C-TAC Hosts DC Conference

The C-TAC website. (No link; they don’t need the additional traffic.)

Last Friday’s March for Life was a reminder that many Americans understand a fact that is lost to those inside the Beltway:  that protection of human life, grounded in Judeo-Christian principles, has been the foundation of American civil society for over two centuries.  By way of contrast, tomorrow an organization called C-TAC, run by right-to-die activists, will begin a two-day conference uniting pragmatic ethicists, political progressives, consumerists and crony capitalists at, appropriately, the National Academies of Science.

C-TAC (the Coalition to Transform Advanced Care) was founded by social marketer Bill Novelli; death-with-dignity activist Myra Christopher of the Center for Practical Bioethics (CPB; formerly known as Midwest Bioethics Center); and former Evan Bayh adviser Tom Koutsoumpas, now at ML Strategies.  The American Bar Association, while not a coalition member, had a hand in development of C-TAC through Charles Sabatino, who is director of ABA’s Commission on Law and Aging.

C-TAC co-founder Myra Christopher of the Center for Practical Bioethics

Bill Novelli is former AARP president, and is also a co-founder of the huge public relations firm Porter Novelli – the firm that made the news last year when it won a $20 million contract from HHS to promote Obamacare. (Porter Novelli handles C-TAC’s press releases.)

Myra Christopher’s claim to fame is that she helped attorney William Colby argue for the death of Nancy Cruzan, and later advised Senators Danforth and Moynihan in crafting the Patient Self-Determination Act.

As Partnership for Caring transitioned to Last Acts Partnership, Tom Koutsoumpas moved to Chairman and Rev. Jeremiah Wright was added to the board of directors. (Website has been removed; this is the web page as it appeared archived in 2005. IRS Form 990 confirms they were both on the board.)

Tom Koutsoumpas was on the board of Partnership for Caring, and appeared on the website as chairman in 2004 as the organization transitioned to Last Acts Partnership and added Rev. Jeremiah Wright to the board.  (Partnership for Caring had been known as Choice in Dying in the late 1990s; before that, it was known as the Society for the Right to Die.)

All of these founding members happen to have been key players in the 1990s death-and-dying project called Last Acts – a Robert Wood Johnson Foundation project that collaborated with George Soros’s Open Society Institute, until Not Dead Yet raised protests, and funding was cut shortly thereafter.   In fact, C-TAC bears a striking resemblance to Last Acts.

Two years ago a two-day celebration of “the Legacy of Nancy Cruzan” brought together a number of people who would go on to launch C-TAC

C-TAC operated “largely under the radar” for about a year (as reported by one liberal blogger in-the-know).  By September 2011 their strategic plan included “SWAT Teams” to “respond to questions from the media as well as any attacks”  It is not clear whether this was in preparation for a specific “attack,” or whether they were just paranoid in general.  The worry about “questions from the media” was clearly a ruse, because Christopher has a long history of using the media to foist her propaganda on the public.  In 2000, for example, she and Partnership for Caring collaborated with Bill Moyers on a public television series, by which they were able to generate news stories, magazine articles, photo ops with members of Congress, and establish a community organizing network.  They can always count on newspapers to carry their message.  Susan Tolle –  developer of POLST, a major contributor to Oregon’s guidebook to the Death with Dignity Act, and a board member on one of Christopher’s projects – boasted in a CPB publication:

“Our use of data with the news media often precedes efforts to bring about change in other settings. . . .  If data have not been presented effectively to a wider audience, we are unlikely to be of tremendous influence to legislative bodies. . . . There is no doubt that The Oregonian has made a huge difference.”

What is C-TAC’s objective?  According to Diana Mason, WBAI radio host and president of the American Academy of Nursing, “C-TAC was formed to reframe the discussion” in response to what she termed “fear-mongering” and “’death panel’ rhetoric.”  Blogging at Disruptive Women in Health Care, Mason reported that C-TAC was ready to “take back the conversations with the public about choices in dying.”

