Debunking Death Panels: End of Life Counseling

An Editorial on the Health Care Debate

August 31, 2009

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By Glen R. Finney, MD, AAN.com Advocacy Editor

There has been much discussion about provisions in the House Tri-Committee Bill on Health Care Reform (HR 3200). Concern has been raised about potential "death panels" in the bill. These concerns seem to stem from Section 1233 – Advance Care Planning Consultation.

As currently drafted, this section requires reimbursement for physicians to give information about end of life situations and resources, state and national rules about such, and to note the patient's wishes in end of life situations. The counseling is voluntary. There is no directive as to what should be counseled. In fact, there is a limit on how often such counseling can be reimbursed; no more than once every five years (unless the patient's health deteriorates).

End-of-life counseling in an informational, non-directed manner is consonant with AAN positions and guidelines. It is better to discuss patient wishes in such matters while they are still healthy and able to speak for themselves directly. As a practicing neurologist, my experience with end of life counseling is that there is a wide spectrum of feelings on how much people want done in any given scenario, and thus it is important to have these discussions with patients before they may lack the ability to speak for themselves, and before families are placed in such a difficult situation as trying to guess what their loved one would want in such trying circumstances.

Since this section of HR 3200 simply reaffirms what is already being done in clinical practice by adding reimbursement, the potential for this leading to a "death panel" is extremely low, and the potential for improving patient autonomy, informed consent to treatment, and quality of care for patients and families is high.

Author Disclosure

Within the past year Dr. Finney received research support from Novartis, for work conduced as a Site Principal Investigator for a study of the Exelon patch in Alzheimer's disease participants. He serves as Associate Editor for Advocacy on AAN.com.