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One More End-of-Life Consideration

In my column today on end-of-life counseling I omitted, for reasons of concision, one consideration. While living wills are generally useless, another "advance directive" -- the durable power of attorney -- can be quite useful. It designates the person who will make decisions for you if you are no longer able to make decisions for yourself. That's particularly helpful by establishing a clear line of authority when a genuinely loving family cannot come to agreement over what might be best for the patient.

If that was all Section 1233 was about, there would be no problem. However, it's clear that active counseling about palliative and hospice care -- i.e., letting go of life -- is a major part of the drafters' agenda. And that is where the problem lies.

By Charles Krauthammer  | August 21, 2009; 10:22 AM ET
Categories:  Krauthammer  | Tags:  Charles Krauthammer  
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Comments

If only more conservatives were able to offer more constructive debate like you have on healthcare. I think reform needs direction from non-politicians. The president needs to spell out salient features of health reforms rather than delegate that process to the retards in the congress.
I work as a hospitalist and have experienced the pain and suffering of the dying, while the family members are ambivalent on the next level of care. Usual scenario is patients are placed on life support for a while (days to weeks), having palliative team meeting with the patient's family, and the poor patient suffers through it all. It is just morally reprehensible to put the dying through this torture, and it costs lots of money. Most often, futile measures are finally comprehended to family members and then a morphine drip for management of pain and suffering is initiated just few hours before the patient finally dies. Currently the involved parties are shielded from the cost of such futile measures (usually the patient is on medicare). Not all cases are clearcut in determining the prognosis. when poeple get old or have multiple co-morbid conditions, any small insult to their body can be catastrophic. It is then most essential to know patient's wishes towards the care they would have wanted towards end of life. Would they like CPR? or when there time comes let them go in peace? Hence the essentiality of advanced directives and healthcare proxies. Treatment options in the intensive care are not without consequences, so let us not demonize this debate by calling it rationing. Republican voices have been hijacked by the stupid utterances of Palin and limbaugh. The electorate maybe frustrated by the democratic confusion on healthcare reform, but are disgusted at politics of rantings of these so called conservatives.

Posted by: amitx1 | August 21, 2009 11:46 AM | Report abuse

As a great fan, I differ on what I interpret as to what death panels are. I believe they are referring to gov't boards that determine what services and treatments are to be covered based on cost, age related benefit, and the total health care budget the gov't has set. These boards are in every fully nationalized health care system and become more restrictive as the increased demand a subsidized system encourages and the inefficiencies inherent in a large bureaucracy, develop. They skew the provision of services and will, in the USA, lead to greater politicization of covered services and time value of life while not being applied to certain special groups ( politicians and their donors).

Posted by: awitt5000 | August 22, 2009 6:58 AM | Report abuse

So if its something you believe in, the deaths caused are just "collateral damage"

Posted by: kreator6996 | August 22, 2009 8:36 AM | Report abuse

Mr. Krauthammer now says that advance directives are quite useful, but because of the limitations of space, he didn't mention that in his column, which centered on living wills which he belittles as generally useless, when the time comes to make a decision. Well, Sec. 1233 of H.R. 3200 encourages consideration of both living wells and advance directives in the same breath: (p. 425 of bill says: "an explanation by the practitioner of advance directives, including living wells and durable powers of attorneys.") So why pick on living wills and not say anything at all about the value of advance directives? What harm is there in the patient knowing about both options? Furthermore, living wills can certainly be important if the patient becomes "comatose or demented" as Krauthammer grudgingly recognizes. Witness the Terri Schiavo case.

Posted by: Jere11 | August 22, 2009 11:05 AM | Report abuse

I fully agree with awitt5000. After reading (twice) the June 2009 report of the White House Council of Economic Advisers, and Martin Feldstein's article on the subject, it is clear to me that "death panels" will eventually be real, but not so overtly as many think. Boards will set standards and limits. If you meet the standards and your care is within the limits, you will get it; otherwise you will not.

