WASHINGTON â€” When a proposal to encourage end-of-life planning touched off a political storm over â€œdeath panels,â€ Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1.
Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.
Congressional supporters of the new policy, though pleased, have kept quiet. They fear provoking another furor like the one in 2009 when Republicans seized on the idea of end-of-life counseling to argue that the Democratsâ€™ bill would allow the government to cut off care for the critically ill.
The final version of the health care legislation, signed into law by President Obama in March, authorized Medicare coverage of yearly physical examinations, or wellness visits. The new rule says Medicare will cover â€œvoluntary advance care planning,â€ to discuss end-of-life treatment, as part of the annual visit.
Under the rule, doctors can provide information to patients on how to prepare an â€œadvance directive,â€ stating how aggressively they wish to be treated if they are so sick that they cannot make health care decisions for themselves.
While the new law does not mention advance care planning, the Obama administration has been able to achieve its policy goal through the regulation-writing process, a strategy that could become more prevalent in the next two years as the president deals with a strengthened Republican opposition in Congress.
In this case, the administration said research had shown the value of end-of-life planning.
â€œAdvance care planning improves end-of-life care and patient and family satisfaction and reduces stress, anxiety and depression in surviving relatives,â€ the administration said in the preamble to the Medicare regulation, quoting research published this year in the British Medical Journal.
The administration also cited research by Dr. Stacy M. Fischer, an assistant professor at the University of Colorado School of Medicine, who found that â€œend-of-life discussions between doctor and patient help ensure that one gets the care one wants.â€ In this sense, Dr. Fischer said, such consultations â€œprotect patient autonomy.â€
Opponents said the Obama administration was bringing back a procedure that could be used to justify the premature withdrawal of life-sustaining treatment from people with severe illnesses and disabilities.
Section 1233 of the bill passed by the House in November 2009 â€” but not included in the final legislation â€” allowed Medicare to pay for consultations about advance care planning every five years. In contrast, the new rule allows annual discussions as part of the wellness visit.
To read more, visit: http://www.nytimes.com/2010/12/26/us/politics/26death.html
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