Your editorial “Truth, death and life” (Jan. 3, p. 20) omits important facts.
The controversy over the president's end-of-life program began with House of Representatives bill 3200. That bill did more than reimburse for counseling. The bill went on for six pages detailing what caregivers “shall” discuss. Government should not be scripting what is said between doctor and patient. Uncle Sam is not impartial. The sooner patients give up on medical care, the less money the government has to pay out. It would be like asking any insurer for advice on when to say “enough is enough” to medical care. The scripting was dropped in the final law, but section 936 says government will produce “decision aids” such as brochures to hand to patients. Hospitals already provide information about advanced directives and living wills. Government should stay out of the issue.
As to whether counseling is voluntary, under Medicare's physician quality ratings, No. 47 measures “percentage of patients age 65 and older who have an advance-care plan or surrogate decision maker designated ... or documentation that an advanced-care plan was discussed.” Under the new health law, until 2015 doctors will earn a bonus for high scores, and beginning in 2015 they will be punished for low scores. Doctors are paid so little by Medicare that many are leaving. Of course, some doctors will pressure patients into end-of-life counseling. When a medical professional in a white coat tells a patient to sit and listen, it is hard to say “no.” In that sense, end-of-life counseling will not always be voluntary. The issue should be removed from the quality-rating system, so a patient's decision will have no impact on the doctor.
Betsy McCaugheyChairmanCommittee to Reduce Infection DeathsNew York