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Return of 'Death Panels'? Obama to Enact End-of-Life Planning for Medicare

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After public outcry over "death panels" forced Democrats to drop their proposed end-of-life planning from the health care overhaul legislation, the Obama administration is pressing forward to enact the same measures by bureaucratic regulations.  The new regulations are set take effect starting Jan. 1, the New York Times reports.

Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.

Congressional supporters of the new policy, though pleased, have kept quiet. They fear provoking another furor like the one in 2009 when Republicans seized on the idea of end-of-life counseling to argue that the Democrats’ bill would allow the government to cut off care for the critically ill.

The final version of the health care legislation, signed into law by President Obama in March, authorized Medicare coverage of yearly physical examinations, or wellness visits. The new rule says Medicare will cover “voluntary advance care planning,” to discuss end-of-life treatment, as part of the annual visit.

Under the rule, doctors can provide information to patients on how to prepare an “advance directive,” stating how aggressively they wish to be treated if they are so sick that they cannot make health care decisions for themselves.

While the new law does not mention advance care planning, the Obama administration has been able to achieve its policy goal through the regulation-writing process, a strategy that could become more prevalent in the next two years as the president deals with a strengthened Republican opposition in Congress.

Despite the political firestorm of controversy surrounding such end-of-life planning, the Obama administration insists that research supports its decision to move forward with the controversial measure. “Advance care planning improves end-of-life care and patient and family satisfaction and reduces stress, anxiety and depression in surviving relatives,” the administration's preamble to the Medicare regulation reads, quoting research from the British Medical Journal.

Several Democratic members of Congress, led by Representative Earl Blumenauer of Oregon and Senator John D. Rockefeller IV of West Virginia, had urged the administration to cover end-of-life planning as a service offered under the Medicare wellness benefit. A national organization of hospice care providers made the same recommendation.

Mr. Blumenauer, the author of the original end-of-life proposal, praised the rule as “a step in the right direction.”

“It will give people more control over the care they receive,” Mr. Blumenauer said in an interview. “It means that doctors and patients can have these conversations in the normal course of business, as part of our health care routine, not as something put off until we are forced to do it.”

After learning of the administration’s decision, Mr. Blumenauer’s office celebrated “a quiet victory,” but urged supporters not to crow about it.

Meanwhile, opponents of the measure, including Elizabeth D. Wickham, executive director of a pro-life Christian advocacy group told the Times she was concerned the so-called "end-of-life counseling" would actually encourage patients to forgo or curtail life-saving care.

“The infamous Section 1233 is still alive and kicking,” Wickham said. “Patients will lose the ability to control treatments at the end of life.”

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