Fox promotes smears of health care bill's purported “death panels,” Obama admin.'s purported embrace of VA “death book”

Fox has repeatedly advanced falsehood that House health care reform bill would institute “death panels.” In a Facebook posting, former Alaska Gov. Sarah Palin claimed that under Democratic health care reform, “Obama's 'death panel' ” would “decide” whether her parents or her son Trig, who has Down syndrome, were “worthy of health care.” Several Fox News anchors, hosts, and contributors subsequently adopted Palin's “death panel” term or advanced or expressed support for her assertion, which is based on the widely debunked claim -- originating with Betsy McCaughey and also forwarded by Fox News -- that the House health care reform bill would require end-of-life counseling that would pressure seniors to end their lives.

Fox has promoted “death book” distortion. In a Wall Street Journal op-ed headlined “The Death Book for Veterans,” former Bush administration official Jim Towey claimed that the Obama administration revived a Veterans Health Administration booklet on advanced planning directives that would “steer vulnerable individuals to conclude for themselves that life is not worth living.” On several occasions, Fox News promoted Towey's false claim, ignoring facts that undermine Towey's rhetoric. Notably, in a Fox News Sunday interview with Towey, host Chris Wallace advanced several false claims about the booklet.

Both “death panels” and “death book” are smears

House provision cited as basis for “death panels” calls for Medicare to cover voluntary end-of-life counseling sessions. Section 1233 of the House health care reform bill amends the Social Security Act to ensure that advance care planning will be covered if a patient requests it from a qualified care provider [America's Affordable Health Choices Act, Sec. 1233]. According to an analysis of the bill produced by the three relevant House committees, the section "[p]rovides coverage for consultation between enrollees and practitioners to discuss orders for life-sustaining treatment. Instructs CMS to modify 'Medicare & You' handbook to incorporate information on end-of-life planning resources and to incorporate measures on advance care planning into the physician's quality reporting initiative." [waysandmeans.house.gov, accessed 8/13/09]

Over 40 media reports have debunked the false claims of “death panels” and euthanasia. Media Matters for America has identified more than 40 instances of where media have debunked right-wing claims that the House health care reform bill would encourage euthanasia of the elderly, including Sarah Palin's claim that the bill would create a “death panel” and the related claim -- initiated by Betsy McCaughey -- that the bill would “absolutely require” that seniors on Medicare undergo end-of-life counseling “that will tell them how to end their life sooner.” For example, The New York Times has reported that the “death panels” assertion “has no basis in any of the provisions of the legislative proposals,” and FactCheck.org has stated that “there is absolutely no provision encouraging euthanasia.”

“Your Life, Your Choices” is not a “death book.” The booklet emphasizes that “your wishes will direct future health care decisions” and presents preserving one's life “using any means possible” as an option to consider. An August 23 post by VoteVets.org blogger Richard Smith criticized Towey's assertion that “Your Life, Your Choices” presents “end-of-life choices in a way aimed at steering users toward predetermined conclusions,” writing: “Really, if the document was really trying to get veterans to pull the plug on themselves, then first suggesting to them that their life should be prolonged at all costs is a pretty stupid way to do it” [emphasis in original].

Fox prime time did not cover 2005 Senate bill that was similar to purported “death panel” provisions

2005 Senate proposal called for Medicare to cover voluntary advanced planning consultations. Introduced by Sen. Bill Nelson (D-FL) on February 10, 2005, S.347 would have “provide[d] for Medicare coverage of end-of-life planning consultations.” It would also have required the secretary of Health and Human Services “to conduct a national public education campaign to: (1) raise public awareness of the importance of planning for care near the end of life; (2) improve the public's understanding of the various situations in which individuals may find themselves if they become unable to express their health care wishes; (3) explain the need for readily available legal documents that express an individual's wishes, through advance directives (including living wills, comfort care orders, and durable powers of attorney for health care); and (4) educate the public about the availability of hospice care and palliative care.” [Congressional Research Service summary of S.347 (109th Congress, as introduced)]

Bill co-sponsored by both Republicans and Democrats. The bill ultimately had 14 Senate co-sponsors, including Democrats Hillary Rodham Clinton, Richard Durbin (IL), and Evan Bayh (IN), and Republicans Johnny Isakson (GA), Richard Lugar (IN), and Susan Collins (ME). [Library of Congress' Thomas]

The 2005 Senate proposal and the currently pending House health care reform provisions have similar requirements for what must be part of a covered voluntary consultation.

