried the measure would be criticized, withdrew it. “They just folded on it because it resurrected the smoldering lie of the year,” says Blumenauer. “They completely retreated.”
This time, Blumenauer is working in the open. He says he plans to talk to every member of Congress to build support for his end-of-life bill, known as HR 1173. He’s already had some success. The legislation has 17 co-sponsors, including five Republicans.
“As a society, this is a discussion we need to have,” says Rep. Phil Roe, of Tennessee, one of the first to sign on as a supporter. Roe, a physician, says practicing medicine for 31 years persuaded him that end-of-life directives are good for patients and their families. The issue is not one that excites constituents, but it’s worth doing, says Roe. “As a topic, when I go home to the Rotary Club and say, ‘Guess what? Today we’re going to talk about advanced directives,’ people fall over in their mashed potatoes.” Still, says Roe, he’s committed to helping usher HR 1173 through Congress with a bipartisan coalition.
When Roe explains his position, he’s sounds like he’s on pre-emptive defense. The end-of-life consultations “are not a question of withholding treatment,” says Roe. “This is just a voluntary consultation…it’s not euthanasia.” Asked why the end-of-life care directive provision has been politically toxic in the past, Roe says, “This is an issue that’s easy to demagogue.”
Roe, who Blumenauer calls “a tremendous partner,” may seem like an odd choice to champion HR 1173. Roe has led the charge among House Republicans to remove from the Affordable Care Act a provision that will allow a board of bureaucrats to lower federal payments to doctors to control the growth of Medicare spending. Even though the board, known as the Independent Payment Advisory Board, is barred from altering what procedures and treatments Medicare covers, some Republicans critics have associated it with the “death panels” meme as well.
“On my Facebook page, I’ve been ripped every way but loose on this,” says Roe of his effort to secure Medicare funding for end-of-life consultations. It’s easy for critics “to say you’re rationing care, you’re withholding care, the government’s not going to pay for care and so forth. That’s not the case with this bill.”