I've heard a lot about "death panels" in the health-care legislation and how they will ration care for the elderly. What does the bill really say?
In reality, the U.S. House of Representatives health-reform bill that sparked the controversy says nothing about death panels or having anyone other than the patient control end-of-life decisions.
Instead, the provision in the bill that fed the rumors (Section 1233 in H.R. 3200) would permit doctors to get paid once every five years for an "advance care planning consultation." At the consultation, Medicare beneficiaries would be able to ask about living wills, health-care proxies and other steps to let their family and doctors know their wishes regarding life-sustaining treatment and how they want other medical decisions to be made if they're not able. Right now, Medicare does not provide reimbursement for these types of meetings.
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Some of the decisions you make -- like whether you want to live on life support -- could end up cutting medical costs if you opt out. But the choices you make in advance directives could help guide family members who would otherwise struggle to guess what your wishes would have been. "It's a mischaracterization to say that someone else makes the decisions for you," says Christine Cassel, M.D., president of the American Board of Internal Medicine. "Actually, it's the opposite: It's about you making your own decisions and the people who take care of you knowing what they are."
Under the legislation, the meeting would not be required and you wouldn't need to take any action on the topics you discuss -- and you would be able to change your mind about your decisions.
No matter what happens with this provision of the health-reform bill, it's a good idea to talk with your doctor about such issues, to understand all your medical options. Then have an attorney draft a living will and a durable power of attorney for health care, which are the legal documents that make your wishes known.
A living will provides instructions about the types of medical treatment you do and do not want to receive. Because you can't prepare in advance for all contingencies, it's also important to have a durable power of attorney for health care (health-care proxy), which appoints a family member or another person you trust to make medical decisions on your behalf if you are incapacitated and incapable of making those decisions. You'll need to talk with that person ahead of time about your wishes and follow up with a conversation every few years.
Look for an attorney through the National Academy of Elder Law Attorneys, and learn more about advance directives at www.nolo.com (see the "wills, trusts and estate planning" section).
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