End of life planning--the Blumenaurer way

By Paul A. Byrne, M.D.

Rep. Earl Blumenauer (D. Oregon) has a strong agenda to encourage early death for United States citizens. Oregon was the first state to legalized physician-assisted suicide. This happened November 8, 1994, by the narrow margin of 51% to 49%. Washington State became the second state in 2008. Montana has been added through a Supreme Court ruling.

Medicare is funded by working United States citizens who made it clear through their voice and votes on November 2, 2010 that they do not want to pay for end-of-life counseling or encouragement. But now the government has regulated that they do not care what the people want. This is evident in the fact that just 3 weeks after the November 2 voting, Medicare regulation was printed Monday November 29, 2010 as Federal Register/Vol. 75, No. 228, which changes definitions of "First annual wellness visit" and "Subsequent annual wellness visit" by adding "a new element (vii)" to the final regulation text that would read as follows: "Voluntary advance care planning as that term is defined in this section upon agreement with the individual."

Given that the government requires hospitals to make certain policies and do certain things to receive payment should be a red flag for any United States citizens that any Advance Directive may be interpretated in any way by any doctor who makes any determination which is his opinion. All they need and want is a signed Advance Directive.

"Choices, Living Well at the End of Life" Advance Directives Packet Fourth Edition made for Ohio citizens are provided "as a public service by the Ohio Hospice & Palliative Care Organization with the cooperation of the Ohio State Medical Association, the Ohio Hospital Association and the Ohio Osteopathic Association."

The two conditions that determine when authority is given to doctors to end life in the aforementioned packet are defined as follows:

"Permanently unconscious state means as irreversible condition in which I am permanently unaware of myself and my surroundings. My physician and one other physician must examine me and agree that the total loss of higher brain function has left me unable to feel pain or suffering."

"Terminal condition or terminal illness means an irreversible, incurable and untreatable condition cause by disease, illness or injury. My physician and one other physician will have examined me and believe that I cannot recover and that death is likely to occur within a relatively short time if I do not receive life-sustaining treatment."

Any citizen before filling out any Advance Directive should understand that sedation drugs would need to be removed for a time to determine any irreversible condition, but will they be? They also need to understand that pain medications may be given in such a way that hastens or causes the death as "Comfort care means any measure taken to diminish pain or discomfort, but not to postpone death."

"While we are very happy with the result, we won't be shouting it from the rooftops because we aren't out of the woods yet," Mr. Blumenauer's office said in an e-mail in early November to people working with him on the issue. "This regulation could be modified or reversed, especially if Republican leaders try to use this small provision to perpetuate the 'death panel' myth."

It took a month before this sneaky Medicare regulation maneuver was printed in the New York Times. In fact newspapers printed the New York Times Health-Care Reform article on December 26, 2010. The article was titled "End-of-life planning to be part of Medicare, Regulation to take effect Jan. 1."

Death panels are real and already exist in hospitals where determinations are made for "imminent death." Medicare regulation requires hospitals to refer these patients to Organ Procurement Organizations (OPO). Under the HIPAA statute this can be done without informing the patient or relatives. Hospitals and OPOs together agree to criteria for a written policy that defines "imminent death" in their hospital. The OPO needs to take organs from patients "upon" death not after death and Advance Directives include "Anatomical Gift" section but conveniently neglects to inform patients that organs used for transplantation must be healthy. Healthy organs can be removed only from the living, not after true death. Advance Directives will allow patients to be processed more quickly through end-of-life planning.

Advance Directives found in United States that define terminal condition or terminal illness can be easily compared to the "euthanasia decree" written on Adolf Hitler's personal stationary and dated 1 September 1939:

Reich Leader Bouhler and Dr. Brandt are charged with the responsibility for expanding the authority of physicians, to be designated by name, to the end that patients considered incurable according to the best available human judgment of their state of health, can be granted a mercy death. www.chninternational.com/why guidelines for euthanasia wi.htm#DUTCH%20GUIDELINES%20FOR%20EUTHANASIA%AO

The mercy deaths started as the killing of "all children under three years of age" in whom serious hereditary diseases were suspected. "The reports were assessed by a panel of medical experts, of whom three were required to give their approval before a child could be killed." Soon older children and adults were killed. Various methods of deception were used to gain consent — particularly in Catholic areas, where parents were generally uncooperative. Parents were told that their children were being sent to "Special Sections" for children where they would receive improved care. The children were sent to centers for "assessment," killed by lethal injection, and their deaths falsely recorded as "pneumonia." Of course this euthanasia process was just the beginning of the horrors which later included removing limbs from the joint of living persons that were then transplanted onto soldiers.

Dr. Leo Alexander, a medical consultant at the Doctors' Trial (Nuremberg), wrote in the New England Journal of Medicine in 1949 a warning to the American medical profession:

Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted and finally all non-Germans. But it is important to realize that the infinitely small wedge-in lever from which that entire trend of mind received its impetus was the attitude toward the nonrehabilitable sick.

"Nonrehabilitable sick!" Aren't these the ones who "need" an advance directive? Rep. Earl Blumenauer should explain what he means concerning end-of-life planning to be part of Medicare as being "a step in the right direction."

© Paul A. Byrne, M.D.