Umm … no, and yes.
I was answering a question, viz:
Sorry if it wasn’t clear.
Well, the bill says nothing about signature or consent. And it does say that the order can be used to
So I read it that any intervention can be withheld without the patients signature.
How are you reading it otherwise? What am I missing here?
intention keeps ignoring basic contract law.
If I do not sign something there is no meeting of the minds. You van have 20 doctors sign I want the plug pulled. Without my signature I doubt there is a court in the land that would say having the plug pulled was my wish as there is zero evidence of that.
Say hello to massive wrongful death lawsuit. Maybe even manslaughter charges.
No doctor will abide by a DNR unless the legality of it is crystal clear to everyone.
Perhaps calling it a “contract” is not applicable. I still think a statement of my wishes perforce requires my signature or there is no way to say with certainty what my wishes actually are/were.
Whack-a-mole, as DSeid has shown, in some jurisdictions a DNR does not need to be signed by the patient … it’s still valid, though. Perhaps rather than accusing me of ignoring something, you could explain to all of us how that works?
I think (and I’m not a lawyer) that it is not a contract in any sense, and cannot be, as there is no “quid pro quo”. Perhaps some lawyer will come along and fight my ignorance. Until then, please dial back on the accusation that I’m ignoring things.
This is exactly my point about what the Deathers are on about, because the Bill clearly states that the statement of your wishes does not require your signature. Now you and I might laugh that off, but someone who is very suspicious of the government will read something very different into that … and reasonably so.
I am responding just to the OP without having read the rest of the thread, but the problem here is that everybody’s a liar.
The Republicans–or the Deathers–are saying this means it’s a death panel and the doctor will counsel the patient and tell the patient it’s time to die.
No.
The Democrats, when they backed off of this, said it wasn’t anything of the kind, it was merely a way to pay the doctor for the voluntary counseling session.
Not exactly true, either.
The problem, and it was a real one, was that patients were executing advance directives as part of their estate planning that addressed such subjects as Do Not Resuscitate orders, how long they’d accept being on a ventilator, what level of sustenance they would require such as nutrition, hydration, etc., and for how long. And then when they were in extremis in a nursing home, they would be rushed to a hospital emergency room and none of these orders carrying out the wishes they made while sound in mind and body were followed.
Of course, another problem is that part of these advance directives includes a medical power of attorney. So the patient could have a DNR order, but if the patient was unconscious, the person with the MPOA could override it.
For instance my mother had a DNR order and had stated that she didn’t want to be fed through a tube, ever, and didn’t wish her life prolonged by being on a ventilator longer than 48 hours. So she was in a nursing home, and when she stopped breathing the nursing home called my aunt and said, “Should we send her to the ER?” And my aunt said yes, so they sent her to the ER and got her breathing again. Three times over a period of a few months.
So the counseling session addresses these things, and is intended to address them in such a way that the doctor and patient are very clear about the patient’s wishes.
But it wasn’t written to be voluntary. Basically it said the physician would initiate this conversation every five years or when there was a substantial change in the patient’s health. It did provide for the patient to say s/he didn’t want to talk about it, but that was an opt-out. The default was to give the counseling.
A great many patients give a lot of weight to conversations like this which are initiated by their doctors. The doctor is a person of authority to many.
That’s why it seems to be that the Democrats are being disingenuous when they say it’s voluntary, and the Republicans are being paranoid when they say it’s a death panel.
BUT, to get back to the OP’s question, the “order” in question is the order issued by the patient. The medical professional signs it in order to reassure the patient that their request, whatever it may be–DNR, etc.–is in the system and that they know about it. It is not an order initiated by the doctor, although it’s easy to see how somebody could read it that way, especially as “doctor’s orders” is kind of a catchphrase.
ETA: and anyway, they say they’re taking it out.
If you mean his link in post #28 go read it. Most of the “verbal” stuff in there is about a doctor being able to verbally tell nurses and such to not resuscitate. There is language in there allowing a parent to give verbal consent for a child which must be witnessed by two others including a doctor and documented. It also states all that stuff does not supplant advance directives so it is not even really the same thing as what the Deathers are on about.
Looks to me all the “verbal” jazz in there is in the absence of an advance directive what do people do when faced with such decisions.
As for the “contract” part I agree it does not meet the criteria for a contract in the legal sense. Nevertheless it is a statement of a person’s wishes. How in hell could a doctor/hospital say it was the patient’s wishes to have the plug pulled when there is no signature from the patient? How can they stand before the judge and say, “See! Our doctor signed a piece of paper that says the patient wanted that!” I am betting no court would accept that. Imagine a world where someone else can sign stuff saying you wanted “X” and then enforce it.
No way. Would be a mess.
