Re: OT: Youth In Asia

On Aug 15, 11:08 am, Dale Houstman <d...@xxxxxxxxxxxx> wrote:
RichL wrote:
topaz <topazgal...@xxxxxxxxx> wrote:
On Aug 15, 12:00 am, "RichL" <rpleav...@xxxxxxxxx> wrote:
Fattuchus <fattuc...@xxxxxxxxx> wrote:
On Aug 12, 7:39 pm, "83LowRider" <83lowri...@xxxxxxxxxxxxxxxxxx>
wrote:
"RichL" wrote
There seem to be some on the right for whom there is a moral
imperative to drag out someone's life well beyond what that
person's wishes would have been, under the guise of being
"pro-life".
I think that those beliefs form the "logical basis" (such as it
is) for the "death panel" nonsense.
Watching the Arlen Spector debate in Lebanon PA
yesterday did bring up a couple interesting bits
that are mandatory in the proposed bill. One being
a yearly physical.. all good in theory. Thing is, it's
like any law you create.. you create new criminals.
On the surface a yearly physical sounds like a great
preventitive form of intevention/treatment. Everyone
should have one. But how about the thousands of
youth that are gonna blow that off? Do you now go
arrest them? Your typical inner city 'hood thug' sure
isn't gonna go get his 'yearly'.. A minor point to be
sure, but does gov't. have the right to force someone
into a doctors office? Another mandatory point brought
up is that seniors would be required to go every five
years to a counseling session referred to in the bill
as Dying With Dignaty.. Now, ol' Arlen (there is currently
no bill in the senate) says he would never support any
bill requiring a counseling session, but the mere
fact that it's in the house bill is astonishing to me.
Does this apply to seniors? Why not require it for all adults?
It's scary to me . . . . so, what is the message being sent by
this government if only people over a certain age (like 70) must be
reminded every few years that they can refuse care? Sounds like
the folks in congress decided they are tired of paying medical
bills for bubbe.
NO BILL REQUIRES SENIORS TO HAVE THIS COUNSELING!

It's entirely voluntary.- Hide quoted text -

- Show quoted text -
I believe it s around  page 425 in one bill and 426 in another bill;
every 5 years or when the patient's status changes, patients need to
be told of their right to refuse  aggressive medical measures; here I
have tried to cut and past page 424 of the House version going into
line 17 of page 430.  It does not say that seniors or patients must
choose to be DNR; says they must get the councelling.  Keep in mind
if a patient does not get the councelling medical practice would
dictate that everything must be done for every patient (full code,
respirators, artificial feeding etc.) So by mandating councelling  the
health profession must  tell the patient that they can choose to be a
no code and refuse care; the problem I have with this is the emphasis
on this issue, and the fact that the patient is never told that they
can change their mind!!  Why note put in the law that the patient must
be reminded that they can change their mind??  Patient also needs to
get councelling over and over when their status changes which often
means when Grandma moves from the hospital to a nursing home for rehab
to an adult apartment, over and over she needs to be reminded of the
fact that she can refuse treatment

Starts page 424 house bill HR3200  to page 430

SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.
6 (a) MEDICARE.—
7 (1) IN GENERAL.—Section 1861 of the Social
8 Security Act (42 U.S.C. 1395x) is amended—
9 (A) in subsection (s)(2)—
10 (i) by striking ‘‘and’’ at the end of
11 subparagraph (DD);
12 (ii) by adding ‘‘and’’ at the end of
13 subparagraph (EE); and
14 (iii) by adding at the end the fol15
lowing new subparagraph:
16 ‘‘(FF) advance care planning consultation (as
17 defined in subsection (hhh)(1));’’; and
18 (B) by adding at the end the following new
19 subsection:
20 ‘‘Advance Care Planning Consultation
21 ‘‘(hhh)(1) Subject to paragraphs (3) and (4), the
22 term ‘advance care planning consultation’ means a con23
sultation between the individual and a practitioner de24
scribed in paragraph (2) regarding advance care planning,
25 if, subject to paragraph (3), the individual involved has
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425
•HR 3200 IH
1 not had such a consultation within the last 5 years. Such
2 consultation shall include the following:
3 ‘‘(A) An explanation by the practitioner of ad4
vance care planning, including key questions and
5 considerations, important steps, and suggested peo6
ple to talk to.
7 ‘‘(B) An explanation by the practitioner of ad8
vance directives, including living wills and durable
9 powers of attorney, and their uses.
10 ‘‘(C) An explanation by the practitioner of the
11 role and responsibilities of a health care proxy.
12 ‘‘(D) The provision by the practitioner of a list
13 of national and State-specific resources to assist con14
sumers and their families with advance care plan15
ning, including the national toll-free hotline, the ad16
vance care planning clearinghouses, and State legal
17 service organizations (including those funded
18 through the Older Americans Act of 1965).
19 ‘‘(E) An explanation by the practitioner of the
20 continuum of end-of-life services and supports avail21
able, including palliative care and hospice, and bene22
fits for such services and supports that are available
23 under this title.
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426
•HR 3200 IH
1 ‘‘(F)(i) Subject to clause (ii), an explanation of
2 orders regarding life sustaining treatment or similar
3 orders, which shall include—
4 ‘‘(I) the reasons why the development of
5 such an order is beneficial to the individual and
6 the individual’s family and the reasons why
7 such an order should be updated periodically as
8 the health of the individual changes;
9 ‘‘(II) the information needed for an indi10
vidual or legal surrogate to make informed deci11
sions regarding the completion of such an
12 order; and
13 ‘‘(III) the identification of resources that
14 an individual may use to determine the require15
ments of the State in which such individual re16
sides so that the treatment wishes of that indi17
vidual will be carried out if the individual is un18
able to communicate those wishes, including re19
quirements regarding the designation of a sur20
rogate decisionmaker (also known as a health
21 care proxy).
22 ‘‘(ii) The Secretary shall limit the requirement
23 for explanations under clause (i) to consultations
24 furnished in a State—
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page 427

