Advance Care Planning Consultations - H.R. 3200

We have all heard the debates raging around the country about the Advance Care Planning Consultations also known as "End of Life" consultations and if you are anything at all like me, you don't really know which side is correct. Well, in my quest to find out the truth regarding this matter, I have skipped ahead in my reading of the current House Bill to the area concerning this particular issue. I want to know what the bill REALLY says, not just what either side is saying.
Now, for those of you who know me, it comes as no surprise that I am NOT a supporter of the current, sitting president. I personally did not vote for him, will not vote for him in the future and don't trust him as far as I can throw him! I also truly believe that he has effectively hidden who he "really is" as far as character and political desires from the American people. I feel he is quickly unraveling the threads that made this country great so he can transform the US into something he and his ultra-liberal hacks have wanted for years which is a socialist country. I also strongly feel that this is the most corrupt administration EVER to hit 1600 Pennsylvania Street! So, with this in mind, you will be shocked to read (perhaps you had better sit down for this one......) that I have read and scrutinized HR 3200 tonight from pages 425-430 and have discovered that this portion of this bill is nowhere near as bad as it has been characterized. (I know.....some of you are currently sitting with your mouths agape thinking, "Is he really going to side with the President on this one????" The answer is yes and no.
Remember, I don't like or trust the current administration! (Did I make that evident enough above???) But I DO like honesty, integrity and courage. So, it is with great chagrin that I report to you this night that the negative reports about this area of the bill are not completely truthful.
I recently recieved a list of 51 negative points regarding this bill. Using these particular points, I will address each one to support or debunk the statement. In this particular blog entry though, I will only address 4 of the 8 that deal specifically with this topic. I will torture you with the remaining 4 again soon! (Cue the wicked, demonic laugh......!) With this in mind, let's start with Page 425, Lines 4-12: Government mandates Advance Care Planning Consult. Think Senior Citizens end of Life. (My take: TRUE) This section does in fact specify, "the term 'advance care planning consultation' means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years." With this in mind, a consultation is in fact going to be mandated at a certain point if one has not been conducted within the past five years. My unanswered question though is this: At what point or under what conditions does this particular requirement kick in and who makes that determination? I have not found the answers to these questions yet.
Page 425, Lines 17-19: Government will instruct and consult regarding living wills, durable powers of attorney. Mandatory!(My take: PARTIALLY TRUE) According to the bill, a consultation shall include "An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses." Notice that it states "practitioner", not government. A practitioner as defined in this bill is a physician or nurse practitioner (page 428, lines 14-19). My concern with this is that we are talking about legal matters here which should be addressed by someone in the legal profession, not the medical profession. Physicians and nurse practitioners are already overworked just trying to keep up with what they went to school for in the first place.......medicine and giving quality medical care to their patients!!!! To saddle them with the additional requirement of explaining legal documents and terms will only exacerbate the problem by taking valuable time away from their providing MEDICAL care to their patients. This is NOT a good or well-thought out idea!
Page 425, Lines 22-25, Page 426, Lines 1-3: Government provides approved list of end of life resources, guiding you in death. (assisted suicide). This is just not right!(My take: PARTIALLY TRUE) When they say "This is just not right!", I agree with them. It's not because their point is right but because their "premise" is just not right. The bill states, "The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965). Notice that this is done by the practitioner, not the government. In addition, these are resources that are available to the general public already and have been for quite some time. What these resources actually do is to guide individuals and their families regarding how to set up legal guidance and documentation regarding their desires and wishes for medical care at a time when they may not be able to communicate them to the practitioners. In other words, in my own personal case, I would NOT want to be kept alive as a "vegetable" but would rather be let slip away to go home to my Lord and Savior. By having that stated in a legal document, I can rest assured that if the time comes when I am in that situation, the practitioner has this guidance to show what MY wishes and MY desires are. And guess what? They are REQUIRED to follow them!!! The government has absolutely no say in this matter if I have properly prepared the paperwork (say THAT fast three times....) in advance. This could save my loved ones a great deal of hassle, heartache and expenses by making sure I have taken this step. With this in mind, I would also refer you to Page 426, lines 21 to Page 427, Line 1 in which it states, " the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes. Make sense? It does to me!!!
Page 427, Lines 15-24: Government mandates program for orders for end of life. The Government has a say in how your life ends.(My take: FALSE) I read absolutely NOTHING ANYWHERE that states this. The decision as to whether or not to write up an order for advance care planning is strictly up to the individual. In support of this, I would refer you to Page 429, Line 13 through Page 430. Line 24. In this area, it specifically talks about effectively communicating the INDIVIDUALS preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individuals. NOWHERE does it state or infer in any way that the government mandates the orders or has a say in how your life ends.
So let's wrap up what we've learned today. The bill WILL apparently require an Advance Care Planning Consultation at some point, but that point is not specified. In addition, it appears that once you have a consultation, it will be required at least every five years. (Not sure how I feel about this particular aspect right now.) In this consultation, the individual (patient) and the practitioner (physician or nurse practitioner) will give guidance in the many areas regarding the patient's options for advance care planning to include the legal aspects. (I DON'T think this is a good idea!) If,(notice the "if") the patient desires to draw up an order for advance care planning (there is nothing that states it is mandatory), they can accomplish this with their practitioner. In this order, the patient, not the government expresses their personal wishes and desires regarding their advance care in the event they reach a state where they can't effectively communicate their wishes.
So do I support this bill yet??? NO!!!! There are many problems in just the first 30 pages of the legislation that I noted in an earlier entry. Couple those with the lack of answers noted here, additional non-medical duties heaped on the backs of our already over-worked physicians and nurse-practitioners and I feel it is a recipe for disaster. We also already have the ability to do advance directives and other legal directives such as Durable Power of Attorney's for Healthcare (which not surprisingly since they are LEGAL documents are completed by..........Attorneys!!!) So why do we need another bill that covers this and shifts this responsibility to the health care practitioners? We don't!!!
In my next entry, I will tackle the next 4 concerns and then you can make your own educated decision. But I also urge you not to take my word for it. Check it out yourself. Go to http://waysandmeans.house.gov/ and click on the left side where it says, H.R. 3200, “America’s Affordable Health Choices Act”. You'll be glad you did!