Comments on: Let’s talk about your “End-of-Life,” says AMA

By: Ann in L.A.

Ann in L.A. — Tue, 02 Sep 2014 15:11:07 +0000

Part of the problem here is with the computerized tracking and billing of everything doctors do. MD’s now have to account for every minute they are with a patient and enter billing codes into a computer for everything.

But there was no billing code for the time a doctor might spend discussing do-not-resuscitate orders or organ-donation options with a patient. This provides codes for the computer systems which will allow MD’s to get paid for the time they spend talking about these things.

By: Shane

Shane — Mon, 01 Sep 2014 23:37:12 +0000

But even Jesus let us know that the conforming our lives to reality comes with hard lessons because we are stubborn and arrogant. He said that we should not be stumbling blocks for the little ones and he also gave us the parable of the prodigal son.

Even Christians need to let others find their own way to God (or not).

By: Shane

Shane — Mon, 01 Sep 2014 23:32:31 +0000

That’s the rub, when someone else is putting down the money then they get a say, like it or not.

A childless couple gets to vote on the school board, gets a say in the curriculum, and if active enough pretty much can exert a lot of influence on the system that they pay into but don’t get anything out of.

This will not end well especially when the source of money and the “customers” are completely disconnected. There is nothing in this life that is truly free.

By: gibbie

gibbie — Mon, 01 Sep 2014 23:22:41 +0000

This article presents a libertarian argument. It is not a conservative argument. It is definitely not a Christian argument.

From the Christian point of view, our bodies do not belong to us – they belong to God. We are not allowed to do whatever we want with them.

The religion of unfettered choice is not Christianity.

The classical view of freedom is not the ability to do whatever we want whenever we want. It is the conforming of our lives to reality – that is God’s moral law and his purposes for us.

By: AZ_Langer

AZ_Langer — Mon, 01 Sep 2014 20:08:21 +0000

I’d like to see a lot of informed discussion of this subject prior to individual consultation with our physicians. A group setting with professionals explaining what is involved in various aspects of end of life care could be helpful for many who aren’t that familiar with hospitalizations and alternatives. I would add discussion of organ and tissue donation, and the importance of family members being aware of all our wishes. (My parents mailing copies of their advance directives to each of us, was perhaps not the best way broach the subject, so I’ve been a little more vocal.)

It’s also important to know family availability and limitations and exactly what professional resources are available locally, particularly if in-home comfort care is desired.

By: stevewhitemd

stevewhitemd — Mon, 01 Sep 2014 16:46:48 +0000

I’m a physician. I’m in academic practice where I care for patients with end stage lung disease and with ALS. My thoughts —

1) Sarah Palin was and is right. The Democrats were indeed trying to sneak death panels into ObamaCare, and she correctly called them on it.

2) Wesley Smith at NR also is right. It is fine for Medicare to pay for consultation, depending on the details.

3) We need more consultation and discussion on end-of-life discussion. Those discussions should be initiated by medical professionals with patients and their families, should be confidential, without outside pressure, and with a single agenda — what is best for a patient given the medical circumstances? The focus should be on educating the patient and family on the natural outcome of the end-stage disease, the specific issues involved, the appropriateness of comfort (as opposed to life-sustaining) care, and the ultimate futility of aggressive life-sustaining care.

I have had hundreds — hundreds — of these conversations, and have supervised medical residents/fellows in many. Patients and families often times want these and want more. I’ve had very few interactions that turned out badly. I’ve never once pushed any agenda other than the single one: what is best for the patient.

Recognize that of course we all go through the class stages of grief in death and dying. Care providers need some training in how to make these conversations effective and useful — it’s not something you pick up on the fly.

I welcome the exploration of having Medicare provide a specific CPT code for “end of life consultation”. Just don’t set an agenda other than what is best for the patient.

By: Ozstickman

Ozstickman — Mon, 01 Sep 2014 16:33:08 +0000

Removing choice from the healthcare marketplace is evidenced by the parents of a 5 year old English boy now incarcerated in a Spanish prison under threat of extradition to the UK for “child neglect” because they dared to remove their son to Spain to obtain a particular targeted radiation therapy that is unavailable on UK’s NHS until 2018. This is what occurs when bureaucracy intercedes in patient healthcare relationship. Repeal ACA now!

