Charles Krauthammer on End of Life Counseling

by Conor Clarke

Couldn't have said this better myself:

Let's see if we can have a reasoned discussion about end-of-life counseling. [...] We might start by asking Sarah Palin to leave the room. I've got nothing against her. She's a remarkable political talent. But there are no "death panels" in the Democratic health-care bills, and to say that there are is to debase the debate.

Charles, allow me to get the locks and the barricade. Whew. But now that Palin's gone, let's consider the rest of your argument:

To offer government reimbursement to any doctor who gives end-of-life counseling -- whether or not the patient asked for it -- is to create an incentive for such a chat. [...] What do you think such a chat would be like? Do you think the doctor will go on and on about the fantastic new million-dollar high-tech gizmo that can prolong the patient's otherwise hopeless condition for another six months? Or do you think he's going to talk about -- as the bill specifically spells out -- hospice care and palliative care and other ways of letting go of life?

Krauthammer picks the latter. But this argument is curiously self-defeating. If you share Krauthammer's premise that doctors will offer end-of-life counseling because they have a financial incentive to do so, surely this premise will lead you to the conclusion that the doctor will offer "the fantastic new million-dollar high-tech gizmo" instead of a cheaper one. (I should make clear that I don't share Krauthammer's premise -- and of course I don't share his assumption that such a counseling session is a bad thing. My consistent concern is the sinister protrayal of these sessions as "mandatory" and offering services akin to euthanasia.)

As a side note, I should add that the relevant section of the House bill discusses many options beyond "hospice care and palliative care," so that's a bit of a fudge on Krauthammer's part. I should also add that I have no idea what Krauthammer means when he writes that doctors will be reimbursed for a service rendered "whether or not the patient asked for it." And I am further intrigued by Krauthammer's claim that his living will is "more a literary than a legal document." I've filled out some impressively boring legal documents, but they don't exactly hold a candle to Dickens.