Most patients will say they don’t want heroic measures to be taken, but “some people will tell you, ‘Doc, I want everything done. Don’t spare anything. If there’s something that can be done to prolong my life, do it,’ ” Thomas says. “To me, as a physician, it doesn’t matter to me which position a patient takes. What matters is that I follow their wishes.”

That conversation is essential, says Brandt, whose organization makes advance planning forms available on its Caring Connections website. Medicare pays doctors for procedures and treatments, but a physician who spends an hour explaining the ins and outs of medical directives cannot currently bill for that time and effort. What the Advance Care Planning Consultation proposal would do, she says, is “at least not make it a money-loser for doctors to spend that time with patients.”

But that isn’t how the proposal, known as Section 1233, has been portrayed. Critics charge that it gives doctors a financial incentive to pressure their patients to refuse life-prolonging procedures in favor of palliative care. And that, they declare, is a slippery slope leading to euthanasia—a charge that outrages many doctors and health care workers.

Howard Tuch, M.D., a palliative care specialist and director of health policy at the nonprofit Suncoast Hospice in Pinellas County, Fla., calls the charge “absurd.”

“We estimate it would be a payment of $75 to $80 every five years,” he says. That’s a pittance, Tuch says, compared with the much greater monetary incentive doctors have to perform surgery or provide services like chemotherapy, dialysis and artificial nutrition.

Amid growing signs that Section 1233 could ultimately be dropped from the House Democrats’ health care bill, health experts say the fear-mongering unfairly characterizes an important discussion. “The damage of this hype is that people will be frightened to engage in this conversation at all,” Tuch says.

Study finds benefits

Several studies in recent years have found that when doctors have end-of-life discussions with patients and families, patients have less anxiety. Published last October in the Journal of the American Medical Association, one study found that when terminally ill patients had end-of-life counseling, it enhanced the quality of their final days.

“Less aggressive care and earlier hospice referrals were associated with better patient quality of life near death,” wrote the authors. Moreover, the researchers found family members and caregivers who did not participate in the discussions “experienced worse quality of life, more regret, and were at higher risk of developing a major depressive disorder.”

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