Joan Frawley Desmond, is the Register’s senior editor. She is an award-winning journalist widely published in Catholic, ecumenical and secular media. A graduate of the Pontifical John Paul II Institute for Studies of Marriage and Family, she lives with her family in California..
Beginning January 1, 2016, Medicare will cover counseling sessions for end-of-life care, the Obama administration announced yesterday.
NPR noted that this development comes "just weeks after a Supreme Court decision solidified the Affordable Care Act." And Julie Rovner, senior correspondent with Kaiser Health News, told NPR, "the decision might have prompted Medicare officials to conclude that 'it was safe politically ... to go ahead with this.'"
An estimated 55 million people are on Medicare. The New York Times reported that the new policy will reimburse physicians, nurse practitioners and physician assistants to have "conversations with patients about whether and how they would want to be kept alive if they became too sick to speak for themselves."
In the view of The Times:
"The proposal would settle a debate that raged before the passage of the Affordable Care Act, when Sarah Palin labeled a similar plan as tantamount to setting up “death panels” that could cut off care for the sick. The new plan is expected to be approved and to take effect in January, although it will be open to public comment for 60 days."
Will it settle the debate?
Let's not forget why the public became alarmed about "death panels" back in 2009, during the lead up to the passage of the Affordable Care Act.
"[A] similar Medicare reimbursement was included in early drafts of the Affordable Care Act legislation in 2009 –[and] unwisely identified as a budgetary 'pay for' to help cover the cost of new coverage," explained Stuart Butler in a post for the Brookings Institution website that backs the new Medicare policy. "That political furor set back what should have been a reasoned conversation. Hopefully the climate now is more open to careful consideration."
Indeed, it was politically "unwise" to expose the utilitarian logic behind the 2009 policy. But I must disagree with Stuart Butler on one point: It is still entirely reasonable to scrutinize, and if necessary, challenge any effort to propose end-of-life counseling, because the pressure to cut healthcare costs has only increased, as it must, with the aging of the baby boomers.
So if cost-cutting is not the rationale for proposing end-of-life counseling, let's have safeguards, and let's have a transparent discussion about the language and principles that should be employed in such critical discussions.
Burke Balch, the director of the National Right to Life Committee’s Powell Center for Medical Ethics, said his organization objected to Medicare’s plan under current circumstances. “We feel there is pervasive bias against treatment that is occurring in advance care planning that involves nudging individuals to reject lifesaving medical treatment,” Burke Balch, the director of the National Right to Life Committee’s Powell Center for Medical Ethics, told The Times. He argued that such conversations were “motivated in large part by a desire to cut healthcare costs.”
The National Right to Life Committee hopes to find "a congressional sponsor for a bill that would instead direct Medicare to produce materials about end-of-life decisions that reflect a range of views, including those 'concerned with protecting people’s right to treatment.'”
Elsewhere, Balch has expressed alarm that end-of-life counseling could be influenced by the movement to legalize euthanasia. You can read more about that here.
Compassion & Choices, the nation's leading voice for physician-assisted suicide, has pushed for "value-neutral" language in end-of-life counseling. Take a look at C&C's timeline on this issue here.
I checked in with the U.S. Conference of Catholic Bishops, and they are reserving judgment on this proposal for the moment. However, the U.S. bishops' Ethical and Religious Directives for Catholic Health Care provides a comprehensive framework for dealing with end-of-life issues in a hospital setting, including the introduction of feeding tubes.
To be clear: the Church does not oppose end-of-life counseling when its properly grounded in a deep respect for the dignity of the human person and for the sanctity of human life from conception to natural death.
But Catholic leaders and ethicists do not endorse counseling that is presented in value-free language, and often incorporates a cost-benefit analysis of a patient's quality of life. When that happens, vulnerable people get the message that they are consuming precious resources that others rightfully deserve. This is a tactic of the "throwaway culture" opposed by Pope Francis.
The national debate about end-of-life counseling isn't "settled." Not yet, anyway.