A few conservatives are trying to make mistaken hay out of the House bill’s payment of doctors who withhold food and fluids, even though it will not pay to “promote assisted suicide” (the nuances about which I discussed here) in the end of life counseling provision (revised and made better from the original version, as I also discussed here). From the story:
Wednesday, November 11, 2009
New Study Shows Patients Approve of Pathway.
USCCB Moves to Stop Practice Legal in All 50 States: Removal from ANH.
The health-care bill that cleared the House on Saturday says federal funds cannot be used to “promote” assisted suicide, euthanasia or mercy killing. But Rep. Charles Boustany, Jr. (R-La.), who is a surgeon, says the bill does not prohibit the use of federal funds to pay health care providers who provide “end-of-life care” that involves denying food and water to a patient. “H.R. 3962 does not rule out using federal funds to reimburse health providers should they withhold nutrition or hydration,” Boustany spokesman Rick Curtsinger said. “The bill says end-of-life care planning materials may not ‘promote’ assisted suicide, but it leaves this term intentionally vague so the ban might not apply in states with ‘death with dignity’ laws.”
Sigh. Of course they don’t because they are different things. Indeed, withdrawing tube supplied food and fluids is legal in all fifty states.
Assisted suicide/euthanasia is making someone dead, usually with an overdose of drugs. Withdrawing tube-supplied food and fluids is stopping an unwanted medical intervention, with the cause of death coming from the dehydration due to the underlying medical condition. The issue of food and fluids is very important morally and ethically and anybody familiar with my work knows how adamantly I oppose forcing someone off of basic sustenance based on quality of life judgmentalism. But the issue is distinct from assisted suicide, different arguments apply, and the two should not be confused. The Congressman is making a huge mistake–both factually and from a public advocacy perspective–in confusing the two. In fact, he helps Obamacare by so doing.
Provider Refusal and The Great Exodus of Doctors.
Stupak: I Don't Say It As A Threat.
"We won because [the Democrats] need us," says Mr. Stupak. "If they are going to summarily dismiss us by taking the pen to that language, there will be hell to pay. I don't say it as a threat, but if they double-cross us, there will be 40 people who won't vote with them the next time they need us—and that could be the final version of this bill."
Planned Parenthood Statement on the Impact of Stupak-Pitts.
There has been much discussion about what the “real-life” impact of
the Stupak-Pitts amendment would be on women’s access to abortion
care. The following is an explanation of what this provision will
mean to women, if it is enacted. Essentially, the amendment violates
the underlying principle of , as articulated by
President Obama, that “no one will lose the benefits they currently
The truth is that under the Stupak-Pitts amendment, millions of women
would lose benefits that they currently have and millions more would
be prohibited from getting the kind of private sector health care
coverage that most women have today. To put a fine point on it,
millions of women would lose private coverage for abortion services
and millions more would be prohibited from buying it even with their
own money. Simply put, women’s access to private coverage for
abortion would be restricted by health care reform.
The New Health Insurance Exchange
The new health insurance exchange is intended to provide a new source
of affordable, quality coverage for the roughly 46 million and the millions more whose current coverage is unaffordable
or inadequate. The House bill is expected to cover 96 percent of all
uninsured Americans by offering subsidies for private coverage or the
choice of a public plan. Depending on their income level and the
final package approved by the Congress, individuals would receive
subsidies on a sliding scale to purchase private insurance through the
exchange. In the House-passed bill, all individuals with incomes up
to 400 percent of poverty ($88,000 for a family of four) would receive
subsidies to help purchase health insurance. However, not everyone in
the exchange would have subsidized coverage — a significant portion of
people (for instance, those currently purchasing in the individual
market and those working for small businesses) who would buy insurance
in the exchange would not receive any subsidies, also known as
The Stupak-Pitts Amendment
The Stupak-Pitts amendment prohibits any coverage of abortion in the
public option and prohibits anyone receiving a federal subsidy from
purchasing a that includes abortion. It also
prohibits private health insurance plans from offering through the
exchange a plan that includes abortion coverage to both subsidized and
unsubsidized individuals. Thus, if a plan wants to offer coverage in
the exchange to both groups of individuals, it would have to offer two
different plans: one with abortion coverage for women without
subsidies and one without abortion coverage for women with subsidies.
