End-of-Life Issues in Health Care Reform

Health care reform must respect life, and not contain provisions that mandate or encourage the withdrawal or curtailment of effective life-sustaining treatment to the terminally ill, the chronically ill, or the permanently disabled. Therefore, the provisions that address end-of-life issues must be amended to leave no room for an interpretation that would pressure healthcare providers to make decisions based on cost rather than best medical care.

Section 1233 of the House bill includes vague, federally defined end-of-life counseling. We are concerned that such counseling might put subtle pressure on patients to make decisions not on sound medical bases but in order to conserve costs. Additionally, the bill does not define terms such as “palliative care” and “end-of-life services,” raising the question of whether a discussion about euthanasia might even be mandated.

Section 2707 of the Senate HELP bill requires that insurers develop and implement a reimbursement structure for making payments to healthcare providers that includes incentives for use of evidence based medicine and best clinical practices. This and other provisions in the bill create the possibility that health care coverage determinations could be based on a patient’s health status, age, and/or quality of life. The resulting structure could become a means of advocating for the least expensive treatment at the expense of respect for life. With cost as a primary driver, the elderly, sick, and disabled may find their options for care severely limited.

Supporters of the healthcare reform bills claim that the legislation will not lead to the withdrawal or curtailment of life-sustaining healthcare, or put pressure on doctors and patients to hasten death. However, amendments offered in the Senate HELP Committee to address these concerns were defeated, including the following: (1) amendments to prevent the denial of end of life care and prohibit rationing on the basis of patient age, disability, medical dependency, or quality of life; (2) an amendment to ensure that taxpayers were not forced to fund assisted suicide; (3) an amendment that would have prevented private health insurers from being prohibited from covering treatment; (4) an amendment that would have ensured all individuals have access to essential health benefits; and (5) an amendment that would have required certification that participating plans do not have a pattern of practice or denying coverage based on their age, expected length of life, and disability.

If the supporters of these healthcare reform measures do not intend to withdraw or curtail life-sustaining healthcare for many patients, why are they unwilling to include clarifying language in the bills? We urge members of Congress to clarify these provisions before a bill is brought to the House and Senate floors.