By: imfine

imfine — Mon, 01 Sep 2014 16:10:11 +0000

definitive Conservative point. People can talk to their own doctors on their own dime. the Elderly have had a lifetime to save for their end of life care, they can pay for it or have their kids pay for it. Leave me out of it.

By: JerryB

JerryB — Mon, 01 Sep 2014 16:07:04 +0000

Will you PLEASE get it straight? The “death panels” are NOT the “end of life” DISCUSSION one might have with a provider.

I believe you are making a distinction without a difference. This is about the gov’t interjecting itself into “end of life” decisions, decisions that have always been a private matter. By injecting money, they are buying a stake in the outcomes of these decisions. It will inevitably be tied to the IPAB regulations by influencing patients to be good little commies and go out with dignity. Hence, this money move must be tarred as part of the death panels, for they are inexorably linked.

By: Fiftycaltx

Fiftycaltx — Mon, 01 Sep 2014 16:06:08 +0000

For a closer look at all of the obscene effects of obamacare, see http://covertrationingblog.com/open-wide-and-say-moo-the-good-citizens-guide-to-right-thinking-and-right-actions/chapter-13-age-based-medicine-and-end-of-life-healthcare

By: Fiftycaltx

Fiftycaltx — Mon, 01 Sep 2014 15:50:15 +0000

Will you PLEASE get it straight? The “death panels” are NOT the “end of life” DISCUSSION one might have with a provider. The DEATH PANEL is the “IPAB” Independent Payment Advisory Board. And the IPAB is NOT going to judge whether Aunt Sally should get her pacemaker or not. They are going to make POLICY decisions like “No pacemakers for anyone over 73 years and 6 months of age” as adjusted for what the SOCIALIZED MEDICINE REGIME can AFFORD! And this will be a continuation of the ONE SIZE FITS ALL SOCIALIST AGENDA! Unless of course you are a friend of the current ruling junta. Remember the IPAB is a copy of the ENGLISH SYSTEM whereby patients too “old” or too “young” to be of use to the STATE die off from LACK OF CARE! See “Patients starve and die of thirst on hospital wards” http://www.telegraph.co.uk/health/healthnews/9591814/Patients-starve-and-die-of-thirst-on-hospital-wards.html

By: janitor

janitor — Mon, 01 Sep 2014 15:49:08 +0000

This is “medical treatment”? Physicians want additional payment for answering questions that arise and should be answered in the ordinary course?

(Can lawyers also bill Medicare for these conversations? Lawyers draft advance directives and living wills long before it’s time for a DNR — do not rescusitate — order, which is not about withdrawing tubes, ventilators, etc. already in place, but an order for non-physicians such as paramedics.)

By: JerryB

JerryB — Mon, 01 Sep 2014 14:53:02 +0000

I don’t know why you refer to Sarah Palin’s “death panel” term as “divisive.” Shouldn’t we use the term? You admit, and Avik Roy’s article admit that there’s a real possibility that the gov will one day be deciding when to pull the plug. Leftists, e.g., Krugman, Dean, and Rattner, admit that this will be necessary (see http://www.breitbart.com/Big-Government/2014/08/31/Feds-May-Reimburse-Medicare-End-of-Life-Discussions-After-Mocking-Palin-s-Death-Panels ). Quoting Rattner, “We need death panels …” If the left is willing to be so clear about exterminating the unfit, why shouldn’t we call them “death panels?”

And it’s not just leftist advocates chiming in. The Dear Leader himself said that sometimes you just have to give grandma a pill. In case it doesn’t register: the leader of the free world is interjecting himself into your life-and-death decisions. Nowhere in the Constitution does the gov derive such a position. This is the eugenic socialist agenda taking over our freedoms.

The AMA is a disgusting organization. Doctors are supposed to heal, but now they want the gov’t to pay them to talk us into dying. Talk about conflict of interest! You can’t even trust your own physician anymore.

The bottom line is, if we don’t scream about death panels now, we’re bound to suffer with them sooner or later.