Here's the lead-in for an excellent article by Fact Check:
The claim that the House health care bill pushes suicide is nonsense.
July 29, 2009
Summary
On former Sen. Fred Thompson’s radio show, former lieutenant governor of New York Betsy McCaughey said that the House’s proposed health care bill contained a provision that would institute mandatory counseling sessions telling seniors how "to do what’s in society’s best interest ... and cut your life short." House Minority Leader John Boehner made a slightly more measured statement, warning that the same provision "may start us down a treacherous path toward government-encouraged euthanasia if enacted into law."
Note: This is a summary only. The full article with analysis, images and citations may be viewed on our Web site:
http://factcheck.org/...
That lead-in continues:
In truth, that section of the bill would require Medicare to pay for voluntary counseling sessions helping seniors to plan for end-of-life medical care, including designating a health care proxy, choosing a hospice and making decisions about life-sustaining treatment. It would not require doctors to counsel that their patients refuse medical intervention.
I urge everyone to read the whole article. It deals with an important shift going on in medical care, one that happens to offer major cost reductions for Medicare.
I'm a doctor. I've been in practice 30 years. For the last five of those years, part of my work has been as a hospice medical director, while I've continued in private office practice of primary internal medicine.
Some patients pass through a stage of being quite ill, to the point it's not reasonable to think they can be restored to vigorous good health. For such patients it's appropriate for me to suggest a switch in goals, from curative to palliative. We focus on making whatever time is left as pleasant and comfortable as possible. Most patients who are ready for this change of goals meet Medicare's criteria for hospice; the others are appropriate for a similar palliative medicine approach to treatment.
Those claims that House Bill 3200 requires doctors to push or even mention euthanasia are ignorant at best, and more likely another example of Republican scare-mongering.
This change of goals requires a major change in 'mind-set' for the patient, her friends and relatives, her doctors, and her other health care providers such as nurses and home health aides. There is the potential for friction, if not outright conflict, if all the concerned people in those various groups aren't 'on the same page'.
That "suggesting a switch in goals" is no trivial conversation, even for the doctor. It's a tough subject to bring up, and broaching the subject should include a commitment to at least a half hour conversation. The psychological adjustment is a lot of mental work for all involved -- I think psychologists use the term 'working through' for that work. But it's worth it. Patients and their families that make the switch in goals almost always end up glad they did, and grateful for the help they had in the process.
On May 10, Meteor Blades posted this diary about euthanasia:
http://www.dailykos.com/...
The comments included many glowing compliments about hospice care. Please read them. They're nicer than anything I'd have the nerve to say myself.
I also posted this comment:
Even doctors unwilling to prescribe a lethal dose ...
of a medicine ought [I wish I hadn't written "ought", "will often willing" would have been better] to be willing to order increasing doses of the strongest pain medicines, with the goal of relieving pain, even at the risk of getting to a lethal dose.
For the rare patient in whom it just doesn't seem possible to get to a pain relieving dose of the strongest medicines, there's an alternative known as 'palliative sedation'. Basically, it's giving anaesthetic doses of sedative medicines like sodium pentothal. I've never actually seen it done; but most hospitals that have developed a policy about it want the patient revived every 24 to 48 hours, if only to ask, "Do you still hurt enough to want to go back to sleep?"
With my unconventional sense of humor, I've called it euthanasia on the installment plan, but a lot of doctors and nurses who have reservations about assisting suicide are willing, if not relieved, to go along with palliative sedation. The practice has been endorsed by the American Association of Hospice and Palliative Medicine; the AAHPM is at most on the fence about medically assisted suicide.
In fact, at the 2008 conference of the AAHPM in Tampa,I attended a session on what to do if a patient asks for a lethal dose of medicine. The doctor presenting the session said the first thing he does if that happens is to cancel the rest of his day's schedule, and clear the decks to deal with the situation. As far as time management, he treats it as he would a life threatening emergency.
That strikes me as about a complete opposite as I could imagine to "trying to peddle euthanasia" to sick patients.
Calling this provision of HB 3200 a requirement to recommend or even discuss end of life care, much euthanasia, is a misunderstanding at best, and more likely deliberate lying to scare people.