ObamaCare and the Right to Life: Elderly Patients May Face Pressure to Die

This article was published in the August 9-22, 2009 issue of the National Catholic Register and is presented as a guest commentary, with the Register’s kind permission.

By Robin Rohr

As the pro-life movement fights to keep abortion out of the health-care reform bill, an undercover attack on the elderly may be taking place unnoticed.

At issue is a provision that calls for end-of-life counseling of senior citizens every five years. That counseling can include topics such as how to decline nutrition and hydration, antibiotics and basic care treatments for specific conditions such as flu or pneumonia, and how to choose palliative and hospice care for the terminally ill.

“I’ve read about a third of HR 3200 and the counseling parts are designed to encourage euthanasia,” claimed Dr. Katherine Schlaerth, an associate professor of family medicine at Loma Linda University School of Medicine. “Seniors will be counseled every five years, and more often if they get sicker.”

Schlaerth, who emphasized that she does not speak for Loma Linda University, said that a frail, elderly, ill and depressed patient or that patient’s family “may easily agree to withhold antibiotics or fluid without realizing the full implication.”

“Patients who have a worsening of their chronic condition, but who may not even be pre-terminal, are included in this strong-arm counseling, and their respect for authority figures could pave the way for agreement with cessation of care not in their interest at all,” Schlaerth said. “Health-care providers, meanwhile, may be forced to give counseling directly opposed to their religious or moral beliefs.”

Key lawmakers are in agreement with Schlaerth. “Section 1233 encourages health-care providers to provide their Medicare patients with counseling on ‘the use of artificially administered nutrition and hydration’ and other end-of-life treatments and may place seniors in situations where they feel pressure to sign an end-of-life directive they would not otherwise sign,” said the House Republican leader, John Boehner, R-Ohio, and the Republican Policy Committee chairman, Thaddeus McCotter, R-Mich., in a July 23 statement. “This provision may start us down a treacherous path toward government-encouraged euthanasia.”

Death as Cost Savings
At first glance, the counseling of elders for care options seems like an innocuous requirement. But Schlaerth says the purpose of the counseling has darker roots.

“The real reason for these draconian provisions directed against elders who are not terminal, I believe, is to save on Social Security payments as well as Medicare payments,” Schlaerth said. “The math is obvious. If you kill the disabled and give ‘quality preventive care’ to the well, your health-care statistics will look excellent.”

Bill May, chairman of Catholics for the Common Good, also views the mandatory counseling sessions as an outrageous cover to introduce assisted suicide.

“We need to pay attention to issues related to shortening the lives and hastening death for the elderly, infirm and disabled – another way of getting rid of undesirable, non-useful and costly people,” he said. “This bill creates a platform for assisted suicide for the elderly, infirm and disabled at times they are most vulnerable, depressed and open to suggestions of ending their lives early. Compassion & Choices, the former Hemlock Society, wants to get into the end-of-life counseling business, and it looks like the health-care bill will open the door for them to become government contractors as purveyors of the culture of death.”

The legislative language of the bill regarding counseling is vague and open to interpretation. “I’m a lawyer, and I find this language incomprehensible,” stated Wesley J. Smith, associate director of the International Task Force on Euthanasia and Assisted Suicide. “I believe it is done maliciously. What is clear is that seniors will receive counseling – read ‘re-education’– every five years or whenever their health status changes. The point is to reduce cost. While the language doesn’t require it, these mandatory sessions will often be directed towards not wanting care, in much the same way that genetic counseling of a mother carrying a Down [syndrome] fetus often is directed toward abortion.”

Smith said patients could be referred to organizations like the assisted suicide advocacy group Compassion & Choices to help sort out their choices. “In practice, if not in law, ‘counseling’ will usually be a one-way street,” he said.

Compassion & Choices is an organization that describes itself as working to improve care and expand choice at the end of life. “Wesley J. Smith says the bill is ‘incomprehensible,’ which may explain why he repeatedly misstates what the bill does,” said Steve Hopcraft, a spokesman for Compassion & Choices. “It’s a myth that C&C or any organization [would] be the counselor. The bill specifically says M.D. or nurse practitioner.”

Section 1233 does state the consultation will be performed by a medical provider; however, included in the topics to be discussed is direction to provide “suggested people to talk to” and “a list of national and state-specific resources.”

Rationed Care
Concerns about Obama’s health-care reform adversely affecting older Americans are not new. Earlier this year, the American Recovery and Reinvestment Act (the “Stimulus Bill”) appropriated $1.1 billion for research into “comparative effectiveness,” which compares clinical effectiveness and cost-effectiveness of medical treatments, procedures and strategies. One aspect of this comparison is a concept called “Quality Adjusted Life Years,” where the value assigned to life varies with the health state of the person. This method is controversial because it means that some people will not receive treatment if the calculated cost is not warranted by the benefit to their quality of life.

Burke Balch, director of the Robert Powell Center for Medical Ethics at the National Right to Life Committee, explained that a person’s Quality of Adjusted Life Years determines if a procedure is allowed. “Of significant concern is the phrase ‘comparative effectiveness,’” he said. “This becomes [how] you end up discriminating against a disability. The language in the health-care bills being considered by the House and reported out of the Senate Health, Education, Labor and Pensions Committee can be used for wide-open interpretation of cost-effectiveness leading to denial of treatment based on quality of life. The funding for the promises made in these bills cannot be sustained, and that will create the atmosphere for rationing.”

May agrees and says that health-care rationing takes place in Oregon, one of two states where physician-assisted suicide is legal. People fighting life-threatening illnesses there regularly receive letters saying that the state insurance plan would not cover their medication but would pay for a lethal prescription to end their lives, he said.

Boehner and McCotter also warn that with Oregon and Washington having legalized assisted suicide, “Section 1233 could create a slippery slope for a more permissive environment for euthanasia, mercy killing and physician-assisted suicide because it does not clearly exclude counseling about the supposed benefits of killing oneself.”

Robin Rohr is a National Catholic Register correspondent and writes from Willits, California.