We write today in opposition to the Palliative Care and Hospice Education Training Act, S. 693 and the companion bill, H.R. 1676, passed by the House and now before the Senate HELP Committee.
The Association of American Physicians and Surgeons (AAPS) is a national organization representing physicians in all specialties, founded in 1943. Our motto, omnia pro aegroto, means “all for the patient.”
While there is a place for hospice care, it is improper to dedicate $100 million in additional taxpayer dollars to persuade patients to forgo treatment that might prolong life. To the contrary, Congress should consider rolling back existing policies that perpetuate a culture of hastening death at the expense of increasing patient access to life-saving or potentially curative treatment.
For example: Medicare payment arrangements, like Accountable Care Organizations, “have a strong incentive to adopt advance care planning for long-term success,” explains a prominent health industry consulting firm. Participants in Medicare’s “Patient Centered Medical Homes” are also required to maintain advance directives.
In addition, in 2016 Medicare began paying physicians (and “non-physician practitioners”) for “end-of-life counseling.” Medicare paid out $43 million in 2016 and $70 million in 2017, to convince seniors to forgo treatment that might prolong life. Further subsidies would be inimical to the best interests of patients.
Another problematic aspect of H.R. 1676 / S. 693 is that it appears to support increased intervention in the patient-physician relationship by outsiders whose interests might not be aligned with a goal of prioritizing patient care. Furthermore, “palliative” care should not be a whole separate specialty. All physicians should be skilled in relieving symptoms in all patients, not just dying ones, and provisions in this bill would exacerbate fragmentation that is harmful to patient care.
We also summarily object to “retraining” physicians to violate the Hippocratic tradition of “do no harm.” Such a policy is indefensible on its face. No taxpayer dollars should be allocated for this unsound purpose.
Instead of passing this harmful legislation, we encourage Congress to seek solutions that will truly empower patients and their families, in consultation with physicians of their choosing, to control decisions about appropriate care without interference from politicians or policymakers in Washington, DC, or others who should not be intervening in the patient-physician relationship.
Thank you for this opportunity to communicate our concerns. Please vote “no” on S. 693 or H.R. 1676.
Jane M. Orient, MD – AAPS Executive Director
PDF of letter available at: https://goo.gl/eRHtEW