One page from C-TAC’s Strategic Plan, complete with “SWAT Teams.”
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“Choices in dying” is one part of the agenda, but C-TAC’s objective is much broader.  For one, they plan on “changing the health care delivery structure.” They are working with the new Center for Medicare & Medicaid Innovation (CMMI) at HHS; one of their board members just won $13 million in taxpayer money from CMMI to test a new intervention.

C-TAC likes to talk a lot about honoring a person’s values, but clearly they are in the business of shaping the public’s values and behaviors.  One of the stated goals in their Strategic Plan is (emphasis added)

“Improve the social, policy and health system environment and norms for quality advanced illness care.”

To accomplish that goal, C-TAC plans to

 1. Coordinate public engagement, policy advocacy, clinical model development, and provider education/support to optimize timing, sequence, and priorities to achieve greatest impact.

2. Utilize mass and social media and policy channels to create positive change in normative and expected behaviors regarding advanced illness”

[emphasis added]

Putting aside their lack of a solid definition for the term “advanced illness,” the problem here is that C-TAC clearly intends to impose its own values on the public in terms of defining “quality,” “positive change” and “normative and expected behaviors.”  This is a little troubling coming from an organization whose founders can’t even get it right when it comes to what “ordinary care” means (hint:  nutrition and hydration).

Get the picture? A C-TAC presentation showing that frail, elderly patients are a “cost to society.”
[click to enlarge]
Nor do the C-TAC founders understand the meaning of the word “person.”  According to their definition, a person ceases to be a person when he or she loses cognitive capability – as a number of them would argue in the cases of Nancy Cruzan, Hugh Finn, Robert Wendland, Terri Schiavo, and countless others.  So it is not surprising to learn that two years ago a two-day celebration of “the Legacy of Nancy Cruzan” served both as a reunion for old Partnership for Caring alumni, and a convening of agents who would go on to launch C-TAC.

It would be nice if these bioethicists, statists, and crony capitalists would not use taxpayer dollars to impose their values and agenda on the public, but to obtain government funding is one of their objectives.  And of course, if all goes as planned, with the government money will come regulations and guidelines that will further operationalize their “better-off-dead” values and pragmatic ethics.  Let’s hope they fail.

Emanuel: New “independent entity” would save federal dollars by convincing patients to forgo treatments

In an article just published in the New England Journal of Medicine, former Obama adviser Ezekiel Emanuel (infamous for his “complete lives system”) and Emily Oshima Lee of the Center for American Progress have an idea on how to cut costs:  “share” in patients’ decisions to request expensive treatments by providing patients with “certified” decision aids.  Lee and Emanuel write:

Section 3506 of the ACA aims to facilitate shared decision making. Primarily, it funds an independent entity that would develop consensus-based standards and certify patient decision aids for use by federal health programs and other interested parties.

Not surprisingly, “shared decision making” (as opposed to ordinary decision making), is proven to cut costs:

In 2008, the Lewin Group estimated that implementing shared decision making for just 11 procedures would yield more than $9 billion in savings nationally over 10 years.

The authors suggest that HHS can bypass Congress in making the tools mandatory:

For approaches that provide savings or improve quality of care, implementation can be mandated throughout Medicare without additional legislation.

Lee and Emanuel do not offer specific examples of patient decision aids, but one that comes to mind is a video tool that made news in 2009.  Researchers affiliated with Harvard Medical School, Massachusetts General, and Boston University created a video of a woman with advanced dementia who could not talk or eat.  After viewing the video, almost all dementia patients (96%) declined life-saving treatment, while in the control group (decision-making without the video) only 86% chose to forgo life-saving measures. (Read about the study: Video Images of Advanced Dementia Help Patients Plan Care.  The study and video are online:  Volandes, Angelo E et al.Video Decision Support Tool for Advance Care Planning in Dementia: Randomised Controlled Trial.” BMJ 2009;338:b2159)

Don’t worry; CMS can get started even without the independent entity in place.  International guidelines are available:

The Department of Health and Human Services could quickly launch pilot programs for shared decision making while it works to standardize and certify decision aids. The International Patient Decision Aid Standards Collaboration has developed evidence-based guidelines for certification indicating that decision aids should include questions to help patients clarify their values and understand how those values affect their decisions . . .

The Center for American Progress urges immediate action.