Given the pace of technological advance in health care, I think a certain amount of "rationing" may be unavoidable. We will not be able to sustain the costs of unlimited health care for everyone. With rationing we will also likely see a slowing of the pace of technology. No one is going to invest money to develop a drug or device if he does not believe he can recover his investment.

Posted by: neilwied | August 22, 2009 11:31 AM | Report abuse

This is the most cynical and mentally disturbing analysis of the medical profession, and the choices and preparation we the people have to make about our eventual demise, I have ever witnessed. Under your premise, as our doctors are paid by the procedure and receive "benefits" from pharmaceutical companies, our medical advisors cannot be trusted to do the right thing for our well being even if we go in for an infected toe. The espousal that paying doctors to council the patient and family on all options open to them, would lead them to promote (even subtly) the pulling of the plug on life is baked in partisan demagoguery. Your basic premise convicts the entire medical establishment.

To me, the real concern of the provision is that doctors should have to do this as part of their code of ethics to begin with. Paying them creates too much opportunity for institutional subsidization and fraud. But neither of these were part of our argument, only the dismissive and callas condemnation of our doctors integrity.
This is the most cynical and mentally disturbing analysis of the medical profession, and the choices and preparation we the people have to make about our eventual demise, I have ever witnessed. Under your premise, as our doctors are paid by the procedure and receive "benefits" from pharmaceutical companies, our medical advisors cannot be trusted to do the right thing for our well being even if we go in for an infected toe. The espousal that paying doctors to council the patient and family on all options open to them, would lead them to promote (even subtly) the pulling of the plug on life is baked in partisan demagoguery. Your basic premise convicts the entire medical establishment.

To me, the real concern of the provision is that doctors should have to do this as part of their code of ethics to begin with. Paying them creates too much opportunity for institutional subsidization and fraud. But neither of these were part of our argument, only the dismissive and callas condemnation of our doctors integrity.

Posted by: thecontributist | August 22, 2009 12:42 PM | Report abuse

Sorry. In my earlier post today, I should have used the narrower term "durable powers of attorney" as the other type of advance directive that is mentioned in Section 1233 of the House Bill in addition to "living wills." In other words, "advance directives" consist of two types of documents: (1) living wills, in which you describe the kind of medical treatments or life-sustaining treatments you would want if you were seriously or terminally ill and could not make decisions. It doesn't provide for someone else to make a decision for you. (2) A durable power of attorney (or medical power of attorney), in which you designate someone to make such decisions for you if you are unable to do so. If you have someone you trust you can name that person in the durable medical power of attorney. But if not, you can do a living will. Further, you can do both -- as the living will can inform the designated holder of the power of attorney what your wishes would be in such extreme circumstances. It will also act as type of insurance back-up if that person is not available for physicians to consult at a critical time. My point, again, is that the fact that the power of attorney is usually more practical than a living will-- for all the reasons that Krauthammer well describes-- is not a cogent reason for his objecting to Section 1233 in his first column, especially since he now says that durable powers of attorney (the other type of advance directives that Sec. 1233 names) can be quite useful.
In his more recent blog (above) he says "If that was all Section 1233 was about, there would be no problem. However, it's clear that active counseling about palliative and hospice care -- i.e., letting go of life -- is a major part of the drafters' agenda. And that is where the problem lies." But why is this a problem? As as the posting by the hospitalist amitx1 suggests, NOT to have mention the availability of palliative and hospice care would seem short sighted and cruel where "hanging on to life" at all cost and suffering may in no one's view (including particularly the patient's) be the optimum call after considering all the options discussed in the counseling session.

Posted by: Jere11 | August 22, 2009 2:44 PM | Report abuse

CHARLES!!!! Have you written your own statement to you physicans about EOL? This subject just reeks when there is a discussion concerning this. Most people who know death will eventually come and realize they will not live forever should have a clue by now that they need to discuss such issues with their loved ones. They should have a list of I do want and I don't want and who is in charge of carrying out the little details.

