"Transforming Traditional Care to Palliative Care - Repackaging Death as Life"

Elizabeth Wickham
Elizabeth D. Wickham, PhD
Executive Director, LifeTree
Presented at "Preventing Stealth Euthanasia" Conference
Chicago, IL, Saturday, Nov 9, 2013
Sponsored by Illinois Right to Life & Pro-Life Healthcare Alliance
Reproduced with Permission

I am grateful to the Prolife Healthcare Alliance and Illinois Right to Life for this opportunity to speak to you today. Thanks to each of you for coming.

It is a homecoming of sorts, because it was here in Chicago that my husband and I began our married lives together nearly a half century ago. The world of healthcare was much different then.

Today, in these next few minutes, we will describe how the society has been duped by those who wish to control dying. Their successes were gradual as planned. Before people would accept euthanasia a profound change in our moral sentiments was necessary. They took charge of the language and began an education campaign to change our view on death. Passage of the Affordable Care Act reinforced their victory. The harsh reality is that, unless we are healthy and then suddenly die in our sleep, ALL of us will be impacted because these social surgeons have fundamentally transformed our healthcare system!

I want to acknowledge a brilliant researcher who has educated me for over 10 years. Ione is THE expert on these issues. Her work is nothing short of genius.

Slide 1 -- Dr. Diane Meier, Director of the Center to Advance Palliative Care, speaks at Madison-Dean Initiative 3/28/11

Why is a trained economist talking about stealth euthanasia? Do you remember that those who pressed for health care reform warned that health care spending was the primary threat to the American economy? Soon after passage of the Affordable Care Act Dr. Diane Meier, Director of the Center to Advance Palliative Care, spared no words in criticizing traditional fee-for-service care, calling it a threat to the American economy:1

"It's not fair to expect the US government to be able to change the US's addiction to fee-for-service overnight. Those of us in medicine know you don't take an addict cold turkey ...; you have to taper, or the patient will die... It has to be a gradual process of change. And that gradual process is what's built into the health reform bill. Very gradual increases in paying people for quality, helping people to get used to working under a fixed budget, which we used to call capitation, but now we call it accountable care organizations and patient-centered medical homes and bundling strategies.... Now, that was very effectively bashed both during and after health reform, as rationing and euthanasia... but the fact remains that unless we are able to think about both quality and costs, we will become a third world nation ourselves, just because of healthcare spending."

Really? The best healthcare system in the world leads to economic failure? Two questions come to my mind. Who is defining quality healthcare and why do we need to capitate healthcare expenditure? Why not search for ways to grow the economy and let healthcare expenditures grow accordingly? Inherent in what she says is a unique "value equation" that has become so much a part of the implementation of the ACA. More about that later.

We must very carefully listen to what they say because we are dealing with gnosticism where black is white....and life is death.

The new healthcare law is all about directing resources away from medical research and high-tech medical care to resources that emphasize supportive and comfort care only. So there will be less "real" healthcare. Yes, there is an invisible hand at work, but it doesn't belong to Adam Smith!

The evidence is there -- the uproar about government funded annual End-of-Life consulting sessions for medicare patients, for example -- and, thanks to Ione's brilliant research, a chronology of the bigger picture with names of individuals, organizations and coalitions, together with their funding, is available on the LifeTree website.

Withholding or withdrawing food and water from patients who are not actively dying and who are in palliative sedation is labeled "natural death" these days. Decisions to withhold and withdraw ordinary medical treatment which were once thought controversial are now commonplace.

Slide 2 -- Leadership Circles by Ione Whitlock

This "new" eugenics movement began a few decades ago with the coming together of several groups: 1) the original euthanasia/eugenics people, 2) bioethics centers, 3) providers of healthcare, 4) "grassroots" / community organizations and 5) private foundations.

That movement is all about influence over the minds and hearts of the people who care for the dying -- caregivers, physicians, nurses, chaplains, social workers to name just a few --- so that they can control the timing and place of death.