Jeebus…:rolleyes:
The bill is all about what the government is willing to pay for.
A doctor signing a thing that says, “I counseled intention about a medical advance directive. Pay me!” is what it is all about. This bill is NOT a medical directive from the government telling doctors how they can pull the plug.
Hilarity, thank you for one of the more interesting posts in the thread.
I like your thought that the “order” is* issued by the patient. *You may be correct. However, some things argue against that.
First is the language. I’ve never heard of a patient’s individual end-of-life directive being referred to as an “order”.
Second is what the order is supposed to cover. Is the patient supposed to say what will happen if they are “apneic”? Most won’t even know what apneic means … which would make it hard for them to issue an “order” about it. They could consult with someone who does know, but they can’t issue an order saying “no paxurbanitol for me”.
But in the end, the most convincing thing to me is that, while the Doctor has to sign it, the patient does not. How can it be the patient’s order when they don’t have to sign it, but the doctor does?
The key point for me in what you have said is, “it’s easy to see how somebody could read it that way” … but our response as Democrats has been 180° from your response. Instead of saying “gosh, you misread it, it’s easy to see how that could happen, let’s fix it”, our response has been “Sarah Palin is an idiot, only a total moron could read it that way” …
And now, as you say, “they” are taking it out … but the “they”, the ones who are taking it out, are the Republicans. So “they” get the credit for fixing it, and the Democrats get painted as doubly uncaring:
• uncaring because the clause as they understand it strips them of power over their own health when they are at their most vulnerable, the end of life, and
• doubly uncaring because we didn’t care that people were interpreting it wrong, we just taunted them as “Deathers”, brushed them off, and insulted them for their stupidity.
Like I said, very, very bad tactics. Our foolish handling of this issue may have lost us the entire battle.
Whack-a-Mole, please don’t give me campaign slogans. We don’t know what this bill “is all about”. We can’t even decide what Section One Thousand Three Hundred and Twenty Two is all about. It is a thousand pages long. It gives some powers to some people. It removes some powers from others. It makes some things illegal, and others legal. It proposes new bureaucracies and ends others. It is hugely complex.
Trying to turn it into a sound-bite about “here’s what the bill means” is a mug’s game. Just regarding the current section under discussion, the medical order will have the force of law, it will allow someone to pull the plug on someone else. If you think that is just about who gets paid, you’ve never had to deal with that situation. I have. I would not wish it on you or anyone. This bill in all its complexity is about who will make a host of medical decisions, from who gets access to scarce medical resources, to who gets a new liver, to how much drugs will cost seniors, to who gets their plug pulled. Anyone claiming that the bill is just about what the government will pay for is not following the story.
The Do Not Resuscitate order, for instance. By definition an order.
Yes; it’s a complex issue. Some of the ones I’ve seen cover whether the patient would like nutrition, hydration, pain relief, ventilation, and a host of other things. Next would be the duration of the treatment. Maybe you’d like to be on the ventilator for no more than 48 hours and if you didn’t improve to the point where you could breathe on your own (and most people don’t, after 48 hours, but there’s always a chance), the ventilator will be disconnected. The doctor would need to sit down and counsel the patient on what “apneic” means and what the treatments would entail–that’s why there’s actually a need for this kind of counseling session. There are people who want to be informed. There are others who just don’t want to think about it.
I think at the hospital where I worked the patient had to sign it, or if physically unable to sign it, have it signed by proxy. The idea is to get your wishes in writing while you are still of sound enough mind and body that you CAN sign it.
The thing is, if your lawyer adds this in when you’re making your will, how do you convey your wishes to your health-care providers? It’s both a medical and a legal issue.
While in general I think Palin is an idiot, and her death panel quote was way off base, I think she’s nailed all the objections to this bill here and done so in a coherent and even fair manner.
This is one of many places in that 1000±page document where interpretation will be crucial.
Yes; very bad tactics. The Democrats could have handled this a lot better. There are a lot of problems in the bill. There are conflicts in that bill, and tentacles that reach into many existing codifications (such as the Internal Revenue Code of 1986, various Medicare enactments, Health Care Finance Act) that make it extremely hard to figure out exactly WHAT some of the provisions will entail. The bill creates a new committee or panel or study group every few pages, and all of these new entities will have their own interpretations, very likely self-perpetuating ones. Just what we need, several more layers of bureaucracy.
But government is never going to give us anything simple and smooth.
What are you on about?
Advance Directives have been a part of health care for decades. The government has pushed them, with bipartisan support, for 20 years. Your directive says whatever it is you want to say. Want it to say, “Do everything humanly possible to save me not matter what!” then it can say that. Want it to say, “No paxurbanitol for me.” then say that. Whatever you want you can put in there.
