Until last week, Republican Sen. Johnny Isakson was among the most enthusiastic backers of end-of-life counseling in government health care programs like Medicare.
That was before conservatives called it a step toward euthanasia and former Alaska Gov. Sarah Palin likened the idea to a bureaucratic "death panel" that would decide whether sick people get to live. And even though those claims have been widely discredited, the issue remains a political weapon in the increasingly bitter health care debate.
Now, Isakson and other Republicans who eagerly backed the idea are distancing themselves from it or lying low in the face of a backlash from the right.
"Until last week this was basically a nonpartisan issue," said John Rother, executive vice president for policy at AARP, the seniors lobbying group. "People across the political spectrum recognize that far too often people’s wishes aren’t respected at the end of life and there is a lot of unnecessary suffering."
The idea for government-backed end-of-life counseling — while delicate given the subject matter — has garnered significant consensus on Capitol Hill, fueled in part by cases such as that of Terri Schiavo, whose divided family fought for years over whether she would want to be kept alive in a vegetative state.
Just a year ago, Congress overwhelmingly approved legislation requiring doctors to discuss issues like living wills and advance directives with new Medicare enrollees. And the government already requires hospitals and nursing homes to help patients with those legal documents if they want support, under a 1992 law passed under Republican President George H.W. Bush.
Supporters say the current House proposal just goes one step further by paying for the counseling, with the idea that doctors and patients would spend more time on it instead of just having a cursory discussion in an initial Medicare visit. The counseling is voluntary.
Isakson and other Republicans such as Sens. Richard Lugar of Indiana and Susan Collins of Maine have co-sponsored legislation in recent years promoting the counseling, including in initial Medicare visits and through a proposed government-run insurance program for long-term care.
In the House, Republican Reps. Charles Boustany of Louisiana, Geoff Davis of Kentucky and Patrick Tiberi of Ohio co-sponsored legislation from Rep. Earl Blumenauer, D-Ore., that would authorize Medicare to pay for the counseling. That measure served as a model for the current House language.
Earlier this summer, Isakson sponsored an arguably more far-reaching measure that would have required that new Medicare patients have a living will or other advance directive.
But the Georgia conservative found himself in a storm of criticism when President Barack Obama said at a town hall meeting this week that Isakson was a chief architect of the House approach. Isakson quickly issued a statement repudiating the proposal.
"The House provision is merely another ill-advised attempt at more government mandates, more government intrusion and more government involvement in what should be an individual choice," he said.
Pressed later to explain his opposition, Isakson and his spokeswoman, Joan Kirchner, said he doesn’t like the fact that the House bill would expand Medicare costs by paying for the consultations and giving doctors an incentive to conduct them. He also said the House bill is too specific in detailing what must be discussed in the sessions.
"There are similarities … but there are substantial difference," Isakson said. "I’m not running away from anything but I’m not going to accept the president of the United States telling people I wrote something that I didn’t."
Isakson, who initially called Palin’s "death panel" characterization "nuts" in an interview Monday, declined later in the week to criticize Palin’s statement, in which she said the measure would force people like her baby Trig, who has Down syndrome, "to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide … whether they are worthy of health care."
"The best I can read she’s applying the House bill and using her child with Down syndrome as an example," Isakson said. "I would never question anyone’s defense of their child."
Spokesmen for Lugar and Collins — two other longtime proponents of end-of-life planning — declined to comment on the House bill.
Sen. Charles Grassley, an Iowa Republican and a lead negotiator on health care legislation, told constituents at a community meeting last week that they have good reason to fear the proposal.
"I don’t have any problem with things like living wills, but they ought to be done within the family," he said. "We should not have a government program that determines you’re going to pull the plug on grandma."
Grassley said Thursday that lawmakers negotiating on the Senate version of the health care bill had dropped the provision from consideration, citing how it could be misinterpreted.
Comments like Grassley’s puzzle Rother, who said "it’s been a little disappointing" that more Republicans haven’t stepped forward to defend the legislation.
He and Jon Keyserling, a vice president at the National Hospice and Palliative Care Organization, say there is little difference between the current proposal and past legislation that Republicans have supported. The current bill specifies that the counseling would be covered only every five years to prevent people from overusing it, and describes what the consultations must include.
Keyserling said many people wrongly assume that end-of-life counseling is about terminating treatment. But it really is about making sure a patient’s wishes are known, he said, including if that means continuing life-sustaining treatment in all circumstances.
He said he’s been surprised at the backlash, particularly given the close attention that Congress paid to Schiavo’s case, which he said clearly highlighted the need for better end-of-life planning.
Schiavo was removed from life support in 2005, though the Republican-led Congress and President George W. Bush had intervened in the family dispute in an effort to continue her care.
"I think the House bill is about as innocuous and helpful as possible," Keyserling said. "It’s about making sure people are prepared and informed to make decisions."