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March 7, 2012

The Retreat From Advanced Care Planning

Author Affiliations

Author Affiliations: Department of Internal Medicine, Yale School of Medicine, Yale School of Epidemiology and Public Health, New Haven, Connecticut.

JAMA. 2012;307(9):915-916. doi:10.1001/jama.2012.229

The specter of death panels lives.1 As a reminder of their origin, the House of Representatives version of what eventually became the Affordable Care Act (ie, the health care reform bill passed in 2010) included a provision authorizing Medicare to reimburse physicians for the time they spend discussing with patients their goals and preferences surrounding end-of-life care. “Advanced care planning” is the term used for the process of patients' thinking about and communicating their values and preferences, whereas the term “advanced directive” refers to the related legal document. The advanced care planning process helps ensure that individuals receive the health care they desire at the end of their lives. The provision had widespread bipartisan support until the summer of 2009, when Sarah Palin morphed talk of providing support for patients who wanted to have a discussion with their physicians concerning their priorities into rhetoric alluding to “death panels.” The provision was removed from the pending legislation in reaction to the ensuing maelstrom.