The difference here is to date these have largely been done with lawyers and/or family input. The government, in an impressive display of common sense, is suggesting such discussions are best done with your doctor. Further, when it is done with your attorney/family where is the document? What if you get in an accident while on vacation? Having it with the doctors allows for easier sharing wherever you may be and see that YOUR wishes are carried out.
Finally, rather than you paying an attorney the government will foot the bill if you talk to your doctor. IF you want to.
The horror!
The bill before Congress is about FUNDING! Who pays for this stuff. It is NOT about telling doctors what they can get away with. It is about telling doctors how they get paid if they spend their time counseling patients.
Sarah Palin is an idiot. Seriously. It is not even a debate anymore.
And yeah, only a total moron could read it that way.
Why? Well, republicans have been fanning the flames of this but guess who supported this stuff in the past? Republicans! (Bipartisan actually because it makes sense and is frankly an obvious and smart thing to do.)
How the hell are you supposed to respond to it?
I am sorry there are people out there so stunningly stupid as to fall for this. The people who deserve mockery are the pols who fan these flames. They know damn well it is complete, partisan bullshit truly of the highest order. See the cite above. They fucking voted in favor of this stuff in the past.
Dems/liberals at first laughed this off and did not think much of it. Who would buy into this bullshit? Amazingly people did. There have been many, many, many news reports pointing out it is absurd and not true. Yet these Deathers buy it.
How do you suggest we go about convincing them? Pointing to the text hasn’t worked. Dozens, maybe hundreds of articles calling it bullshit hasn’t worked. The dittoheads/Palindrones flat out REFUSE any, and I do mean ANY, information that says otherwise.
If you are in a bar having a drink and meet a Flat Earther (pretending) and he insists the earth is flat you may try to convince him otherwise. After 30 minutes, no matter what you say, he continues to insist the earth is flat. What do you do from there? You have tried reason. You have tried logic. You have pointed to facts and the person flatly (no pun intended) refuses anything you say and insists the earth is flat.
Willing to bet you leave and assume the person is a fucking moron.
WTF? Campaign slogans?
The Bill is about new ways to fund health care. Are you paying attention at all?
It is about what the government will be willing to pay for in lieu of private insurance if you want it. They are hashing out an insurance policy.
Now, inasmuch as the government may not be willing to pay for “X” procedure you may say they are making a decision for you. They are not. They are saying they will not pay for it. If you can pay for it otherwise knock yourself out and enjoy your new liver.
Insurance companies do exactly that right now. All the time.
To the OP it is not the government telling doctors to pull the plug on grandma. It is the government telling doctors they will be reimbursed for their time if they talk to grandma about end-of-life directives once every five years.
Can you really not see the difference?
Yes, I’m paying attention to the Bill. Paying attention to you, not so much. You keep issuing sound bites and campaign slogans like “The Bill is about new ways to fund health care”, as though that was all that was covered in a thousand page bill … riiiight.
The Bill is about new ways to fund health care as you say … but you keep ignoring that that’s only one single issue among a host of issues it addresses. Please read some more about the bill, your claim that it is only about who pays is nonsense. As Hilarity says above, “The bill creates a new committee or panel or study group every few pages, and all of these new entities will have their own interpretations, very likely self-perpetuating ones.” It sets up a “Health Choices Commissioner”. It sets up a “Public Health Insurance Option”. It sets up a “Health Insurance Exchange”.
If you think all of those committees and panels will only decide how health care is funded, you are not paying attention at all.
Finally, you seem to think I oppose the Bill. Nothing could be further from the truth. I have changes I’d like to see, but it’s at least got a shot at being better than the current system. My concern in raising the OP was that we’ve shot ourselves in the foot over the “Death Panel” issue. Yes, Sarah Palin is an idiot … but in this issue, we’ve been even dumber, and it may have cost us the whole bill.
Once again, there is no current Federal law that mandates patient signatures; there are state laws that either are extant or are not and will stay so whether this provision exists or not.
The death panel lie (not “misunderstanding” - lie) is that there is some plan for panels of doctors to ration care and to decide who gets care and who does not. There is no misinterpreting of the op’s quoted provision into that.
Whack-a-Mole is exactly correct. This provision does one small thing: it creates a consultation code for the work involved in formulating these order sets with a patient that implement a patients expressed wishes so that health care providers can be paid for that work. Individual state laws regarding end of life care still apply and are not nullified or superseded.
As to this:
Is it your impression that doctors always get patients to sign papers saying that they do not want, oh say a bypass operation that the doctor offered as one treatment option and instead opted for a nonsurgical approach? Or do you think that doctors sometimes instead document the conversation in the chart? Doctors’ careful documentation of conversations and patient expressions of understanding and the patient choices made in a timely manner is indeed “accepted” by most courts and is often more important than a form signed that a patient (or their representatives) can claim was signed but not read or read but not understood. In a lawsuit that doctor’s careful documentation of the conversation and of patient expressions of understanding and of their wishes will mean more than the signed form. This isn’t contract law.
