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Tell Congress You Don’t Want Tax Funds to Push Older People to Agree to Premature Death!

Aug 4, 2015 | Medical Ethics

Ask Your Representative to Co-Sponsor H.R. 3251 against Biased “Advance Care Planning” Under Medicare


During the debate over the enactment of Obamacare, there was considerable controversy over paying Medicare health care providers to conduct “advance care planning,” which counsels patients on deciding whether to choose or reject life-preserving medical treatment (and even food and fluids) and advising on legal documents implementing that decision. That provision was taken out of the ultimately enacted law because of an outcry by those who feared it would be used to limit health care spending by persuading people to agree to forego life-saving treatments. Now, the Obama Administration is proposing to use executive power to revive it as a regulation to take effect January 1, 2016.

Rep. Steve King (R-IA) has introduced a bill, H.R. 3251, to prevent the Administration from implementing new Medicare payments for “advance care planning” sessions, which substantial evidence shows are in most cases likely to “nudge” seniors to accept denial of life-preserving care and medically assisted provision of food and fluids.

Talking Points

* If advance care planning provided truly informed consent for decisions about medical treatment it would be laudable. It is good to help people to prepare advance directives, like NRLC’s Will to Live (, that set forth treatment decisions based on what are genuinely their own values and preferences.

* In practice, however, advance care planning is typically less about discovering and applying patients’ own wishes than about pushing them to accept premature death.

* Many “decision aids” in widespread use are suffused with vivid, emotional, and distorted presentations designed to persuade individuals to forego life-preserving medical treatment.

* Both private insurers and the government seek to constrain health care spending, which motivates them to tilt these conversations in a way likely to reduce their liability for expensive treatment.

* Firms hired by private insurers to aggressively conduct advance care planning with their insurees publicize that they save thousands of dollars per beneficiary annually.

* Significant factual inaccuracies have been documented in materials dealing with cardiopulmonary resuscitation and medically assisted nutrition and hydration. Many decision aids paint unquestionably slanted and negative pictures of the quality of life one would have if one’s life is preserved in what one packet called “Conditions Worse Than Death.”

* There is strong reason to believe that these biased already-existing materials will be used far more commonly if tax dollars pay health providers specifically for advance care planning.

* If the government simply writes checks to health care providers for advance care planning sessions with patients, given patient confidentiality requirements there will be no way to monitor these tax funded conversations for bias, factual inaccuracies, or “nudging.” No safeguards will be possible to prevent the highly likely use of our tax dollars to push seniors to premature death.

Contact your Representative to urge him or her to cosponsor H.R. 3251!

More information, including links to a report documenting multiple examples of bias, is available HERE.

Categories: Medical Ethics