So, please-the "idea of death panels" is ridiculous. Unless Palin is the the head of the panel then, jump off the table now!

Posted by: Scar1 | August 22, 2009 6:45 PM | Report abuse

I guess when insurance company bureacrats refuse to pay for treatment that is different than a 'death panel'?

Posted by: orange3 | August 22, 2009 7:12 PM | Report abuse

Have you seen the "Conservative Joker",@www.michellezmilk.com, lets not forget the "free Speech"....

Posted by: catlitterpolitics | August 22, 2009 8:44 PM | Report abuse

I sought and received excellent and compassionate medical and spiritual advice at the end of my mother's life. I hope others can get similar counselling at a very hard time. Which am I, a fool or a knave? You offer not other choice.

Posted by: millergd1 | August 23, 2009 3:30 PM | Report abuse

The entire health insurance system relies on the agonizing fear by all that if they have a health problem they will be taken to the cleaners to have it fixed. Life is precious, and a providential God will take care of it.

Posted by: rmkraus | August 24, 2009 12:27 AM | Report abuse

The opposition to funding end of life counseling is one of the most horrible examples of hypocrisy I have seen in politics. Legislators who previously voted for and supported this have now justified opposition to it. They will do or say anything to defeat health care reform. The only real base the Republican party has now outside of the south and Mountain West is the old folks, and they are using this issue to pump up political contributions. Since the Democrats are now in power in Congress, the big moneyed interests are giving more to the Democrats.

Posted by: eadler2 | August 24, 2009 9:59 AM | Report abuse

Guys, the issue is that Mr. K. is fearful that someone may opt to pull his plug rather than spend all his earthly wealth keeping his body alive, a la Terri Schaivo. One would think that he would rather know ALL his options, benefits, costs, quality of life, etc. and then be able to make an informed choice/decision for himself or have the appointed person (power of attorney) do so on his behalf, based on prior preference (living will). So much for attempts at conservative logic.

Posted by: old_sarge | August 24, 2009 12:50 PM | Report abuse

Mr. Krauthammer has graced us with a display that can only be called unlawful and unprofessional. God help any patient who falls into his hands because he won't. The patient makes the decisions and these documents ARE legally binding even though Dr. Krauthammer may pracitce hsi medicine otherwise.

Posted by: williamwertman | August 24, 2009 1:19 PM | Report abuse

Charles; those in the know already knew, those that didn't probably never will

Posted by: dirtbombbrown | August 24, 2009 7:57 PM | Report abuse

Krauthammer, A death panel, albeit a lie, is better than selling your soul to the GOP against the common good of all citizens of this country.

Posted by: Single_Payer | August 24, 2009 11:01 PM | Report abuse

The arguement is not that end of life decisions should be avoided, it's that those conversations should be between the patient, their family, and their doctor. Government promotion of DNRs, rationing and the reduction of the value of life to a number, and the dubious involvement of ethicists are only necessary if the government is controlling health care and it's costs. When the decisions are private, none of those programs are necessary. Even in the event your insurance company balks at payment, you still have recourse to the government or your own pocketbook. If the government is the denier of care, who can you appeal to???

Posted by: hdc77494 | August 25, 2009 2:04 AM | Report abuse

The last word of Calvin Kleinhammer's "quick-take" sums up just about every word he speaks on the Democrat's health care proposals. Couldn't have said it better myself, C.K.

"Lies," C.K. All you tell are lies.

Posted by: secretaryofspite | August 25, 2009 2:04 AM | Report abuse

Yes and of course next Charles Krauthammer will add that he forgot to mention also that no one will be obligated, under any plan being proposed, to have any conversation one doesn't want to have.

Right?

And he'll add that of course it's doctors having these conversations with patients that is being proposed to be covered by insurance, not government agents or panels or anyone like that, and that of course the purpose is for doctors to advise patients about their options and choices, not to oblige or force anyone to do anything, certainly nothing against their will.

