McCotter: Democrats encouraging elderly suicide

Rep. Thad McCotter’s reputation for inflated and inflammatory rhetoric surely won’t be diminished by a statement he released along with House GOP leader John Boehner claiming that the health care reform bill being crafted by House Democrats is designed to get elderly people to commit suicide. The two GOP leaders wrote:

“Section 1233 of the House-drafted legislation encourages health care providers to provide their Medicare patients with counseling on ‘the use of artificially administered nutrition and hydration’ and other end of life treatments, and may place seniors in situations where they feel pressured to sign end of life directives they would not otherwise sign. This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law. At a minimum this legislative language deserves a full and open public debate – the sort of debate that is impossible to have under the politically-driven deadlines Democratic leaders have arbitrarily set for enactment of a health care bill.

Full and open public debate is always a good idea, of course, but that requires that the participants in that debate make intellectually honest statements and do not engage in distortions and half-truths. Let’s take a look at Section 1233 of the bill, which provides for senior citizens to have a consultation with their caregivers that covers what to do to prepare for the kinds of end-of-life scenarios that often leave families divided and court battles going on, as in the Terri Schiavo case.

Such consultation shall include the following:

‘(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.

‘(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.

‘(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.

‘(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).

‘(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

‘(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include–

‘(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;

‘(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order;

‘(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).

None of this suggests anything like “government-encouraged euthanasia” nor does it say anything about pressuring seniors to “sign end of life directives they would not otherwise sign.” In fact, it seems likely to do the exact opposite. By encouraging seniors to make those decisions calmly, in advance and in consultation with their doctors, these provisions are likely to prevent them from feeling pressured by a family member or anyone else.

There have been a great many situations in which someone has been left unable to communicate with doctors and without any legally valid expression of their wishes. In such situations, families often go to war with one another and drag the courts into it. Certainly we should be encouraging people to avoid such situations by sitting down and planning for such end-of-life scenarios while they are able to do so, with sound mind and body.

There is nothing in the text to suggest that anyone would be pushed to make any particular choice. Indeed, the text explicitly says that patients are to be told about how to make sure they get “life-sustaining care” if that is what they would desire should they become incapacitated:

‘(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.

Each person will make a different choice, of course. Some will say that they want to be kept alive under any circumstance as long as it is technologically possible, regardless of the situation they might be in. Others will decide that they do not wish to be kept alive by machines if they have suffered brain damage or if their condition leaves them dependent on those machines. The range of choices is large and entirely situation-specific.

In any case, making those wishes explicit and legally binding in advance will assure that their choices are carried out and helps avoid a myriad of bad outcomes. Having such consultations to explain all of those options is vital to allowing people to make those choices for themselves while they still can. To suggest otherwise is nothing more than empty fear-mongering.