These private insurance plans would need to be identified as either
providing or not providing coverage for abortion. Health insurance
plans are highly unlikely to operate in this manner, and it is not
even clear that this is feasible under the administration of the
exchange and affordability credits. As one alternative, the Stupak
amendment purports to allow women to purchase a separate, single-
service “abortion rider,” but abortion riders don’t exist. In the
five states that only allow abortion coverage through a separate
rider, there is no evidence that they are available. Furthermore,
women are unlikely to think ahead to choose a plan that includes
abortion coverage, since they do not plan for . In
addition, it is not clear that health plans would even be allowed to
offer two separate plans under other provisions of the act, such as
the anti-discrimination and guaranteed-issue provisions. Those
elements of the bill, which are very important to consumers, may make
it impossible for plans to provide two separate plans, one that
includes abortion and another that does not. Realistically, the actual
effect of the Stupak-Pitts amendment is to ban abortion coverage
across the entire exchange, for women with both subsidized and
Who Would Be Covered in the Exchange
Most immediately, the exchange would offer coverage to many of the 17
million women ages 18–64 who are uninsured. It would also be a source
of coverage for the 5.7 million women who are now purchasing coverage
in the individual market. Typically, these are women who are not
receiving health coverage through an employer — they may be self-
employed, underemployed, or unemployed. Small employers (with fewer
than 100 employees) are also likely to transition their health
insurance to the exchange where they may be able to find more
affordable options. In most of these cases, women will lose abortion
coverage that they currently have — in the current private insurance
market, the majority of health insurance plans include abortion. A
self-employed graphic designer or writer, buying coverage from in the individual market, will likely have abortion
coverage. Under the health reform plan amended by Stupak, she would
purchase that same plan from Kaiser Permanente in the exchange, but it
would not include abortion coverage because it would be barred. This
ban would be in effect even if she were paying the full premium.
Similarly, a woman working for a small graphic design firm, who
currently has abortion coverage through her company’s plan, would lose
it under reform if the company decides to seek more affordable
coverage in the exchange.
Roughly 60 million women aged 18–64 get their coverage through their
employer or through their spouse’s employer. For some of these women,
nothing will change immediately. But if current trends continue in
the erosion of employer-sponsored health care, more and more women
will be getting their health care through the exchange. Women are
much more likely to be covered as dependents on their husbands’ health
insurance plans, and more and more employers are eliminating dependent
coverage as a way to cut costs. Where will these women get covered?
They will get health insurance from the exchange where abortion
coverage is prohibited.
Moreover, women are much more likely to lose employer-sponsored
insurance coverage as a result of a husband’s death or divorce. While
they will be able to purchase coverage in the exchange, their coverage
will not include abortion coverage. Moreover, the House bill opens
the door to large employers joining the exchange by giving the
commissioner the authority to allow large employers into the exchange
beginning in the third year of the enactment of . If
this proves to be true, over time, women who get coverage through
large companies would lose access to abortion coverage entirely.
The Two-Tiered Health Care System
The House-passed health care system adds a huge swath of the female
population to the “have nots” column of an already two-tiered health
care system when it comes to abortion coverage in the United States.