Right?

And he'll also add that the idea of "death panels", that is, any sort of a board making decisions about what's covered and what's not, is a part of any insurance, it certainly is now with private insurance, unless you think they simply say "everything is covered. No exclusions. Any condition is covered for anyone, no matter what".

Do you imagine this is the case now? And of course with insurance provided by the public then the idea would be that everyone IS covered, but logically of course there would be decisions to make about what care is given priority-- just as there is now, even more so now, so this whole issue is really nonsensical.

He'll mention that, right?

Oh and he'll add that no one would be forced to subscribe to public health insurance if they preferred private insurance in the first place, right? I live in France now and even with single-payer universal insurance (much more drastic than the public option) there's plenty of private health insurance for those who want it.

So I await all of those clarifications, because otherwise everything Krauthammer wrote in his column was misleading, disingenuous, scare-mongering demagoguery that bore no relation to reality.

Posted by: BillEPilgrim | August 25, 2009 2:19 AM | Report abuse

Mr. Krauthammer, the best sentence of your column was the first: Sarah Palin should leave the room !

Posted by: wernerthomasi | August 25, 2009 6:08 AM | Report abuse

There is no one right answer to this question. Each person and each family is different. My husband and I chose not to have a medical directive (living will)but a friend of mine, an attorney has a very detailed directive. An important difference is in your assessment of your survivors and whether you trust they will have a concensus in which you have confidence. From personal experience I can add two things; (1) hospice can be immensely helpful and supportive to a family when a member if dying, and (2) you can expect tremendous pressure in a hospital setting for Do Not Resusitate orders and you won't to have your course of action planned before you find yourself in this situation.

Posted by: withersb | August 25, 2009 10:13 AM | Report abuse

As is usually the case with you Sir, whatever is the current talking point of the GOP, your commentary will toe that line.

I am sure that you mean well when you state that a 'living will' is useless, but let's consider happens when a person looses the ability to make decisions for themselves and they later lapse into a coma and become brain dead.

With no 'living will' this person is subjected to the will of his relatives. Some may want that person to live... I am sure you remember the Schivo case wherein the husband wanted the tubes and life-support pulled and the parents didn't want that to happen.

It is my best assumption that your intellect can make the quantum leap to realize that many of us, including yourself, may have wishes that are not the same as those that our surviving relatives who may not agree with what we want when it comes to deciding how we will be taken care of in the unlikely event that we find ourselves in a situation that involves our living on life-support.

Your personal position should not be the commentary that influences your fan club - elderly Caucasians unable to reason for themselves; nor is it my desire that opinions resonating from you should diminish my chances of receiving a service that is free and extremely useful to every elderly person.

Have a conscience and the compassion to envision what your remarks will do so a single living human being...

Posted by: rodnacious1 | August 25, 2009 11:23 AM | Report abuse

Most people nearing death today are well above the age of 65. They are already participants in a government-run socialized payment system called Medicare. Government panels already assess the cost-effectiveness of their medical care and regularly modify Medicare payment mechanisms to try to eliminate services that provide little benefit and to control fraud and waste. Why is this pertinent to attempts to increase the proportion of the working population that is covered by public or private health insurance?

Posted by: SC_observer | August 25, 2009 11:28 AM | Report abuse

As a Midwesterner, I am agog at the absolute naiveness of many of the comments made today. Have we become so caught up in "semantics", that we can not see what is happening? Whether it is due to rationing (which will happen), whether care is denied because of cost (which will happen), whether we have 27 or 227 "appointed" people that are going to make decisions regarding appropriate care, or lack of it, makes no difference. It all amounts to the same thing..People will be subjected to poorer care, less care, fewer, and less competent Drs...this means, whether we have an actual DEATH PANEL or not, it will be...if it sounds like a duck, etc. When will we as a country realize, that NO ONE gets something for nothing?..When will Self-reliance become the mantra, rather than looking for someone to blame?..When will we realize that we can not fix the World's problems, make people who do not want to work...work? Why can the people not see, that when you promise, and GIVE something to someone for nothing, that that becomes what they expect?..I am 71 years of age, (THANK GOD)..What is happening to our country?

