A federal proposal focusing on health care counseling for end-of-life decision making needs further additions, including strong exclusions of assisted suicide, representatives of the U.S. bishops have said. The Department of Health and Human Services’ proposed rule to reimburse Medicare providers for advance care planning counseling sessions has several deficiencies, according to the U.S. bishops’ Office of the General Counsel. The proposed rule would incorporate end-of-life decisions and advanced care planning into Medicare. The U.S. bishops’ Office of the General Counsel’s Sept. 4 letter to the HHS’ Centers for Medicare & Medicaid Services stressed the need for “concern for the well-being and freedom of patients” as well as concern for consistency with existing rules and laws. The letter did not object in principle to the HHS proposal, but said several parts of the proposal deserve more attention. The letter recommended that the final rules should not promote advanced care planning that relies only on pre-packaged documents that could be biased towards withdrawal of treatment. Rather, the rules should stress “the full range” of advanced care planning, including planning that relies on discussion and collaboration among family members. The rules should caution patients about the need to read any document carefully before signing it, and should also inform patients of additional resources from their religious denomination or other sources of moral guidance, the counsel urged. The bishops’ counsel said the final rules should treat counseling sessions as an opportunity for suicide prevention. The HHS rules should “completely exclude counseling and documents that present lethal actions such as assisted suicide or euthanasia as treatment options.” The rules should also be committed to a standard of “equality of life” that upholds the inherent worth of persons with a disability or permanent impairment. “We hold that each human life, at every stage and in every condition, has innate dignity, and that acts or omissions directly intended to take an innocent life are never justified,” the bishops’ Office of General Counsel said. “We also recognize that the moral obligation to preserve one’s life has limits, particularly when the means offered for supporting life may be useless or impose burdens that are disproportionate to their benefits.” The letter said the proposed rule is unclear “whether the government’s primary goal in promoting such planning is to enhance patient autonomy or to save health care costs.” The proposed rule’s preamble is “confusing and inconsistent” in defining an advance care plan. The proposed rule does not acknowledge or reflect important statutory guidance concerning federal laws about funding restriction on assisted suicide and other provisions regarding patient self-determination. The letter cited the Church’s “long and rich tradition” on the boundaries for end-of-life decision-making.
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