Death Spiral

MILLIONS WATCHED as health care demagogue Betsy McCaughey
slammed down a fat binder onto Jon Stewart’s desk on The Daily Show last Thursday night, August 20, claiming that the
infamous “death panel” policy was right there on pg. 425. Portland’s
own Representative Earl Blumenauer originally penned the language on
that page—one small “advance care planning” clause within the
massive health care reform bill.

It makes sense that the national “death panel” hysteria has its
roots here in Portland. Oregonians have dealt with tricky end-of-life
issues in the political arena for over a decade now, since passing the
nation’s first law allowing terminally ill patients to request a lethal
quantity of painkillers in 1998. The debates about “killing granny”
(lies and sound bites included) were first heard here in Oregon.

Blumenauer originally wrote up the now-famous clause six months ago,
introducing it as a bill co-sponsored by a Louisiana Republican,
Charles Boustany. Policymakers folded that bill into the overall
America’s Affordable Health Choices Act and it was not controversial
until Republican leaders like Sarah Palin, Michele Bachmann, and Chuck
Grassley targeted it using McCaughey’s “death panel” phrase.

“This is not a matter of it being criticized, this part of the
provision has been singled out and used as a scare tactic,” says
Blumenauer’s communications director Erin Allweiss (Blumenauer himself
is currently visiting his daughter in the Peace Corps in Africa). “The
truth is that this would do a lot to improve quality of life at the end
of people’s lives.”

In the last six months, Blumenauer’s office received roughly 6,000
comments from constituents about health care, including a lot of heat
in recent weeks as he has defended his end-of-life policy. The
controversial clause is still in the House’s draft of the health care
bill, but Senate leaders are threatening to strike it from their
version.

The little piece of legislation that exploded into “death panels” is
really a rather simple policy change from the status quo: to reimburse
doctors for time spent talking to patients about end-of-life care. It
would be up to the patient whether to have that conversation, which
could include discussion of nursing homes, living wills, directions on
when to pull the plug, or whether to reject artificially
life-sustaining tools such as feeding tubes and ventilators.

“People who want end-of-life care counseling have to pay out of
pocket,” explains Oregon’s Compassion & Choices Executive Director
George Eighmey, who says that doctors will keep alive any American who
does not have written orders to let them die naturally.

The end-of-life counseling included in Blumenauer’s clause does not
allow doctors to prescribe lethal doses of drugs to terminally ill
patients, as Oregon law does, but Death with Dignity Executive Director
Peg Sandeen says health care reform foes are using many of the same
tactics previously used against her movement.

“They’re against the changes in the health care system and they know
the American people are afraid of death. They’re using fear tactics to
derail the debate and they’re very effective,” she says.

Sandeen lists familiar lies that appeared in ads against
death-with-dignity laws that resurfaced in the current debate: the
government will kill your grandma, children will be forced to take
their own parents’ lives, and weaker patients will be killed to save
money.

“When President Obama came out and said, ‘That’s a lie,'” says
Sandeen, referring to death panels, “we were nodding our heads yes.” In
the past 11 years, 401 Oregonians have legally taken an overdose of
barbiturates to end their own lives. There has been not a single
incidence of coercion, says Sandeen.

The Oregon Health Plan got itself into trouble last summer when it
sent a letter to a patient denying coverage of expensive
life-prolonging medication but offering to cover the $50 cost of
barbiturates that would let her take her own life. Offering lethal
drugs to patients is illegal (the patient must bring up the idea with
doctors themselves), but the incident still confirmed the worst fears
of some death-with-dignity foes.

“It makes us very nervous to have the government involved in that
very personal and painful choice in that time of life,” says Oregon
Republican Party Communications Director Greg Leo. “Oregon has been
there, but in other parts of the country, I can see how it would be
shocking.”