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I am not alone in this assessment. Lee Siegel in the Daily Beast points out (what he calls) "Obama's Euthanasia Mistake":
The shading in of human particulars is what makes [ACPC] so unsettling. A doctor guided by a panel of experts who have decided that some treatments are futile will, in subtle ways, advance that point of view. Cass Sunstein calls this “nudging,” which he characterizes as using various types of reinforcement techniques to “nudge” people’s behavior in one direction or another. An elderly or sick person would be especially vulnerable to the sophisticated nudging of an authority figure like a doctor.
A second important point is that ACPC creates situations where financial, budgetary concerns are directly placed side-by-side with end-of-life decisions. Mr. Obama has frequently chided the insurance companies for denying expensive services to the newly-sick, but how much more will the government be tempted to deny expensive services to the sick-and-dying? What makes government different, especially when it has been self-tasked as being cost-effective?
Charles Lane writing in the Washington Post states a similar concern:
Section 1233 ... addresses compassionate goals in disconcerting proximity to fiscal ones. Supporters protest that they're just trying to facilitate choice -- even if patients opt for expensive life-prolonging care. I think they protest too much: If it's all about obviating suffering, emotional or physical, what's it doing in a measure to "bend the curve" on health-care costs?
... Ideally, the delicate decisions about how to manage life's end would be made in a setting that is neutral in both appearance and fact. Yes, it's good to have a doctor's perspective. But Section 1233 goes beyond facilitating doctor input to preferring it. Indeed, the measure would have an interested party -- the government -- recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations. You don't have to be a right-wing wacko to question that approach.
Because ACPC does represent a significant expansion of government into end-of-life issues, it's also useful to gauge the ideological background and practical framework of those who are pushing the legislation. On this count, it's not off-topic to include some rather alarming comments Obama has made about his view on these end-of-life cost issues:
President Barack Obama said his grandmother’s hip-replacement surgery during the final weeks of her life made him wonder whether expensive procedures for the terminally ill reflect a “sustainable model” for health care.
... Obama said “you just get into some very difficult moral issues” when considering whether “to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill.
... “That’s where I think you just get into some very difficult moral issues,” he said in the April 14 interview. “The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health- care bill out here.”
Finding ethically-responsible solutions to these "difficult moral issues" is not assisted by focusing on the financial bottom line. And yet it becomes quite clear why the democratic framers of this legislation, in an effort to be cost-efficient, have included such a mechanism as that proposed by ACPC. After all, shouldn't this "potential 80 percent of total health care [costs]" portion of the population be reminded about their ... options?
Recent clarifications from the administration and Mr. Obama have not provided any great reassurance. The basic problem still exists - the administration wants to cut costs, but seniors represent the majority of these costs. And in the ACPC the government appears to be trying to find a way to remind seniors how they can choose to be more cost-efficient. Attempts to mollify those who are concerned about ACPC remain unsatisfying. For instance, Mr. Obama's claim (at a recent town hall meeting in New Hamphsire) that a republican originally proposed ACPC has been shown to be misleading at best.
And so, when Mr. Obama claims there will be no "death panels" in the health care legislation, that does not answer all the questions about ACPC that ought to be addressed before the bill moves forward.
One answer we should ask ourselves in the meantime, is how comfortable we would be with the idea of our aged loved ones being asked to undertake such counseling sessions as outlined by ACPC at the minimum of every five years, as well as whenever they experience a dramatic change in their health.
update: the Senate Finance Committee has opted to drop this problematic end-of-life counseling, but it remains in other permutations of the bill, including the House version.