Collateral Damage in the Ruckus Over Healthcare Reform


Sep 11, 2009

This commentary originally appeared on on September 11, 2009.

What can you choose when life restricts you to the narrow width of a hospital bed and your view is one of life's final horizon? None of us can choose to live forever. But we can, usually, choose how to make the most of our remaining weeks, months, or years.

Helping patients choose how to live well at the end of life lies at the heart of advance-care planning. This is when patients, doctors, and loved ones talk things over and draw up a plan to match health care services to the patient's goals. Such honest information, discussion, and choice were at the heart of the now-defunct provision in the proposed healthcare reform legislation that would have reimbursed doctors for counseling patients and their families at this crucial time. And yet, something so seemingly straightforward has still ended up at the center of a volley of political charges and countercharges, including a prominent mention in President Obama's address to Congress on Wednesday night.

One of the provision's critics, Sarah Palin, says she, not government bureaucrats, should choose what sort of medical care her developmentally delayed son might get. What parent would dispute her? Just this week Palin reiterated her opposition to advance-care planning provisions in health care reform in a Wall Street Journal commentary. But when a child is facing difficult medical treatment, Ms. Palin and virtually every other parent would need honest information about the medical alternatives and likely effects....

The remainder of this op-ed can be found at

Steven M. Asch and Karl Lorenz are researchers and physicians at the RAND Corporation. Diane Meier, recipient of a MacArthur Fellowship in 2008, is a geriatrician at the Mount Sinai School of Medicine in New York City.

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