Prior to the passage of the House bill, our health care system was a
system in which only women who could afford to pay for abortions with
their own money or through their insurance plans would have access to
abortion. Consider the current restrictions already in place:
• low-income women on Medicaid
• federal employees, their spouses, and female dependents
• women serving in the military overseas
• women in federal prisons
• women in the District of Columbia
The House-passed bill would add to this list of women who do not have
coverage millions of women who are getting their health insurance
through the exchange. Consider just a few examples:
• working mothers in families that earn up to $88,000
• women who are self-employed and paying the entire cost of their
coverage and don’t have access to employer-sponsored coverage
• young women entering the job market for the first time who are the
least likely to have employer-sponsored coverage
• women who were insured through their husbands’ employers, but now
are divorced and have to purchase coverage on their own through the
• women who work in small businesses whose owners decide to seek more
affordable, quality coverage through the exchange
Over the last six months, we have heard much about how important it is
to reform the health care system to meet the needs of women. Women
are much more likely to be left out of the current employer-based
system because this system wasn’t designed for them — it was designed
for higher-wage, full-time earners who have dependents at home —
namely, men. Women tend to be in lower-wage or part-time jobs that
don’t offer insurance, move in and out of the workforce because of
childbearing and childrearing responsibilities, and become uninsured
because of divorce or death of a spouse. But these are the very same
women who are targeted by the Stupak-Pitts amendment. And they will
join the growing ranks of women who are denied coverage of a legal
medical procedure. It’s turning out to be a strange sisterhood: the
poor, the incarcerated, the federally employed, the stateless, the
soldier, and now the middle-class in the exchange.
USCCB Not Just Assaulting Abortion, They Have End of Life Rights in Their Sights Too.
More assaults on women's rights are coming and we would be negligent to not prepare:
1. conscience clause will probably resurface after health care reform (if not in the Senate's form of the bill). "Pro-life" groups are already organized to assert conscience clause laws in response to repro rights and end of life issues. (They don't like Stupak because it doesn't address conscience issues.)
Montana's Supreme Court is expected to uphold constitutionality of aid in dying by end of the year. Pro-life groups are working to better integrate "anti-euthanasia" efforts into their platform in preparation for the conscience clause battle. And employing resources of medical groups and orgs. to push for conscience clause.
Whatever you make of USCCBs role in Stupak-Pitts, Catholic hospitals have 1/5 of all US beds. They are emboldened to push this issue.
2. Federal funding for abortion, as contested in Stupak-Pitts may lead to "pro-life" groups addressing federal funds for hospitals (secular and Catholic currently receive 50% of budgets from medicare/medicaid) and other health care centers
3. Frances Kissling and others have called for a push by choice groups to refocus on overturn of Hyde
Working to get rid of Stupak-Pitts is essential, yet the amendment is only part of a larger effort to limit access or eliminate abortion. Looking at the personhood movement and other efforts around the country, I fear it's hook-or-crook time for emboldened "pro-life" groups.
U.S. Bishops To Vote On Revision Of Ethical Directive On Nutrition And Hydration At November Meeting
WASHINGTON—The full body of the (USCCB) will take into account the most recent Catholic teaching on care for the chronically ill and dying when they vote on a proposed revision of the Ethical and Religious Directives for Catholic Health Care Services at their November 16-19 general assembly in Baltimore . The proposed revision states more definitively the moral obligation to provide medically assisted nutrition and hydration to patients in a “.”
The revision draws from Pope John Paul II’s March 2004 Address to the Participants in the International Congress on "Life- Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas" and the Congregationfor the Doctrine of the Faith's August 2007 Responses to Certain Questions of the United States Conference of Catholic Bishops Concerning Artificial Nutrition and Hydration. The current Ethical and Religious Directives, which predate both documents,reference only the conclusions of "some state Catholic conferences, individualbishops, and the USCCB Committee on Pro-Life Activities."
“It would be useful to update the Ethical and Religious Directives by inclusion of references to these authoritative documents as well as byincorporation of some of their language and distinctions,” said Bishop William Lori of Bridgeport , Connecticut , Chairman of the U.S. bishops’ Committee on Doctrine. “It is particularly appropriate to do so since the recent clarifications by the Holy See have rendered untenable certain positions that have been defended by some Catholic ethicists.”
The current Ethical and Religious Directives for Catholic Health Care Services says, “There should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved to the patient.” Along with other changes, the proposed revision says, “As a general rule, there is an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who cannot take food orally. This obligation extends to patients in chronic conditions (e.g., the ‘ persistent vegetative state’) who can reasonably be expected to live indefinitely if given such care.”
