Editor's note. This is adapted from the invaluable blog of the Robert Powell Center for Medical Ethics-- http://powellcenterformedicalethics.blogspot.com/

There are a number of rationing and euthanasia concerns in the Senate bill, known as the "Patient Protection and Affordable Care Act," offered by Majority Leader Harry Reid (D-Nev.) We will post a series that will address them one by one on this site.

#1. "Shared Decisionmaking"--Advance Care Planning By Another Name?

The Reid bill does not include provisions exactly paralleling those in the House bill which are designed to create incentives for "advance care planning," although there is also language that encourage minors in foster care to prepare advance directives. But Section 936 provides funding to develop "patient decision aids" that are supposed to help "patients, caregivers or authorized representatives . . . to decide with their health care provider what treatments are best for them based on their treatment options, scientific evidence, circumstances, beliefs, and preferences."

The Department of Health and Human Services (HHS) is to contract with an "entity" to "develop and identify consensus-based standards to evaluate patient decision aids for preference sensitive care . . . and develop a certification process" for these "patient decision aids." Additional grants and contracts are to be awarded to develop such "patient decision aids." These are to include "relative cost of treatment or, where appropriate, palliative care options" and to "educate providers on the use of such materials, including through academic curricula." Money is to be awarded to establish "Shared Decisionmaking Resource Centers . . . to provide technical assistance to providers and to develop and disseminate best practices . . ."

Furthermore there is also language in this section about ensuring that materials are "balanced" to help patients and their representatives "understand and communicate their beliefs and preferences related to their treatment options."

The concern, however, is the same as that with the promotion of advance care planning. Given the strong views many in the medical community have about poor quality of life and the considerable emphasis on saving costs, will these measures, in practice, subtly or otherwise "nudge" patients in the direction of rejecting costly life-saving treatment?

Part One