I am writing this article in response to remarks made at the podium in the U.S. House of Representatives in opposition to H.R. 3200 (AKA: America's Affordable Health Choices Act of 2009) by Rep. Virginia Foxx (R-NC) The video of the final remark made by Rep. Foxx can be found on Youtube. The following quote of Rep. Foxx's remark is for the reader who would rather not go to Youtube to view the clip for themselves. She touts a GOP plan over H.R.3200 and says the GOP plan is better because the GOP plan...
...is pro-life because it will not put seniors in a position of being put to death by their government.
The emphasis is mine.
According to a report on the MyFox8 website, a local TV station that serves the Greensboro, High Point and Winston-Salem area of North Carolina, Rep. Foxx explained that her reason for making this comment is her opposition to a provision in the bill that funds counseling for end of life issues.
Please understand that "Advanced Directives" are instructions the patient, or the representative the patient has chosen to make such decisions, physicians and other health care providers. Advance Directives are not mandates issued by the government, the doctor, the state, or the medical facility. Advance directives are the marching orders that the patient issues to the medical team. The provision [Sec. 1233. Advance Care Planning Consultation] currently reads as follows, emphasis is mine:
- Subject to paragraphs (3) and (4), the term `advance care planning consultation' means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:
- (A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
- (B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
- (C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
- (D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).
- (E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.
- (i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include--
- (I) the reasons why the development of such an order is beneficial to the individual and the individual's family and the reasons why such an order should be updated periodically as the health of the individual changes;
- (II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
- (III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).
- (ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State
- (I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and
- (II) that has in effect a program for orders for life sustaining treatment described in clause (iii).
- (iii) A program for orders for life sustaining treatment for a States described in this clause is a program that--
- (I) ensures such orders are standardized and uniquely identifiable throughout the State;
- (II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional's authority under State law) may sign orders for life sustaining treatment;
- (III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and
- (IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.
- A practitioner described in this paragraph is--
- (A) a physician (as defined in subsection (r)(1)); and
- (B) a nurse practitioner or physician's assistant who has the authority under State law to sign orders for life sustaining treatments.
- (A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).
- (B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.
- A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.
- (A) For purposes of this section, the term `order regarding life sustaining treatment' means, with respect to an individual, an actionable medical order relating to the treatment of that individual that--
- (i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional's authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;
- (ii) effectively communicates the regarding treatment, including an indication of the treatment and care desired by the individual;
- (iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and
- (iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed .
- (B) The level of treatment indicated under subparagraph (A)(ii) may range from an to an indication . 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; and
- (iv) the use of artificially administered nutrition and hydration.'.
What follows is quite a bit of legislative housekeeping items to bring some past legislation in line with the new legislation, before proceeding to additional provisions that are meaty in regard to the Advanced Care Planning Consultation benefit and providing for additional avenues for this important information to get into the hands of patients and their families:
(1) MEDICARE & YOU HANDBOOK-
- (A) IN GENERAL- Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall update the online version of the Medicare & You Handbook to include the following:
- (i) An explanation of advance care planning and advance directives, including--
- (I) living wills;
- (II) durable power of attorney;
- (III) orders of life-sustaining treatment; and
- (IV) health care proxies
- (ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including--
- (I) available State legal service organizations to assist individuals with advance care planning, including those organizations that receive funding pursuant to the Older Americans Act of 1965 (42 U.S.C. 93001 et seq.);
- (II) website links or addresses for State-specific advance directive forms; and
- (III) any additional information, as determined by the Secretary.
- (B) UPDATE OF PAPER AND SUBSEQUENT VERSIONS- The Secretary shall include the information described in subparagraph (A) in all paper and electronic versions of the Medicare & You Handbook that are published on or after the date that is 1 year after the date of the enactment of this Act.
I am a firm believer of getting information straight from the actual source documents. Rep. Foxx's gross misrepresentation of this one provision currently written into H.R.3200 perfectly illustrates the importance of going right to the text of the bill to prove or disapprove the truth of the information we are spoonfed by our own representatives.
I am not writing this article to argue the merits of this legislation. There are parts of this legislation that I do not like. I am not writing this article to argue the integrity of one party over another. Both parties have engaged in more than their fair share of dirty tricks. I am writing this article to specifically address Representative Foxx's integrity in making the remark she made. The implication she made with her remark went beyond what both parties euphemistically refer to "spin."
Foxx's remark that our elderly would be "put to death" upset me worse than anything I have ever heard come from the realm of politics. I have been working with elderly patients since I was 18 years old. I worked with the elderly as a nurse for 25 years. In all I have devoted 3 decades to caring for the elderly. Throughout my life, making claims to frighten the elderly has been a rather common, if despicable, political tactic utilized by both parties at one time or another. I can no longer even estimate the number of times one of my patients saw one of these scare tactics on TV and became very frightened or went in to a full blown panic attack for fear that their social security would be cut, or their medicare or medicaid would be lost, leaving them homeless and without any health care. The fear in their eyes caused by some politician trying to advance their party or their own campaign by frightening them.
Those elderly whose reasoning is not quite what it once was, are particularly vulnerable. The oldest generations came from an era that believed much of what they saw on the evening news was true. The oldest generations have vivid memories of a time when a Western country did embark on a mission of mass murder to eliminate a population they had deemed a "problem." Some members of the oldest generations even witnessed first hand this attempt to exterminate that population, themselves survivors of that unthinkable horror. Now imagine, if you will, this population of vulnerable elderly watching a congresswoman at the podium, on the floor of the House of Representatives clearly telling them that if this health care reform bill is passed, they will face extermination so that their health care will not burden the system. Imagine the sheer terror that Representative Foxx has inflicted on this vulnerable population - a population that does not deserve to be terrorized by their own government - for the sake of pushing a political agenda.
Nurses and other health care providers work very hard to earn the trust of their patients. Often, they have outlived their own family and we are all they have now. Imagine the damage to that relationship that Representative Foxx's disgusting remarks may have caused. Has the nurse, who had become the one person they could depend on or talk to, been assigned to administer a pill that will end their life? Will they fear reporting chest pain or shortness of breath for fear that will put them on the short list to be "put to death"? Will they fear consuming their "Meals-on-wheels" if they are still managing at home with some help?
My heart is broken for the damage this callous and gross misrepresentation may have caused. Did Foxx even consider the damage she could cause by making such as outlandish statement? Did she even care? While Representative Foxx would like to represent herself as championing the elderly, it should be noted that if a health care provider had made that remark to an elderly patient it could well lead to charges of psychological elder abuse.
I call on the GOP to denounce this terror-mongering remark that Representative Foxx made. I call on Rep. Foxx to publicly retract that remark. I call on those who have taken the time to read this article to e-mail your protests and demands for a retraction and an apology to Representative Foxx, Minority leaders John Boehner (R-OH) and Senator Mitch McConnell (R-KY) and to the RNC. In addition, if you are represented by a member of the GOP in either the Senate or the House, I encourage you to voice your feelings concerning Representative Foxx's remarks to your representatives.