Thursday, August 13, 2009

Sarah Palin's latest Facebook post on end of life counseling

The post advanced a very nuanced view. So much so that a couple of her commenters as much as accused her of having it ghost-written. And here, for the first time we see detractors of the HR 3200 end of life counseling provision acknowledging that the counseling may not be mandatory. The real problem, they say, lies in the conflict of interest, the slippery slope and the unintended consequences:

As Charles Lane notes in the Washington Post, Section 1233 “addresses compassionate goals in disconcerting proximity to fiscal ones....”

Although a good palliative care service can save an institution money its focus is on what's best for the individual patient. Sometimes those goals are in conflict, sometimes not, but an excellent palliative care team will manage the conflict appropriately by putting the individual patient first, no matter the impact on the medical commons. When an end of life counseling provision is part of a bill with a clear agenda to control costs some degree of skepticism is appropriate.

She goes on to quote Lane further:

If it’s all about obviating suffering, emotional or physical, what’s it doing in a measure to “bend the curve” on health-care costs?” [6]

As Lane also points out:

Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive -- money -- to do so. Indeed, that’s an incentive to insist.

Patients may refuse without penalty, but many will bow to white-coated authority.

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