Tuesday, December 28, 2010

End-Of-Life Planning Is Back!

     Just when you think President Obama has abdicated his leadership, he comes through with something to indicate that the ability is down there waiting to assert itself. For example, witness the flurry of progressive activity that he has got through the Congress since his party's “shellacking” on November 2 (see Dec. 23, “An Early Christmas for the President”).
     Now he has done it again. According to the New York Times, an early December Medicare regulation deals with annual wellness visits, and includes "voluntary advance care planning" as an item that will be covered. Beginning January 1, Medicare will reimburse physicians who advise patients, in voluntary discussions, about their preferences for end-of-life care treatment during their annual Medicare "wellness visit." By having Medicare cover these voluntary consultations, beneficiaries will be able to get information that will help them make their own decisions about their care and what they would or would not want at life's end.
     As part of the preparation of a living will and the appointment of a health care proxy, the physician may ask such questions as, “If you have another heart attack and your heart stops beating, would you want us to try to restart it?” A patient dying of emphysema might be asked, “Do you want to go on a breathing machine for the rest of your life?” And a patient with incurable cancer might be asked, “When the time comes, do you want us to use technology to try and delay your death?”
     The end-of-life-planning consultation, Section 1233, was dropped from the original healthcare reform bill after Sarah Palin claimed it would set up “death panels,” which allegedly would pass judgment, not only on older people's right to healthcare, but on others' as well. House Minority Leader John Boehner (R-Ohio) also chimed in, saying the bill would "start us down a treacherous path toward government-encouraged euthanasia if enacted into law."
     Actually end-of-life-planning is something that most people of sound mind and body have been doing all along: getting advice and making decisions on how they wish to be treated in the event of fatal accident or illness. Virtually all entities that deal with the elderly: doctors, hospitals, hospices, counselors, etc. have been advocating such a procedure for years.
     Maria J. Silveira, MD, MPH, of the VA Center for Clinical Management Research and University of Michigan, and her colleagues found that patients who documented their wishes for limited or comfort care received it approximately 90% of the time. The few who requested all possible care didn't always get it (five of 10) but were much more likely to get aggressive care than those who didn't request all care possible, Silveira's group reported.
     But the dark clouds of ideology are beginning to gather. Elizabeth D. Wickham, executive director of LifeTree, which describes itself as “a pro-life Christian educational ministry,” said she was concerned that end-of-life counseling would encourage patients to forgo or curtail care, thus hastening death. “The infamous Section 1233 is still alive and kicking,” Ms. Wickham said. “Patients will lose the ability to control treatments at the end of life.”
     In an attempt to downplay excessive controversy the administration said Sunday that the end-of-life planning provisions aren't new to health care services provided by the government. According to White House spokesman Reid Cherlin, "The Times story is wrong. This benefit was signed into law under President Bush. The only thing new here is a regulation allowing the discussions - authorized in 2003 by the prescription drug benefit - to happen in the context of the new annual wellness visit created by the Affordable Care Act."
     If Palin, Boehner, et al have not already availed themselves of end-of-life-planning, they are even dumber than I thought.
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     It is important to understand that the Spirit is operating throughout the entire universe simultaneously for all point/events. Imagine that each instant in time corresponds to a station on an assembly line. This organic line differs from the usual mechanistic assembly line in that there is no overall blueprint for the product being assembled. Each station must take whatever point/events are passed to it, and through the action of the Spirit, make its own transformation. In this way constructs are built up, and their constant expansion and jostling makes up the world we see. Each construct at all times attempts to adjust itself harmoniously to the other constructs in its environment.
     An In-depth Look At the Spirit's Activity – The Spirit Runs Through It
 

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