By Peter J. Smith

WASHINGTON, D.C., October 30, 2009 ( – They're back. The provisions on advanced-planning directives labeled “death panels” by concerned observers have re-emerged in the final version of the US House of Representatives health-care reform bill. Moreover, the bill also lacks protective language that would prevent reimbursement of physicians counseling assisted suicide as a legitimate “end-of-life” option in states like Washington and Oregon.

Section 240 of H.R. 3962 “Affordable Health Care for America Act” requires insurance companies offering a “qualified health benefits plan” on the health insurance exchange to provide information related to “end-of-life planning” to enrolled individuals.

Although the section stipulates that advance directives “shall not promote suicide, assisted suicide, euthanasia, or mercy killing,” none of the terms are defined in the bill. That poses a problem since some states like Oregon and Washington have laws legalizing physician-assisted suicide, but these states employ different terms.

Oregon instead has opted for the terms “physician-assisted death” or “physician aid in dying” as substitutes for “physician assisted suicide” after the pro-euthanasia group Compassion & Choices (the former Hemlock Society) asked the state's health and human services department for the language change. The state of Washington has also followed suit.

On that basis, a huge loophole could emerge through H.R. 3962, by which the distribution of “end of life” materials could also include information about assisted suicide options in states such as Oregon and Washington. The bill makes clear that nothing in that section should be construed to preempt a patient's decision to “withhold or withdraw of medical treatment or medical care” or to “withhold or withdraw of nutrition or hydration.” The bill also makes clear that sec. 240 shall not be “construed to preempt or otherwise have any effect on State laws regarding advance care planning, palliative care, or end-of-life decision-making.”

Compassion & Choices was revealed earlier in the summer as a major player behind incorporating the “advanced directives” language and as the only resource on an advanced directives manual for Veterans Hospital patients which critics warned appeared designed to lead patients to the conclusion that their “life is not worth living.”

A number of analysts have also feared that incentivizing doctors to offer “end-of-life planning consultations” could lead to senior citizens, the terminally ill, or disabled, being pressured into accepting lower quality care from a doctor who figures he can receive higher reimbursement rates for talking with a patient about when or how he can refuse treatment.

Read HR 3962 “Affordable Health Care for America Act” 

See related coverage by

Bowling for Death Panels: Euthanasia Group Behind “End-of-Life” Counseling 

Bowling for Death Panels II: Obama Administration Promotes “Death Book” for Veterans


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