To be adopted, the proposed revision must be approved by a majority of bishops present and voting at the November meeting. The revision has been undertaken with the collaboration of the Committee on Pro-Life Activities and in consultation with the Task Force on Health Care Issues, the , the Catholic Medical Association, the , and the National Catholic Partnership on Disability.
Persons seeking credentials to cover the meeting may find information at
www.usccb.org/comm/credentialform.pdf. Credential applications should be submitted by November 7 by fax () or mailed to:
November Meeting Credentials
When I saw Bobby Schindler speak at the PA Pro-Life Federation conference in Scranton last month he alluded to this new change by the USCCB. He also referred to his most recent article that pushes for a discontinuation of the diagnosis of PVS, saying that the tests used to make the diagnosis are not effective and often erroneous.
For months I have been urging feminist and pro-choice groups to pay attention to the increased efforts being made by Catholic and "pro-life" groups to address euthanasia. End of life rights are too being sacrificed for evangelical and Catholic ideology. Our hospital and health facility patients are vulnerable to the imposition of "pro-life" restrictions.
Watch for these groups to use the public's lack of information or understanding or general fear of end of life issues to work conscience clauses through "the back door."
Thanks to Lois Uttley at MergerWatch.org for the hat tip.
Telling McCaughey to Get Real.
Betsy McCaughey, champion of the hyperbolic 'death panel' myth, published an op-ed in the Wall Street Journal this week detailing concerns she had in the House version of the Health Care Reform Bill (aka HR 3962, aka Affordable Health Care for America Act). The one concern regarding hospice and palliative care reads as follows:Sec. 1114 (pp. 391-393) replaces physicians with physician assistants in overseeing care for hospice patients.Here is what the bill actually says:
SEC. 1114. PERMITTING PHYSICIAN ASSISTANTS TO ORDER POST-HOSPITAL EXTENDED CARE SERVICES AND TO PROVIDE FOR RECOGNITION OF ATTENDING PHYSICIAN ASSISTANTS AS ATTENDING PHYSICIANS TO SERVE HOSPICE PATIENTS.
(a) Ordering Post-hospital Extended Care Services- Section 1814(a) of the Social Security Act (42 U.S.C. 1395f(a)) is amended--
(1) in paragraph (2) in the matter preceding subparagraph (A), is amended by striking `nurse practitioner or clinical nurse specialist' and inserting `nurse practitioner, a clinical nurse specialist, or a physician assistant'.
(2) in the second sentence, by striking `or clinical nurse specialist' and inserting `clinical nurse specialist, or physician assistant'.
(b) Recognition of Attending Physician Assistants as Attending Physicians to Serve Hospice Patients-
(1) IN GENERAL- Section 1861(dd)(3)(B) of such Act (42 U.S.C. 1395x(dd)(3)(B)) is amended--
(A) by striking `or nurse' and inserting `, the nurse'; and
(B) by inserting `or the physician assistant (as defined in such subsection),' after `subsection (aa)(5)),'.
(2) CONFORMING AMENDMENT- Section 1814(a)(7)(A)(i)(I) of such Act (42 U.S.C. 1395f(a)(7)(A)(i)(I)) is amended by inserting `or a physician assistant' after `a nurse practitioner'.
(3) CONSTRUCTION- Nothing in the amendments made by this subsection shall be construed as changing the requirements of section 1842(b)(6)(C) of the Social Security Act (42 U.S.C. 1395u(b)(6)(C)) with respect to payment for services of physician assistants under part B of title XVIII of such Act.
(c) Effective Date- The amendments made by this section shall apply to items and services furnished on or after January 1, 2010.So does it 'replace' or 'allow'? I guess it is open to interpretation, but I have to agree with the letter written by Sean Morrison and Gail Cooney to the Wall Street Journal Editors.
This portion of the bill allows nurse practioners and clinical nurse specialists the same rights as physician assistants where state laws allow. With the shortage of qualified specialists in palliative care, all disciplines need to work together to provide the most comprehensive care for the most patients.