You’re welcome to your opinion but not to your own facts. HHS does not set standards of care arbitrarily. It has to be based on a summary of relevant research. Any and every body in the world of medicine has an opportunity to perform and submit sound scientific studies. If people of good moral character choose not to become active in research, then that is their failing, not the government’s.
All doctors counsel people about thousands of things everyday and they do it without a teleprompter. Without a sound medicolegal grounding, anyone practicing medicine is taking a foolish risk as there is hardly an area of medicine not impacted or regulated by the law in some way.
As for “paint by the numbers” medicine, as you call it - I have a healthy respect for it.
Medicine is an art as well as a science. Any physician worth the gunpowder it would take to blow his nose will tell you that. Painting by the numbers might be mathematically precise, but it isn’t art by a long, long way.
I evidently didn’t express myself very well, and perhaps it’s impossible to do it very well in this context. But “evidence based medicine” is mechanistic, and intended to be mechanistic. If you talk to physicians very much (and I do, and with some of the best) you won’t find much admiration for it among those who really are the best. I could tell you stories about that, but it’s not truly germane, because that’s not the point anyway.
The point in bringing that up was to demonstrate that, indeed, there are very formulary and mechanistic methods of medical practice, and the present tendency of governments at every level is to require that. It cannot be prudently assumed that these annual, mostly well person “end of life” counseling sessions will be any less formulary and mechanistic than other formulary and mechanistic methods of practice and, indeed, the VA experience mentioned by me and others above, is as good a demonstration as one could ask for that a mechanistic and government-determined formulary thing is exactly what the government is going to require. And it will require that physicians (more likely contract NPs nurses and “counselors”) document that they did it “right”; that is, according to formula.
Understanding how suggestible many people are, and particularly elderly people, and further understanding that people of every sort will be taking them through it, emphasizing whatever they, themselves, think is most worth emphasizing, and with no legal advice whatever, the question is whether this is something the government ought to be pushing for everybody, sick or well. The very fact that, when it looked like Congress was going to authorize this as part of Obamacare, the Hemlock Society geared itself up to be an outsource for this “counseling function”. Why does one suppose it did?
Most definitely, an oncologist, for instance, is going to say to a terminal patient “Well, chemical X worked for awhile, but the subpleural edema is returning with a vengeance and it does appear there are inoperable metastases to your liver. Now, maybe with Taxol, we can beat it back, but it will make you terribly sick and one of its side effects is precisely to do further damage to the liver. Do you want to try it, understanding that if we do it, we can’t honestly predict much more than three or four more months of life beyond what you can expect if we do nothing, and further understanding that we can do quite a bit to increase your comfort level even if that’s all we do?”
“Doctor, what will it be like at the end?” “It’s not always the same, but most of the time…”
Nobody needs Obama’s “end of life counseling” for doctors to do that. They already do. What they are not now paid to do, and what this will encourage them to do is to present “end of life” choices (and no doubt advance directives) to people who are not ill at all. The oncologist above can present exact knowledge and exact choices to a patient. The doctor presenting “end of life” choices to a well patient cannot, other than in generalities or rejections so proximate to simple curative measures that nobody should opt for them at all.
And if, indeed, the patient signs an advance directive then and there, it will go into his/her chart, which, we are assured, can soon be electronically transferred anywhere.
And some believe that the government headed by a man who opposed saving the lives of infants born of late term abortions and cited the potential lack of cost effectiveness in doing a hip replacement on his own grandmother, and a department headed by a woman who supported a provider of late term abortions, has some beneficent motivation in this. In my mind, the government has no business doing this at all, and most definitely not the present one.
For my part personally, I don’t intend to have well person “end of life counseling” whenever I become “eligible” for it. I am not interested in when the government thinks my life should end by my own direction or my own hand. I have a “Catholic” living will, lawyer reviewed and not something put out by the state. So perhaps I shouldn’t care. And it won’t go into any medical chart unless my own wife or children produce it for that purpose, and after discussing it with a priest, as I have directed.
But I do care that a bunch of elderly people are going to think, as do some on here, that “oh, that’s a wonderful thing for the government to do…and for free”, then to get the same kind of thing that the government produced for the VA, and by someone as insoucient toward life as some of my fellow seminar presenters and audience members were (though certainly not all). This government can and will do whatever it has the power to do. But that doesn’t mean I have to approve of it. And I don’t.