From the 2005 Senate proposal, S. 347:

''(bbb) The term 'end-of-life planning consultation' means physicians' services --

''(1) consisting of a consultation between the physician and an individual regarding --

''(A) the importance of preparing advance directives in case an injury or illness causes the individual to be unable to make health care decisions;

''(B) the situations in which an advance directive is likely to be relied upon;

''(C) the reasons that the development of a comprehensive end-of-life plan is beneficial and the reasons that such a plan should be updated periodically as the health of the individual changes;

''(D) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decision maker (health care proxy); and

''(E) whether or not the physician is willing to follow the individual's wishes as expressed in an advance directive; and

''(2) that are furnished to an individual on an annual basis or immediately following any major change in an individual's health condition that would warrant such a consultation (whichever comes first).''. [S.347, 109th Congress]

From the currently pending House health care reform bill (H.R. 3200, Ways and Means' chairman's mark), Section 1233:

''Advance Care Planning Consultation

''(hhh)(1) Subject to paragraphs (3) and (4), the term 'advance care planning consultation' means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:

''(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.

''(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.

''(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.

''(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).

''(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

''(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include --

''(I) the reasons why the development of such an order is beneficial to the individual and the individual's family and the reasons why such an order should be updated periodically as the health of the individual changes;

''(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and

''(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).

''(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State --

''(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and

''(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).

''(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that --

''(I) ensures such orders are standardized and uniquely identifiable throughout the State;

''(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional's authority under State law) may sign orders for life sustaining treatment;

''(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and

''(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.

Fox prime-time shows did not cover February 2005 Senate proposal. While Fox News has repeatedly advanced the smear that the end-of-life counseling provision in Democrats' 2009 House health care reform bill creates “death panels” and encourages euthanasia, Fox's prime-time shows did not cover the similar Senate legislation proposed in 2005, based on a review of the results from a search of the Nexis database.*

Fox prime time did not cover any events that occurred in the creation of VA's end-of-life planning policy

Bush's VA added language to VA handbook promoting the booklet. Those who assert that the Obama administration added language requiring doctors to show patients the “Your Life, Your Choices” booklet have pointed to its inclusion in the July 2 revision of VA Handbook 1004.2, “Advanced Care Planning and Management of Advance Directives.” However, as Daily Kos blogger Jed Lewison documented, the February 22, 2007, revision of that VA handbook contained the same language regarding the “Your Life, Your Choices” document. The version before the February 2007 edition -- issued July 31, 2003 -- did not mention the “Your Life, Your Choices” booklet.

Bush's VA made “Your Life, Your Choices” booklet publically available. Bush's VA made the document available to the public throughout his presidency, as Lewison documented.

Obama White House: under Bush, booklet available through government document websites. “The print version of Your Life, Your Choices was made available to patients in the Seattle area, but was never distributed nationally to Veteran patients, except that it was publicly available to VHA facilities through government document websites.” [White House “Fact Sheet” on Your Life, Your Choices; 8/25/2009 (via Greg Sargent)]

Fox prime-time shows did not cover VA policy on “Your Life, Your Choices” from 2001 to 2008. In contrast to the network's repeated promotion in 2009 of the smear that the booklet is a “death book,” Fox's primetime shows did not cover the VA's use of “Your Life, Your Choices” from the beginning of 2001 to the end of 2008, based on a review of the results from a search of the Nexis database.*

* Nexis search was: "((((advanc! w/5 car!) or (end! w/5 life!)) w/5 (direct! or plan!)) or (“living will”) or (life w/3 choices) or (death pre/2 book!)) w/30 (legislat! or bill or congress! or law or propos! or Senat! or veterans or VA or VHA) and pub(Fox) and date aft 12/31/2000 and date bef 1/1/2009."