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National pro-life leaders fear health care rationing for Medicare patients


Catholic News Service

NEW ORLEANS — An Obama administration proposal to pay doctors for “advance care planning” for Medicare patients is fraught with dangers for the elderly and those facing serious illnesses, according to the National Right to Life Committee.

Congress needs to act quickly to protect those patients from making uniformed decisions about their care, Burke Balch said during the organization’s annual convention July 9-11 in New Orleans.

Balch, director of the NRLC’s Powell Center for Medical Ethics, said an Obama administration proposal to institute “advance care planning” is designed to “nudge” patients to forgo life-saving treatment and even assisted feeding by giving them “unbalanced, distorted and even inaccurate information” about their condition and the effectiveness of treatment options.

Citing a 2013 Health Affairs article titled “Decision Aids: When ‘Nudging’ Patients to Make a Particular Choice is More Ethical Than Balanced, Nondirective Content,” Balch said advance care planning is touted as a means of drastically cutting health care costs.

Balch said the NRLC favors advance medical directives, it has developed its own “Will to Live” document, and supports alternatives that “provide truly informed consent to decisions about medical treatment.”

The 2013 Health Affairs article offered advice on how doctors could persuade men with prostate cancer to agree not to undergo expensive surgery.

“If incontinence and impotence are presented as plainly stated, that is, with no detailed description of these risks, men with early stage prostate cancer may be swayed toward the option of surgery,” the article said. “If instead those possible side effects of surgery are presented vividly via personal stories, men may be swayed away from the surgery option.”

The Powell Center report, available at www.nrlc.org, cited other widely available advance care planning materials that violate the principle of informed consent by presenting unbalanced facts so that patients might be convinced to forgo cardiopulmonary resuscitation, IV fluids and medically assisted feeding.

Other materials paint disabilities and illnesses in such “an inaccurately repugnant way” they may convince people that a low “quality of life” is not worth living, Balch said.

Balch said Aetna hired the “Center to Advance Palliative Care” in preparing its advance care planning program. The center reported that its program had resulted in a $12,000 average annual reduction in medical benefits.

Balch said using taxpayer money for Medicare advance care planning was so controversial in the original House Affordable Health Care measure that the proposal eventually was dropped.

But July 9, the Obama administration opened a 60-day “notice and comment” period to re-establish the proposal. It was contained in a large set of Medicare regulations. The administration said it plans to finalize the rule on advanced care planning by Nov. 1 and implement it Jan. 1.

Dr. Patrick Conway, the principal deputy administrator and chief medical officer of the federal Centers for Medicare & Medicaid Services, said in a statement that the administration’s proposal “supports individuals and families who wish to have the opportunity to discuss advance care planning with their physician and care team, as part of coordinated, patient- and family-centered care.”

The proposal says Medicare patients will not be required to have that discussion with a physician or sign any directive.

But, Balch said, “we are concerned about the rationing of health care through government action.”

“We support advance directives,” he continued. “We believe patients ought to have the right to make decisions about what medical care they receive. Our ‘Will to Live’ starts with a presumption for treatment, although an individual can indicate specific treatments that he doesn’t want,” he said.

“Tragically, however, there is considerable evidence that in practice, advance care planning is being used deliberately to nudge patients toward accepting a denial of life-saving treatment.”

Balch said many private insurance companies have hired organizations to “cold call” beneficiaries “to talk them into rejecting treatment,” and they usually “report how much money they are saving per beneficiary.”

“In this context, we greatly fear that this advance care planning will not be balanced,” Balch said. “Despite giving lip service to balance, it will be used deliberately to try to reduce health care spending. We are calling on Congress to block this rule.”

Finney is executive editor and general manager of the Clarion Herald, newspaper of the Archdiocese of New Orleans.


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Polls reveal support for abortion at lowest point since 1975


WASHINGTON — A Jan. 21 report from the National Right to Life Committee and new poll results show that abortion is increasingly unpopular in the United States, and also that the number of abortions performed in the United States is at its lowest point since 1975.

The day after the State of the Union Address, the right-to-life organization held a news conference on its second annual “The State of Abortion in the United States” report.

The report showed that the number abortions in the United States, currently at 1.06 million per year, is at its lowest point since 1975, when the number was 1.03 million and is also down from the 1.6 million high seen in 1990.

Anna Clement of St. Rita Parish in Alexandria, Va., holds her 8-month-old son, Sebastian, as they watch March for Life participants make their way up Constitution Avenue to the U.S. Supreme Court building in Washington Jan. 22. Tens of thousands took part in the annual event, which this year marked the 42nd anniversary of the Supreme Court's Roe v. Wade decision that legalized abortion across the nation. (CNS photo/Gregory A. Shemitz)

Anna Clement of St. Rita Parish in Alexandria, Va., holds her 8-month-old son, Sebastian, as they watch March for Life participants make their way up Constitution Avenue to the U.S. Supreme Court building in Washington Jan. 22. Tens of thousands took part in the annual event, which this year marked the 42nd anniversary of the Supreme Court’s Roe v. Wade decision that legalized abortion across the nation. (CNS photo/Gregory A. Shemitz)

A new Knights of Columbus-Marist poll shows 84 percent of Americans want significant restrictions on abortion and would limit it to, at most, the first three months of pregnancy.

