Because AFN aired the Daily Show episode with Betsy McCaughey last night (again) I have decided it's time to throw in my two cents.
McCaughey claims that, according to the bill, doctors are awarded quality points based on consultations with patients concerning living wills and whether or not patients adhere to those consultations. As she reads it, this means that a doctor's score could lower if a patient does not adhere to the wording in their living will - and this is bullshit, because it is almost impossible to quantify. I could make a living will right now and, god willing, not have to use it for another 40 or 50 years - by which time my original doctor will either be dead or no longer practicing medicine. If I decide to go against the will what can Medicare do, retroactively lower my doctor's quality rating?
Rather, the purpose of the bill is to have doctors strongly encourage their patients to make living wills because of the time, money and heartache saved in the future. Their quality points will be based on whether doctors have the conversations; if those conversations include all the required talking points; and if they follow the schedule, having a living will discussion with a patient every 5 years.
Because the bill lists what doctors must discuss, including resuscitation, sustenance, hydration, McCaughey feels - actually, I'm not exactly sure what her problem is here because she never quite details it. Somehow discussing life-sustaining procedures in detail - which is what those elements mentioned above are - gives doctors too much decision-making power in life or death situations. After all, when "most people" are healthy they are all for "pulling the plug", not wanting to exist in a vegetative state and all that, but when the time comes (if a situation occurs where their living will takes effect) they might feel differently and want to change their minds.
Of course, when the time comes the person in the coma is unable to change their mind, hence the reason for the living will. Also, who are these "most people"? Did McCaughey take a survey of people in comas to determine how they felt beforehand? Did she ask five of her colleagues? Could she possibly be making a baseless assumption?
As for the detailed language - ok, let me admit that I am a strong supporter of living wills, even more so of living trusts. After my mom's death took the family by surprise my father had a trust created. It included details, exhaustive details, about finances and medical possibilities such as in a coma but responsive, in a coma but unresponsive, and listed exactly what my father would want done in each situation. For example, if he ended up in an unresponsive state: I do not want artificial means keeping me alive. I want to be provided with food and water sufficient to keep my body performing and medicine, if necessary, to keep my free from pain, until my body naturally expires. So, no ventilators or anything like that, just let me die painlessly and with a bit of dignity. I'm sure it was worded better in the legal document, but you get the idea. Obviously "most people" don't want to imagine anything so horrible happening but the living will is there just in case it does. "Most people" probably also don't realize how many contingencies there can be. A living will, then, provides a sort of death insurance.
But for McCaughey, the living wills clause is disgusting because doctors are (according to her) penalized if patients or their families - and wait, there's the real issue: families. It's not a matter of the patient in the coma changing their mind - they can't; they're in a coma - it's the fact that families will not have any say. It's the son who can't believe his mother wouldn't want to be kept alive at all costs; the husband not wanting to let go of his comatose wife; or the parents selfishly keeping their daughter as a vegetable for 12 years because they refuse to believe she would want anything different. Of course, Terry Schiavo didn't have a living will, only the word of her husband, but even is she did it's possible her parents would have challenged a will court.
A living will allows you to choose either life or death. You can decide that you what to kept alive with all possible means and with any future medical breakthroughs; or you can decide to just peacefully expire, regardless of what others believe should happen. Pro-choice at its finest.
No wonder the fanatic right is foaming at the mouth. Nevermind that Palin and others endorsed living will consultations while they are in the local/ state spotlight - they were just looking out for their constituents. But to support anything seemingly pro-choice on a national level - a clause that allows an individual to make decisions about their bodies - now that's just disgusting.