I've had a chance to look more closely at ex-Gov. Sarah Palin's essay this morning on end-of-life-care. As a more temperate argument, it deserves to be considered on its merits. It remains misleading.

I know I'm arguing from authority here, but the medical research literature simply does not support the idea that end-of-life counseling is stressful, that it fosters less expensive treatments, that it encourages euthanasia or interventions that hasten death. The opposite is true: patients who are counseled in this manner tend to reject euthanasia; they do not find the discussions stressful; they tend to find the experience worthwhile, as it allows them to make tough decisions about their lives and dignity while they still can.
Palin describes the health care reform's bill's stated goal as cost reduction and implies that any provision contained therein has the same aim.  But that's a non-starter: the bill's stated purpose is to improve cost AND increase access AND increase quality of care. Unless Palin is willing to argue that reducing costs shouldn't be an aim of health care reform, it's hard to use the bill itself to cast aspersions on Section 1233.

Then Palin argues that the counseling would encourage people to make death-hastening decisions because doctors would have an incentive to offer them up as options.  At the very least, she argues, it would unduly influence patients by creating undue stress. 

The medical establishment has studied this issue and concluded that patients feel better when they recieve this type of counseling.  And if one of the goals of a good health care system is to preserve and enhance the relationship between patient and doctor, it's weird to argue that counseling like this amounts to a government intervention that takes away choice or somehow limits the actions and words of physicians.  The opposite is true. Adding this benefit provides a financial incentive for doctors to spend more time with their patients. There is no difference in what a doctor gets reimbursed if she discusses expensive treatment with patients versus what she gets if she asks whether the patient might want to consider Hospice care. The post-reform incentive system is behavior neutral.

All of this is sort of moot. The appointments aren't mandatory. If patients don't want to learn about end-of-life options from their doctors, they're exempt. The only difference: if they do, the doctor won't be penalized for providing information about a wider range of options -- not to mention about the benefits to the patient's family of pre-planning for the end stages of a complicated disease. 

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