Death panel
"Death panel" is a political term that originated during the 2009 debate about federal health care legislation to cover the uninsured in the United States. Sarah Palin, former governor of Alaska and 2008 Republican vice presidential candidate, coined the term when she charged that proposed legislation would create a "death panel" of bureaucrats who would carry out triage, i.e. decide whether Americans—such as her elderly parents, or son with Down syndrome—were "worthy of medical care". Palin's claim has been referred to as the "death panel myth", as nothing in any proposed legislation would have led to individuals being judged to see if they were worthy of health care.
Palin's spokesperson pointed to Section 1233 of bill HR 3200 which would have paid physicians for providing voluntary counseling to Medicare patients about living wills, advance directives, and end-of-life care options. Palin's claim was reported as false and criticized by the press, fact-checkers, academics, physicians, Democrats, and some Republicans. Some prominent Republicans backed Palin's statement. One poll showed that after it spread, about 85% of respondents were familiar with the charge and of those who were familiar with it, about 30% thought it was true. Owing to public concern, the provision to pay physicians for providing voluntary counseling was removed from the Senate bill and was not included in the law that was enacted, the 2010 Patient Protection and Affordable Care Act. In a 2011 statement, the American Society of Clinical Oncology bemoaned the politicization of the issue and said that the proposal should be revisited.
For 2009, "death panel" was named as PolitiFact's "Lie of the Year", one of FactCheck's "whoppers", and the most outrageous new term by the American Dialect Society.
Donald Trump instituted a policy in 2025 where the decision-making over providing and withholding healthcare from patients is decided by artificial intelligence. In reference to the previous political scandal of 2009, this has been coined an "AI death panel".
Background
On July 16, 2009, former lieutenant governor of New York, Betsy McCaughey, a longtime opponent of federal healthcare legislation said Section 1233 of HR 3200 was "a vicious assault on elderly people" because it would "absolutely require" Medicare patients to have counseling sessions every five years that would "tell them how to end their life sooner". Conservative talk radio hosts including Rush Limbaugh, Sean Hannity and Laura Ingraham repeated McCaughey's claim. The AARP, a non-profit lobby group for retired persons, responded that the sessions were in no way designed to encourage euthanasia, but would instead help seniors make better decisions and would help ensure that their wishes were followed. PolitiFact said the proposal provided Medicare coverage for optional counseling sessions for patients who wanted to learn more about end-of-life-planning.On July 24, 2009, an op-ed by McCaughey was published in the New York Post. In the piece, which was titled "Deadly Doctors", McCaughey falsely asserted that presidential advisor Ezekiel Emanuel believed disabled people should not be entitled to medical care, and quoted him out of context. On July 27, excerpts from the McCaughey's op-ed were read, with approval, by Representative Michele Bachmann on the floor of the U.S. House of Representatives. Within days, Rep. John Boehner, then the Minority Leader of the House and Rep. Thaddeus McCotter, the Republican Policy Committee Chairman, repeated claims that Section 1233 would encourage "government-sponsored" euthanasia, and Rep. Virginia Foxx charged that the proposal would "put seniors in a position of being put to death by their government." On July 30, former Republican House Speaker Newt Gingrich, declared that the House bill had "a bias toward euthanasia". The Washington Post reported on August 1, 2009 that the claim had been spreading via "religious e-mail lists" and internet blogs. In early August, members of Congress held town hall meetings that were marked by hostility—including shouting, sporadic, physical altercations and comparisons between the proposed reforms and Nazi Germany.
Palin's initial statement
, who had been keeping a low profile after her July 3, 2009, resignation announcement as Alaska's Governor, was the first to use the "death panel" term on August 7, 2009. In her first Facebook note, she said:Although Palin's post did not identify a portion of legislation she believed mandated "death panels", a spokesperson pointed to HR 3200, Section 1233, and Palin herself followed up in an August 12 Facebook note clarifying her argument by discussing Section 1233. However, neither Section 1233 nor any other provision in any health care bill provided for a system to determine if individuals were worthy of health care. Yet, Palin's charge of "death panels" became believed by about 30% of those surveyed in the U.S. within a week.
