The same folks who rammed the Schiavo legislation through in 2005 have tanked the proposal to have Medicare pay for a voluntary conversation about end-of-life options, now claiming that government shouldn't be involved in end-of-life decision making. Chuck Grassley, the ranking member of the Senate Finance Committee said yesterday

“I think the best thing to do is if you want people to think about the end of life, number one, Jesus Christ is the place to start, and after that, in the physical life, as opposed to your eternal life, it ought to be done within the family and considered a religious and ethical issue and not something that politicians deal with,” he said.

This afternoon, the Senate Finance Committee has announced that Medicare funding to discuss advance directives will not be included in any package. However, the sharp-eyed Amy Sullivan notes at Time's Swampland blog that

Remember the 2003 Medicare prescription drug bill, the one that passed with the votes of 204 GOP House members and 42 GOP Senators? Anyone want to guess what it provided funding for? Did you say counseling for end-of-life issues and care? Ding ding ding!!

Let's go to the bill text, shall we? “The covered services are: evaluating the beneficiary's need for pain and symptom management, including the individual's need for hospice care; counseling the beneficiary with respect to end-of-life issues and care options, and advising the beneficiary regarding advanced care planning.” The only difference between the 2003 provision and the infamous Section 1233 that threatens the very future and moral sanctity of the Republic is that the first applied only to terminally ill patients. Section 1233 would expand funding so that people could voluntarily receive counseling before they become terminally ill.

And guess who voted for this measure? Yup — Senator Grassley.

Setting aside my feelings about this truly magnificent degree of hypocrisy for the moment, I will try to look on the bright side — seldom in my fifteen years of practice have I heard so much conversation at the national level about living wills, health care proxies and advanced directives. If the shouting encourages more people to contact attorneys to make sure that they have legally appropriate documents in place, perhaps something good will come out of it. I hope some people have learned that if they don't have advance directives and a health care proxy in place, the default position for doctors is to do everything to keep someone alive, no matter what. And perhaps if the issue has become so politically toxic that it must be removed, some good things will be enacted into law.

Maybe this issue will be revisited in the next legislative session, when the flame-throwing has died down.