Medicare Proposes Reimbursing for End of Life Discussions; Advocates, Opponents Face Off over “Death with Dignity” Bill in Albany

Medicare officials announced this week that will release rules for a sixty day comment period that will allow physicians, nurse practitioners and some other health officials to be reimbursed for having end of life discussions with patients.  The goal is to have patients consider more clearly the types of health care interventions, if any, that they would want as they face the end of life.  This type of counseling reimbursement had been proposed in the Affordable Care Act but was dropped after Alaska Governor Sarah Palin famously charged that the plan was to create “death panels.”   She charged that the counseling would be slanted toward denying care.  That same concern is being raised by the national Right to Life committee, according to a story in Thursday’s New York Times on this issue.   The committee said it preferred that materials be prepared that included information about a patient’s right to continue to receive treatments.  Medicare expects that the new rules would go into effect later this year or by January.

The issue of death and dying is becoming more widely discussed as the population ages.  A controversial bill (A2129) was introduced in Albany during this legislative session that would allow persons to end their lives with assistance from a physician prescribing drugs.  The bill is sponsored by Assemblywoman Linda Rosenthal and co-sponsored by Richard Gottfried, Phil Steck, Earlene Hooper and Carmen Arroyo.   The bill summary says:

Establishes "the death with dignity act"; allows terminally-ill New Yorkers to
end their lives through the voluntary self-administration of lethal
medications, expressly prescribed by a physician for that purpose; requires a
consulting physician to examine the patient and confirm, in writing, the
attending physician's diagnosis that the patient is suffering from a terminal
disease, and verify that the patient is capable, is acting voluntarily and has
made an informed decision; requires an informed decision by the patient; a
patient shall make an oral and written request, and reiterate the oral request
to his or her attending physician no less than fifteen days after making the
initial oral request; a patient may rescind his or her request at any time and
in any manner without regard to his or her mental state; New York state
residency required; requires reporting by the state board for medicine.

Advocates for the bill say that many persons facing horrible suffering should be able to end their lives if they have no prospect for survival.  This type of bill has passed in three states already.  Oregon has been allowed it since 1997. Washington State passed it in 2008 and Vermont in 2013.  Advocates for the bill recently had a strategy session after the legislative session ended to plan the campaign for next year.  The website for the death with dignity national center says: “The greatest human freedom is to live, and die, according to one’s own desires and beliefs. From advance directives to physician-assisted dying, death with dignity is a movement to provide options for the dying to control their own end-of-life care.”

Opposition to the bill is strong with the New York State Catholic Conference taking a leading role in opposition.  The Hospice and Palliative Care Association of New York State is also opposed along with the Medical Society of New York, the American Medical Association, the New York State Right to Life Committee, the Center for Disability Rights and the Independent Living Association of New York.  Opponents argue that palliative care offers comfort care for dying persons. The opponents are greatly concerned that passage of such a bill will increase pressure on older and disabled persons who are terminally ill to end their lives.

The Albany Times Union wrote an editorial last week saying the bill should be seriously studied and considered while acknowledging there are a number of difficult issues and that safeguards need to be included.  Albany’s Roman Catholic Bishop Edward Scharfenberger responded with an op-ed piece saying that palliative care should be supported, “We should be investing in training of doctors and nurses to provide palliative care, and increasing funding for hospice care which helps terminally ill individuals conclude their earthly journey in an environment of compassion and love, free of pain and comforted by the support of their families and caring staff.  It is here we see true death with dignity.”

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I have been a senior advocate for most of my career. I was Executive Director of the New York StateWide Senior Action Council and the New York State Alliance for Retired Americans. In 2007-2010 I was the Director of the New York State Office for the Aging

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