« | »

Section 1233 – Advance Care Planning

Excerpts from the House’s healthcare reform bill, HR 3200 (a pdf file) pp 424-430:

15 SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.

16 (a) MEDICARE.—
17 (1) IN GENERAL.—Section 1861 of the Social
18 Security Act (42 U.S.C. 1 395x) is amended—

4 “(E) An explanation by the practitioner of the
5 continuum of end-of-life services and supports avail-
6 able, including palliative care and hospice, and bene
7 fits for such services and supports that are available
8 under this title
.
9 “(F) (i) Subject to clause (ii), an explanation of
10 orders regarding life sustaining treatment or similar
11 orders, which shall include—
12 “(I) the reasons why the development of
13 such an order is beneficial to the individual and
14 the individual’s family and the reasons why
15 such an order should be updated periodically as
16 the health of the individual changes;
17 “(II) the information needed for an indi
18 vidual or legal surrogate to make informed deci
19 sions regarding the completion of such an
20 order; and
21 “(III) the identification of resources that
22 an individual may use to determine the require-
23 ments of the State in which such individual re-
24 sides so that the treatment wishes of that indi
25 vidual will be carried out if the individual is un
1 able to communicate those wishes, including re-
2 quirements regarding the designation of a sur
3 rogate decisionmaker (also known as a health
4 care proxy).
5 “(ii) The Secretary shall limit the requirement
6 for explanations under clause (i) to consultations
7 furnished in a State—
8 “(I) in which all legal barriers have been
9 addressed for enabling orders for life sustaining
10 treatment to constitute a set of medical orders
11 respected across all care settings; and
12 “(II) that has in effect a program for or-
13 ders for life sustaining treatment described in
14 clause (iii).
15 “(iii) A program for orders for life sustaining
16 treatment for a States described in this clause is a
17 program that—
18 “(I) ensures such orders are standardized
19 and uniquely identifiable throughout the State;
20 “(II) distributes or makes accessible such
21 orders to physicians and other health profes
22 sionals that (acting within the scope of the pro-
23 fessional’s authority under State law) may sign
24 orders for life sustaining treatment;
1 “(III) provides training for health care
2 professionals across the continuum of care
3 about the goals and use of orders for life sus-
4 taining treatment; and
5 “(IV) is guided by a coalition of stake-
6 holders includes representatives from emergency
7 medical services, emergency department physi
8 cians or nurses, state long-term care associa
9 tion, state medical association, state surveyors,
10 agency responsible for senior services, state de-
11 partment of health, state hospital association,
12 home health association, state bar association,
13 and state hospice association
.
1 “(B) An advance care planning consultation with re-
2 spect to an individual may be conducted more frequently
3 than provided under paragraph (1) if there is a significant
4 change in the health condition of the individual, including
5 diagnosis of a chronic, progressive, life-limiting disease, a
6 life-threatening or terminal diagnosis or life-threatening
7 injury, or upon admission to a skilled nursing facility, a
8 long-term care facility (as defined by the Secretary), or
9 a hospice program
.
10 “(4) A consultation under this subsection may in-
11 clude the formulation of an order regarding life sustaining
12 treatment or a similar order
.
13 “(5)(A) For purposes of this section, the term ‘order
14 regarding life sustaining treatment’ means, with respect
15 to an individual, an actionable medical order relating to
16 the treatment of that individual that—
17 “(i) is signed and dated by a physician (as de-
18 fined in subsection (r)(1)) or another health care
19 professional (as specified by the Secretary and who
20 is acting within the scope of the professional’s au-
21 thority under State law in signing such an order, in-
22 cluding a nurse practitioner or physician assistant)
23 and is in a form that permits it to stay with the in-
24 dividual and be followed by health care professionals
25 and providers across the continuum of care;

1 “(ii) effectively communicates the individual’s
2 preferences regarding life sustaining treatment, in-
3 cluding an indication of the treatment and care de-
4 sired by the individual;
5 “(iii) is uniquely identifiable and standardized
6 within a given locality, region, or State (as identified
7 by the Secretary); and
8 “(iv) may incorporate any advance directive (as
9 defined in section 1866(f) (3)) if executed by the in-
10 dividual.
11 “(B) The level of treatment indicated under subpara
12 graph (A)(ii) may range from an indication for full treat-
13 ment to an indication to limit some or all or specified
14 interventions. Such indicated levels of treatment may in-
15 clude indications respecting, among other items—
16 “(i) the intensity of medical intervention if the
17 patient is pulse less, apneic, or has serious cardiac
18 or pulmonary problems;
19 “(ii) the individual’s desire regarding transfer
20 to a hospital or remaining at the current care set-
21 ting;
22 “(iii) the use of antibiotics; and
23 “(iv) the use of artificially administered nutri
24 tion and hydration.”.