Proposed policy
Legislation providing for counseling patients on advance directives, living wills and end-of-life care had been on the books for years, however, the laws did not provide for physicians to be reimbursed for giving such counseling during routine physical exams of the elderly. The Patient Self-Determination Act requires health care providers, including hospitals, hospices and nursing homes to provide information about advance directives to admitted patients. The Medicare Prescription Drug, Improvement, and Modernization Act began providing reimbursements for end-of-life care discussions with terminally ill patients in 2003.A bill to provide for reimbursement every five years for office visit discussions with Medicare patients on advance directives, living wills, and other end of life care issues was proposed by Rep. Earl Blumenauer in April 2009—with Republican cosponsors Charles Boustany, a cardiovascular surgeon, Patrick Tiberi, and Geoff Davis. The counseling was to be voluntary and could be reimbursed more often if a grave illness occurred. The legislation had been encouraged by Gundersen Lutheran and a loose coalition of other hospitals in La Crosse, Wisconsin that had had positive experiences with the widespread use of advance directives. Blumenauer's standalone bill was tabled and inserted into the large health care reform bill, HR 3200 as Section 1233 shortly afterward. Supporters of the Section 1233 counseling provision included the American Medical Association, AARP, the National Hospice and Palliative Care Organization, and Consumers Union; the National Right to Life Committee opposed "the provision as written". It was removed from the Senate version of the bill due to the death panel controversy and was not included in the reconciled and final bill which became law in March 2010 and which is known as the Patient Protection and Affordable Care Act.
In late December 2010, it was reported that a new Medicare regulation had been approved that would pay for end-of-life care consultations during annual physical exams. The regulation was to be effective January 1, 2011, but was deleted on January 4 for political reasons.
Reaction
The "death panel" myth produced widespread reaction among the media, physicians and politicians.Media
The Economist said the phrase was used as an "outrageous allegation" to confront politicians at town hall meetings during the August 2009 congressional recess. The New York Times said the term became a standard slogan among many conservatives opposed to the Obama administration's health care overhaul. Former Newsweek editor Jon Meacham said it was "a lie crafted to foment opposition to the president's push for reform" and Fox News analyst Juan Williams said "of course there is no such thing as any death panel." The Christian Science Monitor reported that some Republicans used the term as a "jumping-off point" to discuss government rationing of health care services, while some liberal groups applied the term to private health insurance companies. Journalist Paul Waldman of The American Prospect called the "death panel" charge a consequential policy lie, a falsehood about a policy that had definite effects on the policy, a type of lie that is not as condemned in the media as personal lies.The Daily Telegraph noted that some critics of the U.S. reform used the United Kingdom's National Institute for Health and Clinical Excellence —"as an example of the sort of drug rationing that amounted to a 'death panel'". NICE, as one of its functions, uses cost-effectiveness analysis to determine whether new treatments and drugs should be available to those covered by Britain's National Health Service. The Sunday Times wrote that Sarah Palin's use of the "death panels" term was a reference to NICE.
Physicians
C. Porter Storey Jr. said the term represents fear that due to financial pressure "some mechanical, governmental method will be used to determine how much of our scarce health care resources will be applied to their situation." Atul Gawande, a surgeon and writer, said that fear of missing out on an expensive life-extending treatment is behind the phrase, but he thought that framing the issue in this way was completely mistaken. "he trouble is not whether we're going to offer a $100,000 drug to help someone get 3 or 4 months"; our big trouble is that patients receive a $100,000 drug that not only yields no benefit—it also causes major side effects that shortens their lives", he said. Gawande said doctor's schedules of 20 minute appointments, a lack of payments and the emotional difficulty of conversations about mortality were barriers to the doctor-patient discussions about end-of-life care issues, which can take about an hour.Geriatric psychiatrist Paul Kettl said his experience in a geriatric unit showed end-of-life discussions and reimbursements were "desperately needed" as these hour-long conversations are "ignored in the crush of medication and disease management." In the Journal of the American Medical Association, Kettl wrote he was in favor of the "death panels that were originally proposed ... periodic discussions about advance directives that Medicare would pay for as medical visits." Kettl noted that the attention-catching phrase "death panels" became "a lightning rod for objections to a series of ideas about health care besides" end-of-life discussions, and that somehow, "the concept of physicians being paid for time to talk with patients and their families about advance directives ... generated into the fear of decisions about life and death being controlled by the government." Kettl also wrote that, "We can expect more good medical ideas to be destroyed by sound bites and needless concerns that will be exaggerated. It makes for good television, but bad medicine."
The American Society of Clinical Oncology published a statement in January 2011 advocating an individualized approach to treatment and supportive care for patients with advanced cancer. They stated that there is:
Benjamin W. Corn, a cancer specialist, wrote in the New England Journal of Medicine that the "death panels" controversy showed Americans were uneasy discussing topics related to the dying process. Corn said the end-of-life care conversations can have an important positive effect on patients, although some patients may not ever welcome them. Corn also said that certain issues, such as whether experimental therapies should be reimbursed, the possible expansion of hospices, restoring dignity to the process of dying, and guidelines for physician assisted suicide, need to be addressed directly. David Kibbe, a physician, and Brian Klepper, a health care analyst and consultant, wrote, "One of American politics' most disingenuous conceits is that health care must cost what we currently pay. Another is that the only way to make it cost less is to deny care. It has been in industry executives' financial interests to perpetuate these myths".