At the National Right to Life news conference, Carol Tobias, the organization’s president, was asked about President Barack Obama’s claim in the State of the Union address that the drop is a result of actions taken by his administration.

She said “the president is on record supporting abortion at any time, for any reason; he is not for any limit or restriction on abortion, but naturally, he is going to put that statistic in the best light he possibly can.”

Tobias believes that the decline in the abortion rate is rather the result of pro-life activism in public discourse and popular culture because “yes, the numbers are going down, but the rates and ratios are also going down, and that’s due to the pro-life movement keeping this issue alive in the public debate.”

“Pro-life education and legislation are helping to make an impact on our culture and in the lives of women with unborn children,” she continued, and as a result “many women have shown that they want their babies to live.”

Randall O’Bannon, National Right to Life’s director of education and research, added that “though the numbers on the whole are going down, there is one group that has remained steady and that group is Planned Parenthood.” The group, which “performs one in three abortions in the United States,” has repeatedly “turned opposition into fundraising fodder” to expand its “taxpayer-subsidized abortion empire.”

“That,” said O’Bannon, “is why they spend millions on elections.”

In its report for fiscal year 2013, Planned Parenthood said it had received $540.6 million provided by taxpayer-funded government health services grants including Title X family planning funds for low-income people.

Federal regulations require abortion services be kept separate from Title X-funded family planning services, but critics of Planned Parenthood say that receiving funding for nonabortion services frees up its resources for providing abortions.

The National Right to Life panel, composed of Tobias, O’Bannon, legislative director Douglas Johnson, director of state legislation Mary Spaulding Balch and executive director David O’Steen, also addressed claims made by the American College of Obstetricians and Gynecologists that were raised in opposition to the Pain-Capable Unborn Child Protection Act.

The physicians’ group said that abortions done after the proposed 20-week abortion ban are rare and the results of “acute medical conditions.”

According to Johnson, such assertions are “the same mythology that came from special interests during the partial-birth abortion debates” and “attempt(ing) to resurrect a baseless claim.”

House members had planned to put the measure up for a vote Jan. 22, the 42nd anniversary of the Supreme Court’s Roe V. Wade decision legalizing abortion virtually on demand. But in a last-minute decision lawmakers decided to postpone action on it, indicating they would not have had enough votes for passage.

The bill would prohibit abortion after 20 weeks, when an unborn baby can feel pain, unless the life of the mother is in danger. There also an exception for cases of rape, but it would require a woman to get the abortion after reporting the rape to law enforcement. That provision brought opposition from a group of women and other GOP leaders in the House.

Not only is the number of abortions declining in the United States, but it is publicly unpopular, according to a recent Knights of Columbus/Marist-poll.

A press release issued by the Knights said the poll showed that 84 percent of Americans “want significant restrictions on abortions” and that “60 percent of Americans say abortion is morally wrong.”

In addition, the poll found that 64 percent believe the abortion rate in the United States is higher than it should be, that 78 percent support parental notification, 68 percent oppose taxpayer funding and nearly 60 percent of Americans support legislation that would “permit medical professionals and organizations to refuse to provide abortions or refer patients for abortions,” which are also known as “conscience protection laws.”

“In light of the ongoing controversy over the HHS (Health and Human Services) contraception, sterilization and abortifacient mandate,” the release said, “it is notable that 70 percent of Americans also support religious liberty rights when religious values conflict with the law.”

It noted this was the same percentage of Americans who self-identify as “pro-choice.”

For the poll, 2,079 adults were surveyed by phone between Jan. 7 and Jan. 13. The Marist Poll conducted the survey, which was sponsored by the Knights of Columbus. The margin of error was plus or minus 2.1 percentage points.

In addition, results of a Pew Research Center poll released Jan. 22 showed that 51 percent of U.S. adults say abortion should be legal in all or most cases, compared to 43 percent who say it should be illegal all or most of the time. But when asked about the morality of abortion only 15 percent of Americans view abortion as being “morally acceptable,” while 49 percent currently believe that it is morally wrong.

Sixty-four percent of Hispanics Catholics think abortion is morally wrong, compared to 53 percent of white Catholics, according to the Pew results.

The poll also showed a growing regional divide when it comes to views on life and abortion; the percentage difference between people in New England (75 percent) and the South (40 percent), the two most disparate groups, who think it should be illegal in all/most cases has nearly doubled since the mid-1990s.

 By Nate Madden


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