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Monday, August 3, 2009

Recommended Article on End-of Life Counseling

A lot of concern has been expressed (correctly in my mind) about the specter and implications of end-of-life counseling by government representatives hoping to save money.

Check out this article by Wesley J. Smith (h/t Pundit and Pundette) regarding the issue. It's a short piece and be sure to check out the comments especially the first one. Here's a sample from the article, but I highly recommend people to read the whole thing.

"The Medicare 'mandatory counseling' controversy in the Obamacare debate laid bare a realistic fear that compensated counseling under Medicare could easily become subtle (or not so subtle) persuasion to refuse treatment–particularly since the primary point of the clause is to cut costs.

"Here is an example of why I believe that the fear is realistic. The Center for Practical Bioethics has published a 'Caring Conversations' workbook, in which intimate issues and details of life, death, and end of life options are raised. Nothing wrong with that, in and of itself, of course. It all depends on how it is done."

The problem with counseling sessions is that they almost always end up being persuasion sessions. For the counseled, it really comes down to being a matter of trust. Does the counseled trust the persuasion to be with their best interests in mind? A person generally trusts their family doctor to be looking out for their best interests , or at least they should, (as in if they don't then they need to find another doctor that they do trust). However, when counselors, trained to be appear trustworthy, armed with cleverly written and persuasive workbooks, enter with the full weight of federal authority behind them... Well, you get the picture, and it's not pretty.

Yes, of course it is true that private insurers are driven to make money. However, they are subject to various market forces (such as consumer choice) and regulations that the federal government is completely immune to. When saving money becomes the primary goal, as is already the case in this boondoggle bill, when "social justice" (as in determining the public's money might be better served spent elsewhere or spent on a more politically expedient demographic) enters into the picture, we have the foundation of making of a charged and chaotic disaster out of a solid health care system in need of simple renovation.

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