Lynn v. Sekulow

Lynn v. Sekulow

Did We Get Rid of Good Medical Care…And Death Panels

I have just one comment on the cross controversy at the Supreme Court.  In my view, the Court will probably end up not resolving the core issue of the legitimacy of the land tranfer and resolve this either on standing grounds or on the issue of whether the pemanent injunction can be vitiated by act of Congress.  (This will be important to us, but may not make for scintillating television commentary.)

I’d like to move to something new.  I gave a presentation to the annual conference of the group Compassion and Choices yesterday.  This group advocates for serious planning about individual end of life care choices and has supported in limited circumstances “physician assistance in dying”.  When I was reviewing some material for my speech, I noticed that the idea of planning for the end of your life was a postion once advocated by such conservatives as Newt Gingrich and  Sarah Palin.  These are the same people who have now condemned Administration healthcare plans in part because of a provision which would have compensated physicians in Medicare for having voluntary discussions with people about their end of life choices.  That provision seems to be vanishing from current work on healthcare reform.  And that, from my perspective, is a very sad thing to have happened.




So, Jay, I just wanted to know how you feel about this one narrow issue.  Do you believe that physicians should be compensated for discussing options for patients at the end of life (which in 48 states does include “physician assistance in dying”) so that Americans can state their views clearly in so-called “living wills” or in “health care powers of attorney”?

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Your Name

posted October 14, 2009 at 9:14 pm

Barry & Jay
The term “options for patients at the end of life” is ambiguous and slippery. Terms like “aggressive treatment” (attempting to cure or forestall a physical condition) and “palliative care” (treating to ease pain and other symptoms without trying to halt the ailment)are not ambiguous. Barry’s term “Physician assiatance in dying” is broad enough to include any actions to hasten death (deliberate overdose or suffocation, for example). If a physician’s duties are to include hastening a patient’s death, that is a radical change from the previous concept of a physician’s duties for over 3000 years (“First, do no harm…”). If a physician may help a patient die more quickly, is there then no need for a diagnosis of impending unavoidable death? diagnosis by whom? how many opinions? could a patient who wishes to die shop around for someone to give the desired diagnosis/consent? Perhaps if 2 of 20 doctors consulted agree a patient should be helped to die, is that sufficient? what about a patient with dementia who wants to die and the person with healthcare Power of Attorney (HCPOA) opposes this? What about the opposite? suppose a relative merely *alleges* dementia and insists that the patiented be “helped” to die?
All these issues must be addressed if one considers “compensating” a physician consulted for “end of life options.”

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posted October 14, 2009 at 9:56 pm

For years, in the bleak darkness of cold winter nights, I would press the horn button on my steering wheel to sound: Shave and a haircut, two bits. I would do this driving west bound on I-69 at Lapeer, Michigan. Why? Because 200 yards north, behind bars, was a prisoner of conscience named Jack Kevorkian, M.D. I hoped that in his cell Jack could hear my tiny salute, and my tiny protest against “moral” tyranny, and know that he was not entirely forgotten. Often, I’m sure that is exactly how he felt.
Having said that, and affirming the right of any person to a death with dignity – I am opposed to legislation giving imprimatur to “physician-assisted suicide”. My resistance is based upon the psychology of the doctor-patient relationship. First Responders know that the final dying word on the lips of many is, “Mother?” In our fear of crossing the River Jordan we instinctively turn to our first protectors, mommy and daddy. The dying patient gradually becomes infantilized vis a vis the physician, and the dying express the hope: “You’ll be there with me, won’t you?” Doctors already have social power to the degree that it corrupts many.
It is ideal to think that a doctor is only “imparting information” for “end of life planning” – as if preparation for death is principally an intellectual activity. But we all know it is not, and we did not need Elizabeth Kubler-Ross to tell us so. Physicians admit they are not trained for this kind and degree of responsibility. Most became doctors without one single academic course on death and dying. It was merely one topic covered under some course in Medical Ethics. This being the case, the mention of financial remuneration under insurance for a physician’s end of life “bull in the China shop” scene is hard to take. Find a trained and licensed Grief Counselor.
A terrible metaphor in this field of inquiry is that of “pulling the switch”. Most people do not know that the hideous Electric Chairs were connected to multiple electric switches, but the prison electrician only wires up one of them, chosen at random from slips of paper. The guards, who all pull their switches at the same time, do not know who among them is culpable by the laws of physics.
Lesson: our society needs assisted suicide. We need to achieve it in some manner akin to performing a “double blind” experiment. There is no insurmountable need for physicians to participate. In fact, they ought to be roped away from the matter with wide yellow tape.

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N. Lindzee Lindholm

posted October 14, 2009 at 11:35 pm

End of life planning is very important, but if it is conducted with the proper people such as family members and one’s pastor. The reason why many people objected to the initiative in the Health Care Plan is due to the fact that the government was going to be the body that was collecting statistics on the effectiveness of the counseling. Since the government has an interest to keep costs low, especially with an ailing economy, Uncle Sam as the oversight committee seems a little fishy like a conflict of interest, wouldn’t you say so?

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posted October 15, 2009 at 11:47 am

Personally, i’m tired of all the talk about ‘death panels’. They already exist…it’s the Insurance Industry. They decide who gets what and who doesn’t get treatement because the Insurance Industry isn’t interested in helping, they’re interested in making a profit, at other peoples expense and in some cases, their very lives.
This is what the GOP gave us. The Insurance Industry makes the choices, determines the costs and if ones treatment is too expense, that person dies. Now the Insurance Industry is stating they will raise costs, essentially threatening the American People by intimidation. It’s time to have a real checks and balances system in place rather than allowing the Health and Insurance Industries to tell us what is going to happen!

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Your Name

posted October 15, 2009 at 3:18 pm

Are you referring to the doctor helping kill a person. There are alternative treatment plans if the patient is dieing and needs pain treatment of some kind to take the pain away.

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posted October 15, 2009 at 3:27 pm

The language needs to be in specific terms leaving no doubt as to the intent of “Assisting with Last Wishes”.

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posted October 15, 2009 at 7:32 pm

The current administration is the concern about “end of life” decisions.
The authoritarianism being sought by the Obama group is truly frightening when thinking they’ll get a shot at influencing who stays and who goes and when and how.

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posted October 15, 2009 at 8:15 pm

Mere_Christian: “The current administration is the concern about “end of life” decisions. The authoritarianism being sought by the Obama group is truly frightening when thinking they’ll get a shot at influencing who stays and who goes and when and how.”
By paying the patient’s doctor to discuss end of life options, the authoritarianism of which you speak goes from the insurance company actuaries where it is now to the doctor and patient where it belongs. The so-called “Obama group” doesn’t have anything to do with it except to force the for-profit insurance companies to give up that arbitrary control over other peoples’ lives.

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posted October 15, 2009 at 9:16 pm

I’ll bite. You use the word “authoritarianism”. What in the heck are you talking about?
I am 56 years old and have lived through a few administrations. It seems to me that what we have now is a lessening of the authoritarian practices of the prior regime. Warrantless wiretaps come to mind. The “gag rule” that is attached to international funding of family planning programs. The unlawful use of all tax monies to fund religious programs through the Faith Based Embezzlement Dept.
I would love to hear from you what you consider an example of this unbridled quest of imperious authority.

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posted October 21, 2009 at 12:29 am

I think that authorisation is not good when obama comes as a president of USA. The insurance company is responsible for making the payment to the doctors in behalf of patients.

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