Legally Easy

Q I have heard lots of rumors going around about this new plan, and I hope that the people that are going to vote on this is going to read every single page there. I have been told there is a clause in there that everyone that's Medicare age will be visited and told to decide how they wish to die. This bothers me greatly and I'd like for you to promise me that this is not in this bill.

THE PRESIDENT: You know, I guarantee you, first of all, we just don't have enough government workers to send to talk to everybody, to find out how they want to die.

I think that the only thing that may have been proposed in some of the bills -- and I actually think this is a good thing -- is that it makes it easier for people to fill out a living will.
Now, Mary, you may be familiar with the principle behind a living will, but it basically is something that my grandmother -- who, you may have heard, recently passed away -- it gave her some control ahead of time, so that she could say, for example, if she had a terminal illness, did she want extraordinary measures even if, for example, her brain waves were no longer functioning; or did she want just to be left alone. That gives her some decision-making power over the process.

The problem is right now most of us don't give direction to our family members and so when we get really badly sick, sadly enough, nobody is there to make the decisions. And then the doctor, who doesn't know what you might have preferred, they're making decisions, in consultation with your kids or your grand kids, and nobody knows what you would have preferred.

So I think the idea there is to simply make sure that a living will process is easier for people -- it doesn't require you to hire a lawyer or to take up a lot of time. But everything is going to be up to you. And if you don't want to fill out a living will, you don't have to. But it's actually a useful tool I think for a lot of families to make sure that if, heaven forbid, you contract a terminal illness, that you are somebody who is able to control this process in a dignified way that is true to your faith and true to how you think that end-of-life process should proceed.

You don't want somebody else making those decisions for you. So I actually think it's a good idea to have a living will. I'd encourage everybody to get one. I have one. Michelle has one. And we hope we don't have to use it for a long time, but I think it's something that is sensible.

But, Mary, I just want to be clear: Nobody is going to be knocking on your door; nobody is going to be telling you you've got to fill one out. And certainly nobody is going to be forcing you to make a set of decisions on end-of-life care based on some bureaucratic law in Washington.

MR. CUTHBERT: Mr. President, she mentioned, not in her question, but in her preview, that she's talking about Section 1232, the infamous page 425, which is being read as mandatory end-of-life care advice and counseling for Medicare. As I read the bill, it's saying that Medicare will, for the first time, cover consultation about end-of-life care, and that they will not pay for such a consultation more than once every five years. This is being read as saying every five years you'll be told how you can die.

THE PRESIDENT: Well, that would be kind of morbid. (Laughter.) I think that the idea in that provision, which may be in the House bill -- keep in mind that we're still having a whole series of negotiations, and if this is something that really bothers people, I suspect that members of Congress might take a second look at it. But understand what the intent is. The intent here is to simply make sure that you've got more information, and that Medicare will pay for it.

So, for example, there are some people who -- they get a terminal illness, and they decide at a certain point they want to get hospice care. But they might not know how to go about talking to a hospice, what does it mean, how does it work. And they don't want to -- we don't want them to have to pay for that out of pocket. So if Medicare is saying you have the option of consulting with somebody about hospice care, and we will reimburse it, that's putting more power, more choice in the hands of the American people, and it strikes me that that's a sensible thing to do.

Labels: advance directive, H.R. 3200, healthcare, healthcare bill, living will, reform, Section 1232