We will outline how a group of "social engineers" were able to succeed without drawing much attention from the pro-life movement. They are so close to their ultimate goal of making their version of EOL care MANDATORY that it is absolutely critical we become better informed!

A brief history

The modern euthanasia movement in America emerged in the 1930s and was known as the Euthanasia Society of America. Euthanasia proponents sold themselves as pain relief for the dying.

Their first strategy was to secure legalization of passive euthanasia or the withholding and withdrawing of medical treatment as a way to change public opinion to accept active euthanasia, commonly known as physician assisted suicide. But there were conflicts within the movement and by 1980 there came to be two distinct wings when the more militant broke off.

We are all very familiar with the militants, their various organizations over the years -- Hemlock Society, Compassion and Choices, Death with Dignity -- and their successes in legalizing assisted suicide.

But the moderates have remained the proverbial elephant in our living rooms. They have distinguish themselves by arguing that they offer the moral high ground. This more nuanced wing has called itself the Society for the Right to Die and Concern for Dying in the 70s and 80s, Choice in Dying in the 90s, Partnership for Caring in the late 90s, and Last Acts Partnership in the early 2000s. Then they seemed to disappear, but the evidence shows they have quietly filtered into the new field of palliative medicine...

For ten years we at LifeTree have researched this more nuanced wing. In her 2005 book Terri's Story: The Court Ordered Death of an American Woman, author Diana Lynn describes it as the "third path" to death, not wholly natural, not suicide, but something in between.

These moderates insist there is a big difference between withholding and withdrawing medical treatment and giving someone access to a lethal dose of barbiturates. The more militant, on the other hand, see little or no difference. Professor Dowbiggin points this out in his book A Merciful End-- The Euthanasia Movement in Modern America: "Derek Humphry, Faye Girsh, and Timothy Quill all object to the hypocrisy of outlawing physician-assisted suicide, while permitting the practice of physicians drugging pain-wracked dying patients into comas and then removing hydration and nutrition so that the patients die of starvation and dehydration, in what is called 'terminal sedation'."

During this time, medicine has been changing. In 1987 Dr. Josefina Magno of Washington DC, and Dr. Gerald Holman, director of St. Anthony's Hospice in Amarillo, Texas called a meeting of hospice physicians in Granby, CO to form what later became known as the American Academy for Hospice and Palliative Medicine (AAHPM), the professional organization for palliative physicians.2

Slide 3 -- Form 990 for PfC in calendar year 2001

Right-to-Die Partnership for Caring came to be in the late 90s when AAHPM and Choice in Dying came together. PfCs IRS Form 990 shows they self-identified as a Right-to-Die organization. The bottom of the slide shows that they reported their exempt purpose as "Right-to-Die"

Dr. Ira Byock of AAHPM and Karen Kaplan of Choice in Dying described the purpose of the merger in the Partnership for Caring newsletter: "Partnership for Caring will engage in high visibility, high impact activities on both national and grassroots community levels to meet two basic goals. The first ... is to raise awareness in patients, families, and their providers -- about the kind of care that every person in this nation deserves at life's end. The second ... is to create a chorus of informed demand among consumers for improved end-of-life care that cannot be ignored."3

In other words, Partnership for Caring would conduct a major public relations campaign to gain public support and a political mandate for their agenda. According to their 990 form they would hold presentations and training workshops, special events and provide members with information describing people's options and rights with regard to life sustaining treatments.

Let's take a brief look at the early strategies, people, projects and funders of the "third path"

Many foundations funded this low profile euthanasia movement, but two stand out as the leaders. The Robert Wood Johnson Foundation funded research and infrastructure and George Soros' Project on Death in America (PDIA) funded a cadre of professionals. In the last 20 years these two foundations have provided several hundred million dollars to advance THEIR VERSION OF PALLIATIVE CARE into our American health care system and worldwide.

