5 Things You Should Know About Palliative Care

On Saturday, May 17, 2014, I had the pleasure of speaking at a conference in Wooster, Ohio.  The conference, titled “The Healthcare Trojan Horse,” was sponsored by the Pro-life Healthcare Alliance and Wayne/Homes Right to Life.  Following is the presentation as it was written; the actual talk was abbreviated due to time constraints. —Ione Whitlock

The promise of hospice palliative care was that it would provide comfort to the dying, ease symptoms, and help grieving loved ones.  Modern palliative care promises to be Continue reading

Ethics Professor Zeke Emanuel on “Who is to Blame?”

Ezekiel Emanuel — an architect of Obamacare as well as ethics professor  — had a tough time Friday answering Megyn Kelly’s question as to whether Obama intentionally lied to the public.  The video is about 9 minutes, but watch to the end, where he complains that he didn’t have enough time to answer the question.

Electronic Health Records: Guiding Physicians Toward So-Called “Best Practices”

In March I posted “Palliative Care Wants Electronic Health Records to Collect More Data (and re-direct patients into palliative care).

Here is more evidence. Continue reading

Palliative Care Wants Electronic Health Records to Collect More Data (and re-direct patients into palliative care)

Here’s a bit of irony.

The Obama administration called for comments prior to launching the third phase of its plan to push everyone into electronic health records (EHRs).  The AMA and other medical societies responded with requests to postpone implementation.  CHIME (College of Healthcare Information Management Executives) warned:

We strongly caution policy makers not to expect that health professionals will be willing and able to capture significant amounts of structured data—unreasonable expectations in this regard are not only likely to compromise patient care (by unduly interfering with physician-patient interactions) but also lead to an anti-EHR response by the physician community.


It was a different story when it came to comments from the hospice and palliative care associations.  They rather liked the course the administration is taking.  In fact, they recommended that electronic records should collect even more data about patients and their families than was contained in the original plan.

Yes, these are the same hospice and palliative care professionals who are always moaning about the “technological imperative.”

Palliative care (i.e., the National Coalition for Hospice and Palliative Care (NCHPC))  submitted comments in January.  You can read the letter here.  (See also comments blogged by Joanne Lynn.)  NCHPC recommended that electronic health records collect data for research; compel patients to make decisions on future treatments; and automatically flag patients who are candidates for symptom treatment in lieu of more expensive and unnecessary aggressive curative treatments.

In one section, NCHPC suggests that the controversial POLST form might be used as a model to collect data, to coax “health systems who are not so forward-thinking.”  They write (emphasis is theirs):

Goals of care can and should be captured as structured data so that future measures can be developed related to goals of care that will not require laborious chart abstraction … To help imagine what this might look like, we cite the below example from an eMOLST1 form. MOLST forms [a version of POLST] are only appropriate for those very ill individuals with very poor prognoses, but [below is] illustrative of what is possible for goals of care generally. Indeed, forward-thinking health systems are … developing EHRs that can record goals of care. The meaningful use program should include objectives for health systems who are not so forward-thinking in leveraging EHRs in this way.

Generally speaking, advance care planning aids work in a two-step process.  Start by assessing the patient’s “values and beliefs” – i.e., how wretched is your quality of life now; how wretched will it be?  Are you now, or will you ever be, a burden to loved ones?  (multiple choice, the better to pigeon-hole patients):

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The next step is to set goals.  NCHPC’s sample:

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So it appears that organized palliative care is in favor of the Technological Imperative when it aids and abets the Quality-of-Life Imperative.

Here is my question:  How often will we be subjected to these types of questions, and from whom?

A quick note on the people who signed the NCHPC letter speaking on behalf of the world of palliative care:   Three of the four signatories are Timothy Quill, Diane Meier, and Sean Morrison.  “Tim” Quill (as he is known by his friends in the palliative care world) is infamous for helping a patient to commit suicide, and then writing about it.  Meier, Quill and Morrison later co-authored a controversial study of (illegal) physician-assisted suicide practices.  Shortly thereafter Meier had second thoughts about advocating the legalization of physician-assisted suicide. Coaxing patients out of life-saving treatment on the basis of the quality of life imperative might be another matter.

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.”
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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.