Posted by: marilynnelson1 | August 25, 2009 12:28 PM | Report abuse

Like it or not, people die. Old folks and sick folks die, regardless of the medical care available to them at any point in time. and nothing stops this process.

Palliative care is an option to relieve pain and provide comfort as far as possible, to the very ill. As opposed to one more operation, one more round of medication -- which will, eventually, no longer work anyway. no matter how you operate, medicate or mediate, everybody dies in the long run, and saying so is not a political position.

Posted by: MrsGRP | August 25, 2009 4:28 PM | Report abuse

I don't know if this “one more consideration” and your final outrageous statement was deliberately delayed and hidden away so that you would not endure the full wrath of your Friday readers. Suffice it to say that you are clearly playing to the crazy community. Having family members at that stage of their lives, I know how much they want to have that conversation with their doctor so that they can make their own decisions. Inferring that this was put in the bill to reduce cost is ridiculous at best; deliberately misleading your readers is more like it.

Posted by: enuf | August 25, 2009 5:33 PM | Report abuse

Palliative care is an option right now. But that's exactly what it is - an option. Many care givers choose life even if the diagnosis is terminal. Remember Terry Schiavo? After several years of internal family confrontation regarding ending her life-support, she became a cause-celebre. Her husband wanted to end life- support and her family, and ultimately the entire Republican congress, were involved with trying to keep her alive. Think of how much money was spent trying to fight the decision-maker's decision? Congressman flew back to DC from their breaks, grass-roots groups from around the world mobilized, it was big.

The primary decision-maker prevailed. An autopsy revealed that her brain had shriveled to the size of a plum. Terry was long gone several years before it ever came to this.

My point is that perhaps thought ought to be given to a palliative care system where hard decisions are truly made.

Posted by: RobertaHigginbotham | August 26, 2009 12:03 AM | Report abuse

Charles, I have downloaded a copy of SEC. 1233. ADVANCE CARE PLANNING CONSULTATION. I don't know what kind of bias or ideological point your trying to support. As a 64 year old man whose parent's both died of cancer and my wife's mother is currently dealing with multiple issues associated with advanced age including hospice you are reading more, much more into this that is really there. Hospice services for my wife's mom have been so excellent in helping our family manage through this very difficult time. I am of the opinion that right-wringers have largely taken leave of their higher faculties in their paranoid hunt for eugenics, euthanasia and other strange fascinations in order to bring Obama down.

Posted by: mickster1 | August 26, 2009 3:20 AM | Report abuse

Mr. Krauthammer, I have always enjoyed your honesty and open reasoning that is brought to the table. It is like a breath of fresh air after the daily bombardment of drivel and contradictions from the left. Although I try to listen to liberal ideas that have brought light to a dark world, there are no real liberals around anymore, only guilt ridden left wing socialist that insist on forcing a repressive big government agenda on everyone that will always lack heart, soul and conscience because it is only government and knows nothing of truth. The difference in people that know and people that think they know is apparent. Keep up the good work.

Posted by: longbow651 | August 26, 2009 8:14 AM | Report abuse

Our nation spends $2.4 trillion dollars per year on health care. $800 billion of that is spent on unnecessary tests because doctors and hospitals get paid by the number of tests they order and perform. The only thing the panel would do would be to study and present the treatments that have the best outcomes for patients. If this was how Medicare was run, the country would save hundreds of billions of dollars but patients would have a better chance of health. The Mayo Clinic is world renowned for it's level of health care and success rates and that's how they operate their system------at a cost per patient that is half as much as some areas in this country. Also, end of life counseling doesn't kill you. It gives you the information you need to make your own decisions. A ninety year old man shouldn't have to undergo painful procedures or spend six months on a ventilator if he doesn't want to. These paragraphs in the bill that have been the subject of so much fear mongering are the very paragraphs that would empower Americans to insist upon their own wishes being followed. Old people are a tremendous source of income to the health care industry, but that year of life---and a million dollars---comes with a terriffic price in suffering. A person should have the right to say No Thanks and die with their dignity in tact if they want to. Don't let anyone scare you into doing harm to yourself by fighting these provisions.