Note that the ‘stakeholders’ will be the deciders here.

This article was posted by Steve on Tuesday, August 11th, 2009. Comments are currently closed.

22 Responses to “Section 1233 – Advance Care Planning”

  1. Liberals Demise says:

    One look at this gobblety-goop and it just SCREAMS for culling the lawyer herd with a Lawyer Rodeo.
    “Advanced Care Planting” is more like it!!

  2. proreason says:

    This clause is why I’ve started calling it Death Care.

    “the identification of resources that an individual may use to determine the requirements of the State”

    And what might the requirements of the State be?

    And what is the constitutional justification for those requirements?

    I was born in a country we called the United States of America. In that country, the “State” had no “requirements” for my health or life.

    What has become of that country?

    • Liberals Demise says:

      (insert “WHAT?” in Spanish)

      Then press 1 and the # sign for English

    • Colonel1961 says:

      Exactly right, PR. We’re a Country not a ‘state’ or the ‘state’… Ugh.

      LD: Press 1 for ‘Freedom’, Press 2 for ‘Everything else’.

      p.s. We’re No. 1! Let’s keep it that way!

    • DoctorRock says:

      Or just “take a deep breath, let half of it out, and squeeze”.
      Relax. As far as the Libs are concerned, I’m talking Navajo.

    • openminded says:

      Um, it says “to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes.” “State” here means Florida,Ohio, California, Wyoming, etc., doesn’t it? And “requirements” means the state’s rules about how to specify one’s own wishes about what to do if one is incapacitated, doesn’t it?

  3. conservativegirl says:

    If you’ve got the stomach for it, go back and reread this section of the healthcare bill and insert Dr Ezekiel Emanuel for “the State” or “the Secretary.”
    Feeling ill?

  4. VMAN says:

    Sounds like they are planning on offing a bunch of old people to me.

  5. Our generation is getting it from two ends. The generation-previous was trying to kill us in Vietnam, now the next generation is trying to wipe us out with Obama care.

    Country Joe MacDonald updated:

    Come on all you geezer men,

    Uncle Sam needs your help again.

    He’s got himself in a terrible jam,

    trying to sell Obama’s plan.

    So gulp down your pills and smack your gums,

    You’re gonna have a whole lot of fun.

    And it’s 1, 2, 3. What are you living for?

    Don’t ask us. We don’t give a damn.

    You’re gettin’ Obama’s plan.

    And it’s 5, 6, 7. Open up them Pearly Gates!

    Why it ain’t no time to wonder why.

    Whoopee, you’re all goin’ to die.

    Well come on daughters throughout the land,

    Get your parents on Obama’s plan.

    Come on sons don’t hesitate,

    Get them on before it’s too late.

    Be the first one on your block,

    To have your dad come home in a box.

  6. canary says:

    (1) if there is a significant
    4 change in the health condition of the individual, including
    5 diagnosis of a chronic, progressive, life-limiting disease,
    ” life-limiting “? won’t this conflict with the American for Disabilties Act.

    “life-limiting” such as arthritis, poor vision, poor hearing, not able to walk without a cane, parkingsons disease, dementia, alzheimer’s, “life-limiting” things that only need medication? A broken leg that they won’t fix, getting worse. Well, Obama speech problem, ah duh uh, better improve, that teleprompter is to costly. And Diabetis only get’s worse, often leading to increased infections, amputations. Next time they are in a comma, I guess just don’t do anything.
    Hide your canes, handicap stickers/

    a
    6 life-threatening or terminal diagnosis or life-threatening
    7 injury,
    ” “life-threatening injury ‘? Might as well, just haul you off in a wrecked car. Those few stitches that might save a bleeding life-threatening cut, no more.
    ” the use of antibiotics”
    Dr. Boogey Obama: Well, I see the baby is lying in bed with limiting life activity. Can’t walk, feed itself. Swine flu is getting worse. Antibiotics could cure the baby, but baby still wouldn’t has very little life activity. Keep on life support until all functioning organs can be sold.
    ” the use of antibiotics”
    Dr. Boogey Obama: Well, Swine flu has progressed to the patient lying in bed, fever growing worse. Appears life-limited activity is progressing at rapid rate. We are short on antibiotics. There are other people in the world, more deserving.

    Dr. Boogey Obama: Is the patient registered Democrat or Republican. My WH astro-turf needs fertilizer.

  7. jobeth says:

    Note as you read this tripe, that just as Obalmy talks, it “talks” in circles, saying nothing in frank language. Sort of hints of things…but not toooo much…just a little.