I) in which all legal barriers have been
2 addressed for enabling orders for life sustaining
3 treatment to constitute a set of medical orders
4 respected across all care settings; and
5 ‘‘(II) that has in effect a program for or6
ders for life sustaining treatment described in
7 clause (iii).
8 ‘‘(iii) A program for orders for life sustaining
9 treatment for a States described in this clause is a
10 program that—
11 ‘‘(I) ensures such orders are standardized
12 and uniquely identifiable throughout the State;
13 ‘‘(II) distributes or makes accessible such
14 orders to physicians and other health profes15
sionals that (acting within the scope of the pro16
fessional’s authority under State law) may sign
17 orders for life sustaining treatment;
18 ‘‘(III) provides training for health care
19 professionals across the continuum of care
20 about the goals and use of orders for life sus21
taining treatment; and
22 ‘‘(IV) is guided by a coalition of stake23
holders includes representatives from emergency
24 medical services, emergency department physi25
cians or nurses, state long-term care associa-
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428  (PAGE)
•HR 3200 IH
1 tion, state medical association, state surveyors,
2 agency responsible for senior services, state de3
partment of health, state hospital association,
4 home health association, state bar association,
5 and state hospice association.
6 ‘‘(2) A practitioner described in this paragraph is—
7 ‘‘(A) a physician (as defined in subsection
8 (r)(1)); and
9 ‘‘(B) a nurse practitioner or physician’s assist10
ant who has the authority under State law to sign
11 orders for life sustaining treatments.
12 ‘‘(3)(A) An initial preventive physical examination
13 under subsection (WW), including any related discussion
14 during such examination, shall not be considered an ad15
vance care planning consultation for purposes of applying
16 the 5-year limitation under paragraph (1).
17 ‘‘(B) An advance care planning consultation with re18
spect to an individual may be conducted more frequently
19 than provided under paragraph (1) if there is a significant
20 change in the health condition of the individual, including
21 diagnosis of a chronic, progressive, life-limiting disease, a
22 life-threatening or terminal diagnosis or life-threatening
23 injury, or upon admission to a skilled nursing facility, a
24 long-term care facility (as defined by the Secretary), or
25 a hospice program.
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429  (PAGE)
•HR 3200 IH
1 ‘‘(4) A consultation under this subsection may in2
clude the formulation of an order regarding life sustaining
3 treatment or a similar order.
4 ‘‘(5)(A) For purposes of this section, the term ‘order
5 regarding life sustaining treatment’ means, with respect
6 to an individual, an actionable medical order relating to
7 the treatment of that individual that—
8 ‘‘(i) is signed and dated by a physician (as de9
fined in subsection (r)(1)) or another health care
10 professional (as specified by the Secretary and who
11 is acting within the scope of the professional’s au12
thority under State law in signing such an order, in13
cluding a nurse practitioner or physician assistant)
14 and is in a form that permits it to stay with the in15
dividual and be followed by health care professionals
16 and providers across the continuum of care;
17 ‘‘(ii) effectively communicates the individual’s
18 preferences regarding life sustaining treatment, in19
cluding an indication of the treatment and care de20
sired by the individual;
21 ‘‘(iii) is uniquely identifiable and standardized
22 within a given locality, region, or State (as identified
23 by the Secretary); and
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430
•HR 3200 IH
1 ‘‘(iv) may incorporate any advance directive (as
2 defined in section 1866(f)(3)) if executed by the in3
dividual.
4 ‘‘(B) The level of treatment indicated under subpara5
graph (A)(ii) may range from an indication for full treat6
ment to an indication to limit some or all or specified
7 interventions. Such indicated levels of treatment may in8
clude indications respecting, among other items—
9 ‘‘(i) the intensity of medical intervention if the
10 patient is pulse less, apneic, or has serious cardiac
11 or pulmonary problems;
12 ‘‘(ii) the individual’s desire regarding transfer
13 to a hospital or remaining at the current care set14
ting;
15 ‘‘(iii) the use of antibiotics; and
16 ‘‘(iv) the use of artificially administered nutri  LINE 17
tion and hydration.’’.

I understand the words above sound  innocent however the point is
without the mandate, the legal and moral assumption is that the
patient will have everything done when they are very ill.    Sure,
people young and old should know that they can be a no code etc.
however by putting in this mandate, combined with  comparitive
effectiveness research that uses the patient's age  among other
factors to ration care,  the whole tone of the legislation to me
implies that if you are older better just do everyone a favor and
consider dying already.  And again if the law will mandate the end of
life discussion why not tell the providers to remind the patient that
they can change their mind?

The segment of the bill that you posted simply spells out what the
advanced planning care consultation consists of.  Nothing in the bill
itself, particularly the segment that you posted, indicates that the
consultation is mandatory.

This segment starts out stating that previous bills (particularly
Section 1861 of 42 U.S.C. 1395x) are being amended.  One has to refer to
that bill to determine the context into which the current phraseology is
being inserted.

There is no "mandate".  There is simply an opportunity for people to
avail themselves of an opportunity that they would otherwise have had to
pay for out of their own pockets.

It's a slippery slope argument at this point: you give people the choice
one day and the very next day we're herding old people into train cars!

Hysteria rules...

dmh

I never said that we are hearding old people into train cars. Again, I
posted earlier I am not sure what this "death panels" claim is so I
cannot comment on it.
.

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