The wingnutosphere is breaking out with visions of euthanasia, eugenics and state-planned terminations of patients. The impetus for this is deliberate misreading and snipping-out-context portions of Section 1233 of HR3200.
You can read the full bill here, among other places:
http://www.opencongress.org/...
It is Section 1233 Advanced Care Planning Consultation that is under review here.
Here is the section about stakeholders defining options to use in advance care planning.
SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.
(a) Medicare-
(1) IN GENERAL- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended--
...
(B) by adding at the end the following new subsection:
‘Advance Care Planning Consultation'
‘(hhh)(1) Subject to paragraphs (3) and (4), 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. Such consultation shall include the following:
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‘(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include--
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‘(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State--
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‘(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that--
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‘(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.
In plain English, social security recipients shall be briefed about their end of life options. Those option include a patients order for end of life care. The order includes options that have been developed in consultation with the providers of end of life care.
It does no good to indicate that you don't want 'heroic measures' if the ambulance that shows up doesn't know about your preferences. That's what this section is for.
Doctors consult with their patients.
The patient indicates their preferences for end of life treatment.
The doctor writes an order that treatment providers can read and follow.
OH NOEZ!
A second line of attack is coming from misrepresenting the following quote "to limit some or all or specified interventions." But as the full context makes clear, it is the patient who is limiting the options for end of life care - not the State.
‘(5)(A) For purposes of this section, the term ‘order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that--
‘(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;
‘(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;
‘(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and
‘(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.
‘(B) The level of treatment indicated under subparagraph (A)(ii)[tcb: also known as "the patient's preferences"] may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items--
‘(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;
‘(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;
‘(iii) the use of antibiotics; and
‘(iv) the use of artificially administered nutrition and hydration.’.
How do we know the patient's preferences are being "effectively communicated?" Because they have consulted with the doctor in the last five years on just this issue.