John Boehner and Thaddeus McCotter issued a statement last week saying the provision 'may start us down a treacherous path toward government-encouraged euthanasia.' Will proposal promote euthanasia?

Sean Hannity believes it. So does House Minority Leader John Boehner. Talk show host Fred Thompson calls it “the dirty little secret” of the health care reform debate.

The focus of their ire is a provision tucked deep inside the House bill that would provide Medicare coverage for an end-of-life consultation once every five years. If a person falls ill with a life-threatening disease, more frequent sessions would be allowed.


Republicans are now using this language as a wedge between senior citizens and Democrats. Boehner and Republican Policy Committee Chairman Thaddeus McCotter (R-Mich.) issued a statement last week saying it “may start us down a treacherous path toward government-encouraged euthanasia” — even though the concept behind the provision has been embodied in federal law since 1990 and has been promoted by Republicans and Democrats for years.

The House Republican leadership statement capped days of chatter on talk radio and in the blogosphere — serving notice to AARP, Democratic lawmakers and other supporters of the health care reform bill that an under-the-radar distortion, in their view, was building steam.

“Can you imagine the response of the American people when they find this out?” Thompson said of the provision during an interview July 16 with Betsy McCaughey, a former New York lieutenant governor and conservative health expert who first wrote about it. She is also behind some of the most scathing — and irresponsible, critics say — assessments of the health reform efforts of President Barack Obama and President Bill Clinton and then-first lady Hillary Clinton in 1993-94.

On Thompson’s radio show, as well as in a New York Post op-ed and other interviews during the past week, McCaughey has said the provision requires senior citizens to submit to end-of-life consultations. Rush Limbaugh and Sean Hannity touted the New York Post article on their shows. “Congress would make it mandatory, absolutely require, that every five years, people in Medicare have a required counseling session that will tell them how to end their life sooner,” McCaughey said to Thompson.

“The bill expressly says if you get sick somewhere in that five-year period, you have to go through that session again — all to do what is in society’s best interest or your family’s best interest and cut your life short. These are such sacred issues of life and death. Government should have nothing to do with it.”

But proponents of the end-of-life care measure say it does nothing close to what McCaughey, Thompson, Boehner and others assert.

The provision would require Medicare to cover advanced care consultations for the first time, but it does not mandate individuals to take advantage of the benefit, proponents say. The consultations would take place between the patient and a doctor or nurse practitioner, not a government bureaucrat. And there would be no requirement for the individual to sign a directive or living will at the end of the discussion.

“This measure would not only help people make the best decisions for themselves but also better ensure that their wishes are followed,” AARP Executive Vice President John Rother said in a statement. “To suggest otherwise is a gross, and even cruel, distortion — especially for any family that has been forced to make the difficult decisions on care for loved ones approaching the end of their lives.”

Jon Keyserling, vice president for public policy and counsel at the National Hospice and Palliative Care Organization, said: “I was surprised that any responsible legislative analyst would indicate this is a mandatory provision. That is just a misreading of the language and, certainly, of the intent.”

Asked to respond to the criticism of her statements, McCaughey told POLITICO she stands by her interpretation that the consultations are mandatory.

“In so many words, it is — because although it is presented in the bill as a Medicare service, when a doctor or a nurse approaches an elderly person who is in poor health, facing a decline in health, and raises these issues, it is not offering a service. It is pressuring them,” McCaughey said Monday. “I would not want that to occur when I am not at my parents’ bedside.”

The provision states that as part of an advanced care consultation, an individual and practitioner shall have a consultation that includes “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.”

The government has long encouraged medical providers to discuss such life and death issues with patients. Congress passed the Patient Self-Determination Act in 1990, requiring health care agencies, including hospitals and long-term care facilities to give patients information on state laws regarding advance directives such as a living will. It also requires those agencies to ask whether patients have an advance directive and to follow what they stipulate, according to the American Cancer Society.

In 2003, under the Bush administration, the Agency for Healthcare Research and Quality issued a 20-page report outlining a five-part process for physicians to discuss end-of-life care with their patients.

Rep. Earl Blumenauer (D-Ore.) teamed up with Rep. Charles Boustany (R-La.), a physician, to introduce a stand-alone bill this year that is replicated in the House health reform bill. Sen. John Rockefeller (D-W.Va.) worked with Sen. Susan Collins (R-Maine) on similar language in the Senate, Keyserling said.

Blumenauer went to the House floor Friday to challenge Boehner’s statement that the provision “could create a slippery slope for a more permissive environment for euthanasia, mercy-killing and physician-assisted suicide, because it does not clearly exclude counseling about the supposed benefits of killing oneself.”

“I cannot tell you how disappointed I was to see this type of reaction to a carefully crafted piece of legislation we have been working on for more than six months that is bipartisan and that speaks to the needs of American families,” Blumenauer said. “The American public, especially our senior citizens, deserve our best efforts to meet their needs — not treat them like political footballs.”

Rick Curtsinger, a Boustany spokesman, said the congressman supports the measure he co-sponsored but he now believes it should include language stating that taxpayer money would not be used to counsel patients on physician-assisted suicide.

But Keyserling said such a stipulation may not be necessary.

“I can’t imagine that you need a prohibition on conversations about assisted suicide when it is not allowed or is illegal in 48 states,” Keyserling said.

In addition to Oregon and Washington, the Montana Supreme Court is reviewing a lower court ruling from December that said physician-assisted suicide is a right protected under the state constitution.

An earlier version of this story misidentified the person who issued the statement with John Boehner critical of the end-of-life consultation provision. It was Republican Policy Committee Chairman Thaddeus McCotter (R-Mich.).