    It’s worded juuuust right so if you try to pin Obalmy on something…he says you are mistaken and are believing “untruths”, rumors or people who are trying to talk us into being against him.

    But once enacted, it says just enough his government goons can “interpret” anyway they want.

    Like I said…just like he talks…Ever try to figure out what the heck he says sometimes. Talks all around a subject…wanders really….and never actually answers the question he is asked. Takes up a lot of time and doesn’t say anything. Sort of like voting “present”

    This health care bill does the same thing. Its long…worded in a way to intimidate prospective readers…then goes on to wander around in legal speak to say nothing but giving wide berth to later “interpret” it any way they want it.

    Brilliant…and damned evil!

    • DoctorRock says:

      The hell you say!
      Government Motors just previewed a car that gets 230 miles to the gallon!
      And those are the very numbers from the EPA. Would you doubt our dear
      president’s candor, then I suggest you put John Murtha and Arlen Specter
      in a Chevy Volt with a single gallon of gas in Scranton PA, and unleash the
      peasants with the pitchforks. I’ve got a nickel that says our their honored representatives make good their escape.

    • canary says:

      yeah, after 100 miles you have to charge battery for 16 hours. The gas can kick in to get you the extra miles. 40.000 for a little car. Hope it doesn’t have a sparking problem.

  8. wardmama4 says:

    Oh come on – The Won is thinking globally – and of course with eco-wackiness in mind too:

    Soylent Green is People.

    Rent the movie – given this drivel – America isn’t that far off its end.

    I Want the Whole 20 minutes –

  9. canary says:

    under this title. “(F) (i) Subject to clause (ii), an explanation of

    (i) is (i) to consultations furnished in a State— (ii) is Secretary of State

    orders regarding life sustaining treatment or similar orders, which shall include— (I) the reasons why the development of such an order is “beneficial” to the individual and the “individual’s family” and the reasons “why such an order should be updated periodically” as the health of the individual changes;

    Dr. Boo Obooba: Well me and my wife don’t want to take care of my typical white grandmother. Just put her in a home. What? She broke her hip, just give her a couple of asprin, she only has 6 monthes to live anyways, and healing from hip replacement will just put her in a wheel chair for monthes. She can lay in bed and tough it out. Give her a couple of asprins. Hmmm. Better yet, she’s pretty mad about me slurring her to the world, put her on a drip that will keep her quiet. Set Hospice up so I can knock her off in 3 days. Preferably the day prior to election. Ya know for sympathy.

    “(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and “(III) the identification of resources that an individual may use to determine the require-ments of the State in which such individual re-sides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including re-
    quirements regarding the designation of a surrogate decisionmaker (also known as a “health care proxy “!).

    Dr. Boo Obooboo: Well, she was found unconcious and we don’t know her relatives, so according to (III) I will eeni minee mo the “health care proxy” decisionmaker to order no treatment be given until someone finds out she’s here. Then we’ll discuss with the individuals family what’s best to do.

    (ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State— “(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders
    respected across all care settings; and “(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).“(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that— “(I) ensures such orders are standardized and uniquely identifiable throughout the State;
    (II) distributes or makes accessible such orders to physicians and other health profes
    sionals that (acting within the scope of “the professional’s authority” under State law) may sign orders for life sustaining treatment;

    Dr. Obooboo. “oops she’s gone. next?

    life sustaining treatment (IV) is guided by a coalition of stake-holders….

    Dr. Obocommunism “I am the President over Health Care. Too much money at stake. get them out of my office. Next.”

  10. U NO HOO says:

    The Seinfeld episode with Kramer and Elaine at Ben Stein’s office making a living will was on tonite.

    That’s all.

  11. Rusty Shackleford says:

    From the AP today:

    FACT CHECK: No ‘death panel’ in health care bill

    By RICARDO ALONSO-ZALDIVAR, Associated Press Writer Ricardo Alonso-zaldivar, Associated Press Writer – Tue Aug 11, 3:04 am ET

    WASHINGTON – Former Republican vice presidential candidate Sarah Palin says the health care overhaul bill would set up a “death panel.” Federal bureaucrats would play God, ruling on whether ailing seniors are worth enough to society to deserve life-sustaining medical care. Palin and other critics are wrong.

    Nothing in the legislation would carry out such a bleak vision. The provision that has caused the uproar would instead authorize Medicare to pay doctors for counseling patients about end-of-life care, if the patient wishes. Here are some questions and answers on the controversy:

    Rest of article: http://news.yahoo.com/s/ap/20090811/ap_on_go_co/us_health_care_end_of_life_q_a

    I guess the way we’re gonna have to fight this is to spell it out by first citing the page, paragraph and sentence in the bill, then extrapolate a scenario-based example then ask the question.