Posted by: karela | August 26, 2009 2:26 PM | Report abuse

Only the people who have had thier loved ones in Hospice or needed palliative care should comment here.

Everything is different when they tell you and/or your loved that death will come within a matter of months.

The hospice people and palliative care people are so needed at this time.

The doctors are there to keep you alive, but when all hope is gone and the doctors turn and leave the room after saying there is no more treatment, that's when hospice comes in and cares like no one else does.

And palliative care.. they are the ones that sit with your and your loved one, and keep changing the meds to try and get rid of the unbelievable pain and suffering.

These are the people that CARE when all hope is gone.

They explain no CPR from the emergency people and why, they explain the meds, they are available 24 hours a day.

They are not "death panels", or anything else except special people.

These are the people that the health care bill wants all people to have access to when and if they are needed.

No one but the people who have terminal deseases, and the caregivers who love them so very very much can understand what hospice and palliative care are about.

Everyone should really just save their opinions.

Posted by: MUPPET | August 27, 2009 7:40 AM | Report abuse

Charles,
Your opinion about Eand EOL and power of atty is noted and justly ridiculed by many posts here, as I do. Have you ever had a Mother or father on their death bed??
Hospice and EOL workers do all they can to ease suffering and do what the patient wants, save me at all costs or let me die with dignity, if that is how they look at it.
Your Bush years of kissing his rear and supporting his sick ideology makes you a joke to all but a few right wing sycophants.

Posted by: rosenfan1 | August 27, 2009 9:20 AM | Report abuse

CHARLES - Not certain I share your gloom forecast(s) re: CIA as expressed last evening [Wednesday - Aug 26th] on Fox News. However, it wouldn't surprise me that the ABC-TV 'investigative piece' recounted during "The Factor" is a foretaste of (possible maybe?) Leon Panetta leaving DCI post to re-organize the White House Staff after Labor Day - as he did for former Pres. Clinton, when his approval ratings turned South, too -- in the day. BTW - Isn't your appearance to speak at The Air Force Association meeting forthcoming?

Posted by: gogosian2001 | August 27, 2009 9:29 AM | Report abuse

I wonder if political writers have any common sense at all. We get all kinds of explanations, one more insane than the other.
Cut the chase and get to the point. It is all very simple.
Accept some simple facts and it all very clear.
Fact 1: Politicians are not in the game to benefit you or me. They are in the game for personal benefit and power.
Fact 2: Once elected to a position of an acceptable level the only goal in life is to re-assure re-election and if possible move up with little risk.
Fact 3: The constitution and peoples rights are obstacles to politicians and any deception to circumvent or eliminate them is acceptable.
fact 4: The government is owned by the politicians and the people are there to serve it.
Fact 5: The entire election system has become an insurance policy for the incumbents. They receive an unfair advantage at election time. Fair elections were gone long ago.
Fact 6: Political promises and statements have no value. There is no penalty for breaking them. A business could not operate that way.
Fact 7: There are no real political parties. There is only one group of politicians. They all follow the same road. The multiple parties create the perception that they work for you by "fighting" against the other party for your benefit.

Why don't we just abandon the constitution and grant unlimited power to the government so that we return to the old days when the rulers had unlimited power and authority and the people were their slaves? That is where we are going anyways.

Any politician who deceives and misleads the population should go to jail. Campaign promises and statements to the general public by elected officials should be treated as contracts between that person and the population. They should be honored and should be enforcable by law.
All "political positions" in government should have term limits. The emphasis should be on doing the job, not on being re-elected.

