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The Boston Globe

Senators Eliminate End-of-Life Provision

Foon Rhee

Republican Sen. Charles Grassley speaks to voters during a town hall meeting, Wednesday, Aug. 12, 2009 in Adel, Iowa. (AP Photo/Steve Pope)

A plan to provide hospice counseling and other end-of-life advice to
patients and their families is being dropped by US Senate health care
negotiators after critics charged that it would lead to the formation
of federal “death panels,’’ a key GOP senator said yesterday.

The theory that encouraging doctors to discuss such sensitive topics
would lead to euthanasia of the elderly was among the more inflammatory
accusations floated against the health care overhaul in the last week,
leading President Obama to complain in New Hampshire this week about
“wild’’ misconceptions about the proposals. Among the leading
proponents of the “death panels’’ criticism was former Alaska governor
Sarah Palin.

The original sponsor of the provision and a variety of specialists
all debunked the allegation and said end-of-life counseling can help
families deal with difficult choices. Nonetheless, Senator Chuck
Grassley, the Senate Finance Committee’s top Republican and one of six
committee members trying to hash out a bipartisan bill, said yesterday
that the provision could be misinterpreted and that it will not be
contained in the committee’s proposed legislation.

The language is still in the House legislation, which would permit
Medicare to pay doctors for voluntary counseling sessions on
end-of-life issues, including living wills, making a close relative or
friend a health care proxy, hospice care, and information about
medications for chronic pain.

Under the proposal - supported by the American Medical Association
and the National Hospice and Palliative Care Organization - counseling
sessions would be covered by insurance every five years, and more
frequently for the seriously ill.

The episode illustrates the intense passions in the health care
debate. The phrase “death panels’’ proved to be a volatile buzzword,
and it quickly caught on in talk radio, cable television, and at town
hall meetings conducted by members of Congress on summer recess.

The provision was turned into a “horrific, totalitarian
institution,’’ and deleting it should help ease the way for the health
care overhaul, said Ross Baker, a political scientist at Rutgers

“It’s too tough to try to explain,’’ he said. “It’s better to just
ditch it. At this point, they’re trying to get rid of anything with the
least ability to frighten people. The message now is reassurance and a
very light government hand.’’

Palin, the 2008 Republican vice presidential nominee, called the
end-of-life counseling provision “downright evil,’’ contending that
federal bureaucrats would decide whether ailing seniors or children
with Down syndrome - like her son Trig, born last year - should receive

In a town hall meeting Tuesday in Portsmouth, N.H., President Obama
tackled the issue head-on, saying he wanted to “clear the air’’ on a
rumor that the House somehow “voted for death panels that will
basically pull the plug on grandma because we’ve decided it’s too
expensive to let her live anymore.’’ That view, the president said,
came from a misreading of the legislation.

But in a Facebook posting late Wednesday night, Palin refused to
back down. She argued that under the legislation, the elderly and ill
could be coerced into accepting minimal care to reduce costs.

“With all due respect, it’s misleading for the president to describe
this section as an entirely voluntary provision that simply increases
the information offered to Medicare recipients,’’ she wrote. “It’s all
just more evidence that the Democratic legislative proposals will lead
to health care rationing.’’

White House spokesman Robert Gibbs said yesterday that death panels are the biggest misconception about the overhaul.

“It does us no good to incite fear in people by saying that there’s
these end-of-life provisions, these death panels,’’ he said. “Quite
honestly, I’m so offended at that terminology because it absolutely
isn’t in the bill.’’

As part of the White House counteroffensive, senior adviser David
Axelrod included the claim among eight “common myths’’ about the health
care overhaul in an e-mail to Obama supporters.

“It’s a malicious myth that reform would encourage or even require
euthanasia for seniors. For seniors who want to consult with their
family and physicians about end-of life decisions, reform will help to
cover these voluntary, private consultations for those who want help
with these personal and difficult family decisions,’’ Axelrod wrote.

Democrats have criticized Grassley for what they see as adding to
the firestorm when he assailed the end-of-life provision himself during
a town hall meeting Wednesday in Iowa.

“You have every right to fear’’ it, he said. “There are some people
who think it is a terrible problem that grandma is laying in a bed with
tubes in her . . . and that the government should intervene. I think
that’s a family or religious thing that needs to be dealt with.’’

Yesterday, Grassley criticized the House bill, saying there was a
difference between a “simple education campaign, as some advocates
want,’’ and paying “physicians to advise patients about end-of-life
care’’ and rating doctors “based on the creation of and adherence to
orders for end-of-life care.’’

“We dropped end-of-life provisions from consideration entirely
because of the way they could be misinterpreted and implemented
incorrectly,’’ Grassley said. “Maybe others can defend a bill like the
[House] bill that leaves major issues open to interpretation, but I

However, other Republicans, including Senators Lisa Murkowski of
Alaska and Johnny Isakson of Georgia - who sponsored similar
legislation - have said Palin’s claim was hurting the party’s attempts
to influence the bill.

Portions of the Democratic health care bills “are bad enough that we
don’t need to be making things up,’’ Murkowski said, repeating a phrase
Palin used last month when announcing her resignation as Alaska’s
governor, when she asked the news media to “quit making things up.’’

Isakson said it was “nuts’’ to claim the bill encourages euthanasia.

Representative Earl Blumenauer, an Oregon Democrat who wrote the
provision in the House bill, called references to death panels or
euthanasia “mind-numbing’’ because the bill would block funds for
counseling that presents suicide or assisted suicide as an option.

“It’s a blatant lie, and everybody who has checked it agrees,’’ he said.

Material from The Associated Press was used in this report.

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