    It’s no wonder they get testy. They have no idea what it says!

    • canary says:

      This is a life or death subject, that an irresponsible news whose reporter is playing the role of a medical professional, is wreckless and negligent. And to waste it with a personal comment that is irrelevant. Pathetic.

      Free counseling and hospice is already performed. The laws are written that someone else can decide to force a patient to use hospice.

      And I’ve no respect for the quality of hospice or their opinion, because their induced and aided death in the home, is not properly monitored and can mean a horrendous torturous painful death! Two cases I witnessed.
      #1. 2 Sisters move in home with mother who had lung cancer that spread leading to brain cancer. Mother hits point she is vegetable state unable to speak. One sister is drug addict and starts taking mother’s pain medicine, as the mother can not signal or tell anyone she is in pain. The body goes through enormous pain as the organs shut down, yet alone, no fluids are given. Other sister assumes since mother isn’t acting or looking like she’s in pain, not to tell the hospice attendants what the sister has done.

      #2. Little old lady, decides to go hospice route. Niece volunteers to play martyr role, as she has done it before, and feels it’s her calling. Relative called that the grandmother is nearly dead, can not speak or hear anymore, and should come to say good by. Relative comes, notices the black urine, old woman laying there, and starts to talk to her. Old lady starts gapping mouth open, tongue and lips frantic? Relative asks if old lady is thirsty, and old lady nearly dead, nods head. Relative gives cup of old ladys favorite drink coca cola. Notices it’s not enough. Goes back, and helps old lady drink another cup. Then niece comes in “stop. she might choke and die”. Then little old lady crys out she’s in pain. Niece, who really believed little old Aunt was really near death took little old Aunt’s pain medicine. Next day, hospice comes. Niece, tells hospice, little lady can not speak or drink anymore. Other relative tells hospice the truth. Little old lady is thirsty and in pain, and can talk and say names. Hospice lady doesn’t blink an eye, smiles and leaves. I hope a few die miserable deaths. Hospice is never going to admit to any wrong doing.

      I could say more, but just trying to get point across. It’s something people need to think about, before taking the Hospice route. Dying in your home sounds good, but can you trust who is authorized to aid and quicken your death.

  12. BannedbytheTaliban says:

    Breaking News…..

    Nancy Pelosi is quoted as saying “Those not wishing to submit to the President’s plan are un-American. Carrying symbols of aborted geysers and such, judge for yourselves, they should be astroturf. They are on the wrong side of this issue and the wrong side of the lawn. Those greedy old timers wishing to hoard all that valuable healthcare for themselves while decent everyday citizens go without…”

    When asked about his response to the speaker’s comments, BannedbytheTaliban responded: “Nancy Pelosi? Didn’t a house fall on her?”

  13. Here are the poetic writings of the principled liberal: Camille Paglia. When supporters like her turn it’s time to reconsider your direction.
    http://www.salon.com/opinion/paglia/2009/08/12/town_halls/index.html

    “…But who would have thought that the sober, deliberative Barack Obama would have nothing to propose but vague and slippery promises — or that he would so easily cede the leadership clout of the executive branch to a chaotic, rapacious, solipsistic Congress? House Speaker Nancy Pelosi, whom I used to admire for her smooth aplomb under pressure, has clearly gone off the deep end with her bizarre rants about legitimate town-hall protests by American citizens. She is doing grievous damage to the party and should immediately step down.

    There is plenty of blame to go around. Obama’s aggressive endorsement of a healthcare plan that does not even exist yet, except in five competing, fluctuating drafts, makes Washington seem like Cloud Cuckoo Land. The president is promoting the most colossal, brazen bait-and-switch operation since the Bush administration snookered the country into invading Iraq with apocalyptic visions of mushroom clouds over American cities….”

    “…As a libertarian and refugee from the authoritarian Roman Catholic church of my youth, I simply do not understand the drift of my party toward a soulless collectivism. This is in fact what Sarah Palin hit on in her shocking image of a “death panel” under Obamacare that would make irrevocable decisions about the disabled and elderly. When I first saw that phrase, headlined on the Drudge Report, I burst out laughing. It seemed so over the top! But on reflection, I realized that Palin’s shrewdly timed metaphor spoke directly to the electorate’s unease with the prospect of shadowy, unelected government figures controlling our lives. A death panel not only has the power of life and death but is itself a symptom of a Kafkaesque brave new world where authority has become remote, arbitrary and spectral. And as in the Spanish Inquisition, dissidence is heresy, persecuted and punished….”


« Front Page | To Top
« | »