The government take over is a gradual process. They take our freedoms away a little bit at the time. Just sit back and think about what freedoms we have lost since WWII. It is amazing that it could happen. It is amazing that it is allowed to continue.

Poor people depend for survival on the government hand outs.

The current administration is making us all poor with lightning speed.

It won't be long and we all depend on government hand-outs. That is when government has reached its ultimate goal and controls everyone.

Stop this maddness before it is too late.
There is not much time left.

Posted by: duif100 | August 27, 2009 10:46 AM | Report abuse

You have no comprehension what hospice care is. Twice I have had the benefit of their supportive, assistive care to the family and patient after the doctors have said they had no more treatment to offer a
family member. It would be inhumane to seek to deprive people of this benefit. Stick to writing about things you know something about please.

Posted by: withersb | August 27, 2009 11:49 AM | Report abuse

amazing that the same republicans that voted for the same wording in 2003's medicare drug bonanza regarding end of life care are now disingenously raising the issue they voted for as an argument agsainst affordable healthcare. i wish the republicans would get their act together, as much as i disagree with the republicans. america needs vibrant discussion. what a shame they bring nothing to the table but ad hom, & divisive distortions.

Posted by: dconaty1 | August 27, 2009 2:19 PM | Report abuse

Charles, face it; the 'death panel' argument is a specious canard. Only the haters: birthers, etc. believe it at all.

Face it.

Posted by: Heerman532 | August 27, 2009 4:09 PM | Report abuse

Posted by: Jere11

Mr. Krauthammer now says that advance directives are quite useful, but because of the limitations of space, he didn't mention that in his column, which centered on living wills which he belittles as generally useless, when the time comes to make a decision. Well, Sec. 1233 of H.R. 3200 encourages consideration of both living wells and advance directives in the same breath: (p. 425 of bill says: "an explanation by the practitioner of advance directives, including living wells and durable powers of attorneys.") So why pick on living wills and not say anything at all about the value of advance directives? What harm is there in the patient knowing about both options? Furthermore, living wills can certainly be important if the patient becomes "comatose or demented" as Krauthammer grudgingly recognizes. Witness the Terri Schiavo case.
---------

Geez, read for comprehension. Krauthammer put advance directive in quotation marks. A durable power of attorney has nothing to do with end-of-life counseling or living wills which is just another name for advance directives.

Clearly you are a typical left-winger. Can't read, think or comprehend.

Posted by: j9zig1 | August 27, 2009 10:30 PM | Report abuse

I'm not really concerned about the "death panels" per se. I'm more concerned that when you read this bill (of which I have read portions) it is written in such a way as to leave too many things open to interpretation in the long run. Our leaders should not be writing such important bills that it takes a supreme court to interpret them. And down the road when the true costs of universal coverage become evident, that's when I am more worried about the "death panels and end of life counseling and withholding elderly care, etc. I certainly don't want the government running this!!! They haven't run anything else sucessfully ever.
I would support a VAT tax to fund this program (on the condition that these taxes are only used for this and nothing else) and that way everyone who benefits would also be adding to the pot. If the poor can afford game boys then they can afford to chip in also. If the rich can afford porsches, then they can afford to chip in more. If they are going to slip in the illegals in time they can contribute to the pot also.
I am an extreme conservative who believes in a hand up not a hand out. I have no problem helping my neighbor as long as he/she is contructively trying to help themselves.
If the liberals were to doggedly pursue the elimination of illegal drugs in this country, like they are doing with healthcare and their pet projects I would then feel much differently about them.
That would save money in healthcare, rehabilitation and incarceration costs, etc.

Posted by: tjmlrc | August 28, 2009 9:50 AM | Report abuse

Dear Editor,

Like Mr. Krauthammer, I also have no idea what I'm talking about most of the time, and I too can make up spurious "facts" to back up any of my spurious conclusions. If you ever need another columnist, I am available.

Posted by: miden1 | August 28, 2009 6:02 PM | Report abuse

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