Distinction without a difference? Guidance from the NCBC

Last month the National Catholic Bioethics Center posted an article that was meant to guide Catholic clinicians on what to do when a patient or proxy or government requests treatment that the clinician considers to be morally wrong [“Transfer of Care vs. Referral: A Crucial Moral Distinction”]

The subject is important and timely, and I looked forward to reading the piece, but unfortunately it misses the mark when it comes to issues where withholding/withdrawing treatment and palliative care would be involved. Continue reading “Distinction without a difference? Guidance from the NCBC”

Progressives lobby for end-of-life funding “to change health care delivery”

On July 23 a new pro-Obamacare coalition called the Patient Quality of Life Coalition (PQLC) lobbied on Capitol Hill for “two bills to change health care delivery.”

The bills (H.R. 1339 / S. 641; and H.R. 1666) would authorize (to start) roughly $300 million for advertising to the public, training navigators, educating health professionals, establishing a national supervisory board, and promoting research, all with the goal of replacing standard care with palliative care (symptom treatment and hospice) for sick people, in lieu of costly life-saving treatments.

Dick Woodruff -- former chief of staff to Rosa DeLauro; former legislative advisor for Alliance for Justice -- gives the PQLC lobbyists some final instructions.
Dick Woodruff — former chief of staff to Rosa DeLauro; former legislative advisor for Alliance for Justice — gives the PQLC lobbyists some final instructions.

Veteran lobbyist Dick Woodruff explained why the urgency:  “Because these people who have these illnesses . . . are the ones who are driving healthcare costs more than anybody else . .  if we can figure out a way to manage their care, we can make life better for them, but then save the system money. . . .  [These bills] could have major returns over the next 25-45 years.” [my emphasis]

Woodruff, who served as chief of staff for Rosa DeLauro (of EMILY’s List fame), and later as senior Continue reading “Progressives lobby for end-of-life funding “to change health care delivery””

Obama Administration Cuts Deal with Big Insurance (and others)

I smell quid pro quo.

Two events occurred on May 21.

The Los Angeles Times reported the fact that the Obama administration (aka, Big Government) has cut a deal with AHIP (Big Insurance). (hat tip Matt Drudge, who picked up the story.)

In exchange for holding down premium increases next year, the administration has promised the insurance industry a bailout worth billions of taxpayer dollars if the insurance companies lose money in the process.  The bailout is hidden in regulations that were issued a little over a week ago. Continue reading “Obama Administration Cuts Deal with Big Insurance (and others)”

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.”
[click image to enlarge]
“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.

POLST in Care Transitions

The so-called Physician Orders for Life-Sustaining Treatment (POLST) Paradigm is in the news because the Catholic bishops of Wisconsin have issued a warning against the use of POLST.

List of seven popular “interventions” for care transitions,; POLST is one of the interventions. (Slide is from a presentation on “Interact”, from the Health & Human Services Administration on Aging website. [click image to enlarge])
POLST and other advance directives play an important role in the Community-Based Care Transitions Program (CCTP) and Partnership for Patients discussed in a previous post here at Belbury Review.

In order to reduce hospitalizations within a community, participants in the care transitions demonstration projects generally use one of a handful of “intervention” programs. A few of those interventions appear on a useful diagram that is posted at the Administration on Aging website (see illustration at right).  Though the slide was part of a presentation on “Interact” — just one of the interventions  — it presents a good summary of some of the others. POLST is one of those interventions.

CFMC — the National Care Transitions QIO Support Center — is promoting POLST.  One of the tools they offer on their website is a flyer for POLST that was created by the QIO for Pennsylvania, Quality Insights of Pennsylvania.  Quality Insights is actually a program out of the West Virginia Medical Institute.  West Virginia was one of the first states to actively promote POLST, so it is not surprising that Quality Insights is promoting POLST.

A poster advertising POLST was created by the QIO of Pennsylvania and is offered by CFMC as a sample tool for care transitions projects across the country.

While some of the care transitions interventions focus on pressuring patients and families to be responsible for proper medication, symptom identification, doctors’ appointments and so forth, a number of the interventions focus on end-of-life decisions, DNRs, and advance care planning.  This is particularly true of interventions involving patients in nursing homes who are frail and might request another trip to the emergency room.

For example, the tool from Interact on “Tips for Starting and Conducting the Conversation” suggests framing the issue of CPR in the negative context:

 “Sometimes when peoples’ hearts stop, doctors and nurses try to delay
the dying process … Have you considered whether you would want this or not?”

The rest of the discussion contains carefully chosen “facts” to discourage life-saving measures; facts such as:

The possibility of surviving CPR in a nursing home is very low, and CPR
often results in broken ribs and the need for a respirator (“breathing machine”) in
an intensive care unit.

The Interact tool also discusses “Artificial Hydration/Nutrition” and the supposed dangers of feeding tubes.

These are but a few examples of POLST and end-of-life discussions prompted by the “care transitions” project.

Erik Fromme, MD, is a hospitalist at Oregon Health & Science University who specializes in palliative medicine and is frequent co-author with POLST’s developers.  In early 2011 he articulated how POLST and palliative medicine would take a role in “care transitions.”  In an article titled “Transitions in End-of-Life Care:  the Oregon Trail,” Fromme remarked that “transitions” is a malleable term; useful because it can take on a variety of meanings suitable to meet a number of objectives:

Transitions is a broad term that can refer to moving from one care setting to the next, changing goals of care, changing both care setting and goals (as happens with the transition to hospice care), or even death.

Fromme concludes:

Strong palliative care teams, statewide outreach and education, and programs like POLST allow hospitals and healthcare systems to support patients, families, and clinicians in the inner work of letting go.

Not all of the care transitions interventions focus on “letting go,” but coaching patients and families in end-of-life decisions is a key feature in many contexts.