Thursday, August 13, 2009

ObamaCare end of life counseling

First - the gross mis-statement. What I am calling ObamaCare is not health care, and does nothing to care for anyone but insurance companies and B. Hussein Obama's good buddies.

But - end of life counseling, that has been touted as euthanasia and an excuse to withhold care for the elderly or grievously injured or ill, this is supposed to be an implementation of living wills.

Living wills go by several names, my mother has one, my father did before he died. This is where you make a legal, binding request that hospitals not make any "heroic" intervention or effort to resuscitate or revive you, if you are close to death.

People do choose this kind of restriction on their doctor. Often the ventilator, the vegetable coma, the impairment and pain of partial successes seem so daunting, that one chooses not to. For many, they struggle for all the breaths available, and wish for every chance for another day. That is, they choose, or refuse to consider or choose the matter, which is another kind of choice.

What some families have faced, though, is hospitals, nurses, and doctors that refuse to follow clear and legal instructions. Instead they impose their particular morality - without accepting the legal, moral, human, and financial consequences.

One summary of end of life counseling as expressed in the House-passed version of the bill today, is that this means the physician discusses wishes and options, about every five (5) years for the elderly or infirm. I would compare this to counseling women before performing an abortion - bring care giver and patient together for a review of options and to confirm the patient's choice.

In either case, abortion or end of life, it would be immeasurably sad to overlook an alternative that would have been reasonable, beforehand, to the patient.

In both cases, though, government participation raises a spectre, a shadow of grave concern. Just as liberal forces have played our elementary schools to inflict their social engineering on our nation's children, there is the real likelihood that someone at some level - local, regional, national - will use the counseling provision to slant the message. To recommend, refuse to discuss, or demand one choice or another. That federal programs will introduce intimidation, denial of services, or harassment to bias "choices" in a preferred direction.

It is guaranteed that the "counseling", when implemented by the government, will expand the scope to include additional provisions, etc. Governments hire bureaucrats that only advance within government circles, and most often by expanding the scope and range of their organization.

If end of life counseling and abortion counseling were recommendations of the American Medical Association - and every American visited a family physician regularly - I would be much happier about this topic.

I am much happier that Mom talked to (the late) Dr. Frink about resuscitation, about heroic interventions, than to the IRS agent at my last audit. Dr. Frink never, to my knowledge, lied to a patient, or made up problems.

For one thing, doctors make money prescribing medicines and caring for patients. Government agents advance by keeping costs down. I know which influence I trust to waste less life and cultural experience.

Would a young doctor tomorrow, briefed on the legal requirement for end of life counseling, be affected by how the government presents the program? I cannot imagine otherwise. Would that doctor's patients then be influenced by the government procedures and representations? Yep.

The concept, or possibly even the intent of the ObamaCare end of life counseling provision might be well intentioned. Stuff happens. But I do not trust a government intervening into the discussion between doctor and patient. There is already too much intrusion.

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