On the ABC nightly news, Charles Gibson presents, what the newscast calls, a ‘Fact Check’ on the health care debate. The report alleges that opposition to the Obama HealthCare initiative presents the so called ‘Advance Care Planning Consultation’ as a method for denying care to the elderly or individuals who would not otherwise qualify for optional medical care; in other words ‘rationing’ or refusal of care.
Gibson’s report, however, does not fully explain the basis or reasoning behind the planning consultation. Dr. Ezekiel Emanuel, MD, PhD Dept. of Bioethics, NIH, has written extensively about this particular subject. In a paper published in the Hastings Center Report--November-December, 1996, Dr. Emanuel spells out his reasoning for limiting care to certain individuals. On pgs 13-14 of the report he specifically states “ (s)ervices provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia. A less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason".
Clearly, the explanation listed in section 1233 of the prospective healthcare legislation does not attribute the planning consultation to Dr. Emanuel’s report, but a logical deduction can be implied with respect to a five year review of a patient’s medical condition. Should the review be found not to meet the ‘basic’ needs of society, then one can assume that care can be withheld.
A more disquieting aspect of the report by Dr. Emanuel would be his reference to citizens that are not “participating”. Exactly how one could define this term is extremely subjective. I would not want either myself, or a loved one, to be classified as such without my consent or understanding. Does Dr. Emanuel suggest that the medical profession can make that determination on its’ own or with only the consent of a governmental body, thus leaving the patient to face the prospect of denial of care?
H.R.3200 needs to be looked at carefully before we rush this legislation and give it the force of law.