NRL News

“False premise” of overtreatment is partly to blame in Obama administration push to reimburse docs for advance care planning

by | Sep 2, 2015

Editor’s note. The following comes from NRLC’s Robert Powell Center for Medical Ethics.

Diane Coleman

Diane Coleman

What is driving the current major nation-wide push, both in the private and public spheres, to promote “Advance Care Planning”? One major disability rights group points to a very important reason, the “false premise” that there is widespread overtreatment.

In her presentation to the 3rd International Society of Advance Care Planning and End of Life Care Conference, Diane Coleman, JD, CEO of disability rights group Not Dead Yet pointed to a major flaw in the thinking of those promoting advance care planning:

I call the Disability Perspective a Quest for Balance because advance care planning has developed under the false premise that the primary or only problem is overtreatment of dying people. A balanced approach would also address the problem of undertreatment of people who may or may not be terminally ill. I want to emphasize that while the disability community may be most sensitive to this problem, it affects everyone who may find themselves on the patient end of the health care system.

Ms. Coleman highlighted one shocking example of Terrie, 19 year old who was in an accident and was initially on a ventilator.

“While I was lying in the hospital bed . . ., the doctors would come in and ask my mom if she was ready to pull the plug on me. ‘Why would I want to do that?’ she would ask? The doctors answered, ‘What kind of life will she have— she won’t. She won’t be able to dance, walk, work, have a social life, or be independent.’…Terrie’s parents argued with the doctor, who “responded that any good mother would pull the plug instead of seeing their baby suffer. . . .”

According to accounts,

[Terrie] had a rough time medically for about five months, but eventually, she said “I was spending hours a day off the ventilator and the doctors were still asking if I wanted to live the rest of my life with this condition. If I chose no, they would keep me off the ventilator and I would die. I could get injected with Morphine so I couldn’t feel it.”…”

When she returned a year later, with a power chair like mine and no ventilator, the doctors’ “jaws dropped to the floor and their eyes began to fill with tears.” Their reaction suggests that the doctors always meant well and thought they had been doing the right thing.”

The full story can be found here.

Information on how advance care planning materials already in widespread use are suffused with vivid, emotional, and distorted presentations designed to persuade individuals to forego life-preserving medical treatment can be found here.

What is worse, this summer, the Obama Administration has proposed a regulation using its executive power to pay doctors to conduct advance care planning conversations with seniors, to take effect January 1, 2016.But Rep. Steve King (R-IA) has introduced a bill, H.R. 3251, to prevent the Administration from implementing that funding.

You may ask Your Representative to Co-Sponsor H.R. 3251 against Biased “Advance Care Planning” Under Medicare by clicking here.