Betsy McCaughey Should Probably Never Be Believed Again

[This post is a little off-topic for this blog, but I can't help myself. I have no other outlet.]

Although she did not use the words "death panels" (a term that was introduced by Sarah Palin), the whole ruckus over the allegation that the health care overhaul would encourage euthanasia of seniors was started by Betsy McCaughey. She is a former lieutenant governor of New York and gained national attention when she helped to sink the Clinton health care plan.

As already mentioned, her latest appearance on the national scene came from saying the following on former Senator Fred Thompson's radio show.

And one of the most shocking things I found in this bill, and there were many, is on Page 425, where the Congress would make it mandatory -- absolutely require -- that every five years, people in Medicare have a required counseling session that will tell them how to end their life sooner, how to decline nutrition, how to decline being hydrated, how to go in to hospice care. And by the way, the bill expressly says that if you get sick somewhere in that five-year period -- if you get a cancer diagnosis, for example -- you have to go through that session again. All to do what's in society's best interest or your family's best interest and cut your life short. These are such sacred issues of life and death. Government should have nothing to do with this.

I don't think I need to elaborate on how that claim has played out in the national discussion. It's an absurd claim that has consumed an inordinate amount of attention and scared a lot of people.

This week, McCaughey appeared on The Daily Show to explain herself--and she did not back down. You can read some analysis of the interview, as well as watch it in its entirety (which I have), here. At the end of the interview, McCaughey invoked her Ph.D. and experience reading legislation to bolster her authority on this issue. Either she or I have problems with reading comprehension.

There are problems from the very beginning. In part 1 starting at 1:43, she says regarding advance care planning consultations,

"The government prescribes what must be covered in detail, including foregoing nutrition, hydration, and even antibiotics. . . . But it does prescribe that the medical professional shall, not may, shall--must include all these issues."

Oh really? Well let's have a look at that. The text of the House bill is available here (pdf). The outline format of the bill is a little tough to follow; if you want to see it laid out in a more visually friendly fashion, see here.

OK, page 425 and 426 lay out what elements an advance care planning consultation covered by Medicare "shall" include. The elements are spelled out in paragraphs A-F. It's pretty straightforward stuff--what a living will and power of attorney is, what kind of resources are available for helping patients make decisions, the continuum of end-of-life services, the advantages of planning ahead, and so forth. No mention of foregoing nutrition or hydration, although of course they would fall within the continuum of end-of-life services.

Page 427 appears to be about how this section would apply to States, depending on State law. Anyway, no mention of nutrition or hydration.

Page 428 defines who can provide advance care planning consultation, states that an initial physical examination does not count as a consultation, and gives the circumstances under which such a consultation "may" occur more often than every five years.

Page 429 says that the advance care planning consultation can include the formulation of a "life sustaining treatment or a similar order." It then defines what elements must be included in such an order. It must (i) be signed by a physician or other approved health care provider and be in such a form that it can stay with the patient, (ii) communicate the individual's wishes for treatment, (iii) be uniquely identifiable and in a standard format, and (iv) may include advance directives.

Page 430 is where the scandal is. Remember on page 429 when it said that a life sustaining treatment order should communicate the wishes of the patient about treatment? Well page 430--referring back to page 429--suggests the kinds of things that an individual "may" include in their wishes.

‘(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items--

‘(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;

‘(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;

‘(iii) the use of antibiotics;

‘(iv) the use of artificially administered nutrition and hydration.’.

So there you go. That's it. The bill says that in expressing their treatment wishes, a person "may" include such items as where they want to be, whether they want antibiotics, and whether they want artificial nutrition and hydration.

McCaughey goes on to assert that page 432, which basically says that the government will measure "both the creation of and adherence to orders for life-sustaining treatment," means that you will be locked into your life sustaining treatment order. You see, according to her, physicians will be rated, in part, by the percentage of their patients that have treatment orders, and the percentage of those orders that are followed. It's unclear to me whether physicians would actually have a financial incentive to ensure that their patients have treatment orders, but given that its contents are decided on by the patient I don't see the big deal even if that is true--which I doubt. And would you want your doctor to ignore your wishes? I don't think so. But McCaughey envisions a bizarre scenario where lucid patients change their mind about their treatment options but physicians refuse to allow any changes because they have to report whether they followed through on the treatment order.

McCaughey has established a pattern of making false claims. Whatever one thinks of the Clinton health care plan, and whatever one thinks of the current health care plan, and whatever one thinks of McCaughey's motives, I hope we can come to a consensus on this: On matters of health care reform or interpretation of legislation, Betsy McCaughey should not be believed anymore.

[Now that I've had my turn, commenters may also vent their spleen--within reason of course.]

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