I figure that the people who are really convinced that end of life counseling = death panels are not going to be swayed by any kind of logic and fact, but it can’t hurt to have accurate information posted everywhere possible, if only to prove even further how ridiculous the whole thing has become.

From Sherwin B. Nuland, in The New Republic:

In 1990, responding to several high-profile court cases–notably, those of Karen Ann Quinlan and Nancy Cruzan, two young women in deep and irreversible comas who were kept on life support for unconscionably long periods, even as their families petitioned for cessation month after month–Congress mandated that any health care institution receiving Medicare or Medicaid funding (which means all but a very few acute and chronic care hospitals) must, on admission, provide patients with three statements: one outlining their right to accept or refuse any type of treatment; another laying out their right to issue advance directives to ensure that their wishes about continuing life-sustaining therapy be carried out; and a third explaining any policies that govern the institution’s withholding or withdrawal of life-supportive treatments.

. . .

In order for patients to make knowledgeable decisions under the 1990 law, it is essential that they thoroughly discuss with their physicians the implications of the directives they are choosing, such as “do not resuscitate” orders. H.R. 3200 would, for the first time, legislate that the physician receive a fee for these discussions, making it more likely that they will take place and that they will be of real substance. From these provisions of the bill, the ignorant, the nefarious, and the just plain stupid have extrapolated that the purpose of the periodic consultations is really to determine life or death, with government officials and even physicians–heaven forfend–taking on the role of Dr. Mengele. It is ironic that the very legislation designed to protect patient autonomy is that from which Sarah Palin and her ilk have derived the fantastical notion that her son, Trig, who has Down syndrome, would be euthanized if H.R. 3200 were passed.

[emphasis mine]

Issue has been taken with the possible cost-saving effects that more people having advanced directives in place will have — as if doctors will be encouraged to pressure their patients to choose to forego medical treatment to save money.

It seems to me that if more people are given the opportunity to make knowledgeable decisions about how they will be cared for in the event that they are incapacitated, it is logical to assume that a majority will choose not to undergo heroic measures or artificially life-sustaining treatments, for any number of reasons — and this will end up saving money, because all of those measures cost a whole heck of a lot. But, that doesn’t change the fact that the default will always be to do everything medically possible to keep a person alive, unless they have a binding advanced directive in place with orders otherwise.

And, an advanced directive can also specifically stipulate that everything be done to keep a person living, no matter the quality of that life. Control of what the advanced directive says is completely in the hands of the patient.

This provision of H.R. 3200 is not meant to pressure people to make a choice one way or another about their end of life care, it is meant to give people the opportunity to make their wishes known while they are still of sound mind and body. This provision is meant to stave off some of the heartache that can occur when one’s family is faced with making tough choices without knowing what their loved one really wants, or fighting with each other to make the right decision when disagreements arise.

It’s about having conversations about hard things, to make it easier in the end. More people need to be having these conversations — with their families, and with their physicians, since a physician’s signature is legally required for an advanced directive to be binding.

There is nothing sinister about giving more people the opportunity to create an advanced directive, and fairly compensating those medical professionals who provide this service to their patients.

Really. There isn’t. The end.