Health care issues: End-of-life decisions

Health care issues: End-of-life decisions

A look at key issues in the health care debate:

THE ISSUE: Would proposed health care legislation pay for counseling that might encourage elderly people to end their lives sooner than they might otherwise do?

THE POLITICS: This became one of the summer’s most explosive topics, with flatly untrue claims competing with mere exaggerations and often-confusing explanations. Pending House legislation would let Medicare reimburse doctors who consult with patients on end-of-life care. Patients could discuss the degree to which they want extensive steps taken to keep them alive as they grow increasingly ill or incapacitated. They might draw up advance directives, powers of attorney, “do not resuscitate” orders and other documents to express their wishes or authorize someone to make crucial decisions. Proponents say many old people welcome such voluntary discussions, and Medicare should pay for them. Critics say such government-paid consultations, especially in the context of an effort to reduce health care costs, could encourage people to accept approaching death rather than opt for costly medical procedures that could extend their lives. Some contend that “death panels” would promote euthanasia. Proponents of the bill, including authors of the provision, call the claims absurd and reckless.

WHAT IT MEANS: The furor became so intense and distracting that Obama administration officials have signaled the proposed Medicare benefit will be dropped. It’s unclear what political lessons might be drawn. Did conservative activists inspire their base by showing that loud, emotional protests can force President Barack Obama and other Democrats to back down? Or did they spend a tremendous amount of energy on a fairly minor proposal that will be tossed aside while Congress enacts far-reaching changes that conservatives oppose?

—Charles Babington