Were you aware that the Robert Wood Johnson Foundation celebrated its 40th anniversary last year? From its beginning, the Foundation acted like a quasi-university, allowing intellectuals to test ideas with the Foundation's money. The Foundation is notorious for funding pilot projects so that it can later convince government to replicate them on a much grander scale.

Starting in 1989, RWJ launched the six-year SUPPORT study of how 10,000 patients were cared for at the end of their lives. Dr. Joanne Lynn, who is currently Director of the Altarum Institute's Center for Elder Care and Advanced Illness (CECAI), led the study.

During this time, the Clinton attempt at health care reform had failed. Death and dying was a hot topic. Trumpeting the SUPPORT study in the news their message became: "The way we care for people who are dying and their families is dreadful. But with adequate communication we could change all that… just get people to fill out living wills and forego treatment." But it didn't work. Fewer than 20 percent of us signed living wills.

Slide 4 -- list of participants at Soros meeting in Nov. 1995

Enter George Soros in the mid-90s. His 1994 speech at Columbia Presbyterian Medical Center announcing the formation of Project on Death in America included this summary statement: "The mission of the Project is to promote a better understanding of the experiences of dying and bereavement and by doing so help transform the culture surrounding death.

In November of 1995 Soros called 20 foundations together who were committed to transforming the culture of dying.4 In addition to Soros' Project on Death in America, his Open Society Institute and RWJ, the list of attendees include some people from many other foundations ---- AARP, Commonwealth Fund, Greenwall Foundation, Mayday Fund and Kornfeld Foundation, Milbank Memorial Fund, Nathan Cummings Foundation, the Rockefeller Family Office, and the Gerbode Foundation.5

Slide 5a -- participants at first Last Acts Conference

Also in 1995 RWJ began a big communications and outreach effort called Last Acts. Last Acts worked at the grassroots level. They held their first Leadership Conference in March, 1996. 140 national leaders came to Washington, DC.6

Notice that bioethics (Hastings Center, Center for Practical Bioethics in KC and Park Ridge Center in IL), providers (American Hospital Foundation, American Nurses Association, Hospice Foundation of America, National Association for Home Care), Euthanasia (Concern for Dying) and many foundations were all there.

Slide 5b -- participants at first LA Conference cont

Daniel Callahan described the Last Acts three-pronged strategy moving forward.

They needed some bridges with two way traffic between those working on the big picture at the institution level and those advocates and activists working in the communities.

The first Soros-scholar-led projects were directed at professionals --- EPEC was for physicians and ELNEC was for nurses. Other projects were aimed at changing the general culture including RC EPEC for Roman Catholics and APPEAL for African-Americans.

Soros' Project on Death in America provided the physician leaders to integrate RWJ projects into mainstream America. His PDIA Faculty Scholars were quickly in place in many of the country's medical schools.

.....(For those who are interested in learning more about the chronology of the "third path" euthanasia movement, see LifeTree's timeline -- long version at www.lifetree.org/timeline or short version at http://www.lifetree.org/timeline/EOLchronology.pdf.)

Their institutional engine of change was a new view of palliative medicine ...

Slide 6 -- Newsweek cover

So said Newsweek in its cover story on October 9, 2006 titled "Fixing America's Hospital Crisis." This is what it had this to say:7

"Determined people .... are transforming the way U.S. hospitals care for the most seriously ill patients. The engine of change is palliative medicine."

It was interesting to discover that Newsweek chose the same phrase as we have been using for several years to summarize the main reason transformation has been so successful.

Slide 7 -- Traditional view vs current view of palliative care

Today's palliative care is much more than symptom management. It is a PROCESS. In the beginning palliative care applied to cancer patients. See the contrast between old and new pictured in a 2001 article in the Journal of the Royal Society of Medicine.8 The traditional (old) view of palliative care was associated with volunteer hospice care for these patients. The current (new) view of palliative care is not only for cancer patients. This diagram shows that the new view is to introduce palliative care at the time of diagnosis, and then increase the PROPORTION of symptom management "palliative" treatments to traditional "curative" treatments to the point of death. Note that palliative care includes a period of managed grief.