Geez…
The point is the bill is not a medical directive. It lays the foundation for a health insurance plan provided by the government. What they will and will not pay for. How it will be administered. What systems they will setup to assess current and future things they will cover (e.g. perhaps a given drug has some promise but at $1 million per pill they will not pay for it…this is done today by private insurance companies).
It is a massive thing to set up so yeah, there is a lot in there.
But it is not, repeat not a list of medical directives.
Honestly…fuck them.
Shot ourselves in the foot?
Go with my Flat Earther example above. If you meet someone dead-set on “the Earth is flat” and no amount of logic/reason/FACTS will sway them what would you do? If you left and I said, “Dude, you shot yourself in the foot with that guy, you could have handled it better” you’d think I was nuts.
Perhaps a more apt analogy is the Birthers. Literally wave fact after fact under their nose, indisputable facts, and they ignore all of it.
These people are the same.
At this point you write them off. They have sidelined themselves. Yeah they will yell a lot but there is noting else to be done. They do not want compromise. They do not want honest debate. They want to stop health reform at any cost.
Why should they have a seat at the table? They have proven there complete recalcitrance and contempt. There is NO winning them over.
So tell them to kiss our ass and we will try to get something done. Maybe we will fail but not because we didn’t play nice with these assholes since all they want is failure anyway.
This is not the same thing at all.
At question are advanced directives. Telling doctors what you want done ahead of a time when you cannot speak for yourself.
In the absence of such directives the hospital’s default is to do everything possible to save you. Today however medical science can keep you technically alive but in a fashion many people would rather not live in (see Terry Schiavo). It is here where your advance directive comes into play.
Barring such an extreme your doctor is fine talking to you about a bypass surgery that you refuse and noting it in your medical record.
DSeid, you say:
Medical care is a scarce resource. Under any system, somebody decides who gets care and who doesn’t. Currently, this is done primarily by insurance companies. But going to a single payer system will not mean that suddenly we will have a surplus of MRIs, or replacement hips, or livers to transplant. Somebody has to decide, under any conceivable system, who gets scarce resources. There aren’t enough livers to go around. Somebody will get one, and somebody won’t.
So contrary to your pollyanna view, the plan does propose ways to allocate scarce medical resources. We can’t give a new liver to everyone who wants one. The question is not whether that choice will happen. It is who will do the choosing, the insurance companies, or the doctors.
Me, I vote for the doctors … but for you to claim that there will be no rationing under the plan is nonsense unless you have a secret stash of livers you’ve been holding for this time in history.
Next, if there is no Federal law saying that I have to sign an order to pull my plug, then shame on us. That is an egregious oversight. I have blithely assumed my whole life that a doctor would need at least that to pull my plug, heck, I needed a signed note to get out of school, and I would think this is a bit more important.
And I suspect that most Americans believe that they can’t have their plugs pulled unless they sign a piece of paper saying so. So when somebody says “Hey, here’s the new bill, and it clearly says that a doctor can pull the plug without you signing anything”, I can understand it if people are fearful.
You seem to think that all those seniors out there are either lying or stupid when they say they are worried about that. I say they are reasonably fearful, and our response should be to reassure them, not tell them they are lying morons.
You sure that you’re a doctor? Do you talk to your patients like you address me? Do you pull the plug on people without a signed piece of paper? Do you understand why people might legitimately be afraid of a bill that says that a doctor can issue a DNR for them without their signature? Do you routinely demonize the patients you disagree with?
Sure, there are people out there pushing this as an agenda. But they would be ineffective if there were not a whole host of people out there very concerned about this issue.
Heck, I’m concerned about it. I’m an intelligent man, I voted for Obama, I’m a liberal, I’ve traveled and worked and lived all around the planet, I’ve written scientific papers, I’ve read the bill section very carefully, and I think it authorizes a Doc to issue a DNR order without my signature. Now I could very well be wrong, that’s happened more than once … but by god I’m not a liar, and for you to call me a liar is a very … very … well, let me bring my blood pressure down and call it a very un-Hippocratic thing for you to say. I’ll thank you to retract it.
Dude, you claim to be all of these things, but for 58 posts people have been telling you that you are wrong in your interpretation, they have shown you the language and the state(s) laws applicable, explained that state laws will not be trumped or changed by the bill, and yet you are still arguing that you are right.
How are you any different from the shrill shills we see at town halls now? What will sway you? What will convince you that your reading of the bill was wrong? Is there anything that will convince you?