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Is there a Bias Against Life-Preserving Treatment in Advance Care Planning? Clearly there is!

Mar 20, 2015

By Dave Andrusko

On Thursday—in anticipation of a conference being held today by the influential Institute of Medicine—National Right to Life’s Robert Powell Center for Medical Ethics alerted the public to a report it had produced entitled, “The Bias Against Life-Preserving Treatment in Advance Care Planning.”

That very important document can be read in its entirety at www.nrlc.org/communications/advancecareplanningbias.

What is the nub of the Powell Center’s analysis?

There is currently a major nation-wide push, both in the private and public spheres, to promote Advance Care Planning. As this report documents, there is strong reason for concern that, motivated by cost concerns, promotion of advance directives and advance care planning frequently deviates from a neutral effort to elicit and implement patients’ genuine wishes in the direction of influencing them, subtly or not too subtly, to reject life-preserving treatment.

This is one of those under-the-radar developments that must be exposed to the light of day. This is one instance where money really is a crucial component. According to the report

Both governmental policy-makers concerned about the budgets of programs subsidizing health care and private health insurers see themselves as having strong incentives to limit health care spending.

National Right to Life News Today has posted a number of stories about what Powell Center director Burke Balch, JD, has described as “a fundamental premise of Obamacare”: that “Americans spend too much money on health care and the rate of growth in such spending must be significantly limited.” The report reminds us that

The original House bill controversially funded “advance care planning” in Medicare, precisely because of the belief that it would help reduce what otherwise would be spent on health care. In fact, the President himself called for “a very difficult democratic conversation” about “those toward the end of their lives [who] are accounting for potentially 80 percent of the total health care bill out here.”

The report offers a number of quotations from influential think-tanks beating that same drum. To name just one, Holly Prigerson of Boston’s Dana Farber Cancer Institute, who said

“We refer to the end-of-life discussion as the multimillion-dollar conversation because it is associated with shifting costs away from expensive…care like being on a ventilator in an ICU, to less costly comfort care….”

The report re-addresses and puts into context developments leading up to the passage of ObamaCare and the “multiple mechanisms in Obamacare” intended to “prevent ‘too much’ private money being spent on health care—even money people might want to choose to spend on preserving their lives or the lives of their family members.”

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The last third of “The Bias Against Life-Preserving Treatment in Advance Care Planning” offers example after example of information which bears such ominous titles as “Are Some Conditions Worse Than Death?” and booklets intended to “nudge” people in the direction of foregoing life-preserving treatment.

To answer the report’s opening question—“Are advance care planning programs in practice predominately even-handed attempts to find out and apply patients’ own wishes, or are they instead primarily directed to convincing them to agree to forego life-preserving treatment as a means of saving money?”—clearly the answer is the latter.

Be sure to read the report at www.nrlc.org/communications/advancecareplanningbias.

Editor’s note. If you want to peruse stories all day long, either go directly to nationalrighttolifenews.org and/or follow me on Twitter at twitter.com/daveha.

Categories: Health Care