The "third path" is totally committed to "upstreaming" or changing the American healthcare system so that palliative care is integrated with traditional care early on.

The official definition of palliative care is still a work in progress, but this much is certain. Palliative care is critical to the success of health care reform! So if we are unhappy with the Affordable Care Act WE NEED TO UNDERSTAND PALLIATIVE CARE.

Their unified message is that palliative care is supposed to improve QUALITY of care for all with serious illnesses OR those who have several chronic conditions.

Eight Palliative Care Training Centers (PCLCs) are run by Dr. Meier's Center to Advance Palliative Care. They are training people who work in all healthcare settings -- hospitals, rehab centers, nursing homes, assisted living centers, outpatient clinics, senior centers, volunteer respite caregivers, volunteers at healthcare community centers, ... The list goes on.

Coincidentally, this weekend is a big training weekend for CAPC.In cooperation with the American Cancer Society and the American Hospital Association, CAPC is holding its National Seminar in Dallas. Attendees are paying $1,045 to hear 86 seminar faculty experts in palliative care over the course of 3 days. "Palliative Care has arrived in the mainstream" will be Diane Meier's opening address.

Slide 8 -- Characteristics of a Shift in the Conception of Health and Health Care

To help understand the philosophic difference between traditional EOL care and the new palliative EOL care we turn to a 2001, Last Acts document called "Report on Transforming Death in America: A State of the Nation Report."9 It compares and contrasts the OLD MODEL with today's EXPANDED (NEW) PALLIATIVE CARE MODEL. Let's read the table carefully.

First, in the old model health is defined as physical health and the absence of disease, but in the expanded model health includes mental, social, spiritual and physical health. The goal of the old model was to find a cure for the disease, but the new palliative care model seeks only to promote functional capacity and well being. Note the term "functional capacity." It indicates a very secular notion of personhood. Third, the old model's context is acute episodic illness and treatment of disease while in the new palliative care model context treats the whole person (physical and spiritual) in the context of chronic illness, as well as acute illness and treatment of disease.

Finally, the term "expanded model" suggests that all the features of the OLD MODEL are present in the new model. But notice what they say about value in the old model. "Defeat Death!" What does that mean? Did the old model really believe death could be defeated? Notice that value in the new palliative care model includes 1) prevent illness, 2) prevent injury and untimely death, 3) relieve suffering, and 4) provide care for those who cannot be cured. Lots of room for hastening death there.

The CAPC-SOROS-RWJ version of palliative care is about coordination of care by an interdisciplinary team (IDT). The main members of the IDT are physicians, nurses, social workers and chaplains. Nutritionists, respiratory therapists, physical therapists, music therapists and caregivers can also be part of the team.

The palliative care team helps develop relationships. It is designed to promote and then help implement advance care planning. The team communicates risks and benefits of various treatments with an emphasis on "realistic" expectations, discusses the patient's concerns -- all with the objective of helping the patient develop goals of care. The underlying problem is that they emphasize supportive rather than "real" medical services, and they base their analysis on a quality of life index. The palliative care team will insert itself into the family dynamic and try to bring consensus that it is time to "let go"!

Progress to "maturity" of palliative medicine

The rapid rollout of palliative medicine as a board certified specialty has been nothing short of phenomenal. Here's a brief timeline.10

Slide 9 -- timeline of the steps to palliative care maturity

2001 to 2004, the National Consensus Project for Quality Palliative Care, with the collaboration of four major palliative care organizations and Partnership for Caring, develops and issues the National Consensus Project Guidelines.

2006, hospice and palliative medicine becomes an official medical subspecialty.

2007, building on the Guidelines, the National Quality Forum establishes its National Framework and Preferred Practices for Palliative and Hospice Care. There are 38 Preferred Practices within 8 Domains. Here is one example:

Preferred Practice 22: Specialized palliative and hospice care teams should include spiritual care professionals appropriately trained and certified in palliative care.

Put another way, they are educating your priests, ministers and rabbis. The Florida Clergy End-of-Life Education Enhancement Project is a model program to educate the clergy about accepting hastened death.

2008, the first board-certifying examination in hospice and palliative medicine is offered. The Graduate Medical Accreditation Council also approves program requirements for fellowship training in hospice and palliative medicine.

For only four years -- 2008-2012 -- no palliative care fellowship is required for anyone to sit for the exam to become board certified.

Starting this year, in 2013, only fellowship-trained palliative professionals are allowed to sit for the certification exam. It is very significant that you can no longer be grandfathered in without official fellowship training!

2013, the Guidelines for Quality Palliative Care are revised to reflect rapidly evolving clinical practices resulting from new mandates for quality under the Affordable Care Act.11

In summary, they created the standards, got the specialty officially recognized, and now require that you complete one of their fellowships before you can even sit for the board examination --- all in the last 12 years!

Slide 10 -- The Value Equation

Under the Affordable Care Act, the new healthcare imperative is to improve value V where V = Quality/Cost.

So how do they go about defining quality in healthcare?

Slide 11 -- NQF definition of quality

They look to the National Quality Forum, a national membership organization created by RWJF to develop and implement national quality measures of improvement. NQF has adopted the Institute of Medicine's six quality goals.12

Notice that we are no longer talking about health care that is essential for living, but rather that which is deemed important as reflected in the 4 principles of bioethics -- autonomy, non-malfeasance, benevolence and justice.

Categories of health and CAPC Triggers for Palliative Care: More Tools for the Planners.

Slide 12 -- Lynn's eight categories of health

The importance of electronic health records to the "third path" movement cannot be overestimated. They plan to use EHRs to segment the population as a tool for guiding clinicians IN FUTURE DECISIONS ABOUT CLINICAL CARE. Dr. Joanne Lynn has outlined eight categories of health to separate out the curable from the not curable --- 1) Healthy, 2) Maternal and Infant, 3) Acutely ill but mostly curable, 4) Chronic condition, normal function, 5) Stable but significant disability, 6) Short period of decline near death, 7) Organ system failure, and 8) Long dwindling course (frailty, dementia).13

In 2007, Dr. Joanne Lynn was the lead author of a Center for Medicare Services (CMS) article proposing a "Bridges to Health" model. That model specifically marries the six NQF bioethics quality goals to these eight patient categories and proposes that the planners shift to a matrix model of "resource allocations" over the 48 cells in the matrix, and away from the traditional model of tailoring services to each patient's situation which is said to be too difficult and costly.14

Make way for the army of planners. In her recent www.belburyreview.com posting, Ione has correctly observed that most of Dr. Lynn's work has been about constructing more efficient "bridges to death."

Slide 13 --- CAPC Triggers

Under the direction of Dr. Diane Meier CAPC has become a well-oiled training and marketing machine. Among its projects was to develop a list of triggers for recommending palliative care consultation in the presence of a serious or chronic illnesses.15 Several of those triggers indicate clearly how the new palliative care does not wait to enter at the end of life like it used to!

These triggers will introduce the palliative care process into patient populations which may be declining, but are not dying. Note especially that those with limited social support and/or declining abilities are identified as ripe for palliative care.

Last Acts focused on Communities -- Community-State Partnerships

Slide 14 -- list of C-SPs

We now shift our focus from the planners to action at the grassroots level.

As part of Last Acts, RWJ funded an $11.25 million national framework for statewide activities called Community-State Partnerships. The National Program Office was at the Center for Practical Bioethics in Kansas City. Grants which averaged $450,000 were given to set up 25 statewide coalitions, often tapping into established bioethics networks.16

These state-wide coalitions acted as "social entrepreneurs" at the grassroots level. You may recognize some of their advocacy activities at the state level. They advocate 1) for required professional training in palliative care, 2) for POLST legislation, 3) for better reimbursement for palliative care, 4) to reduce restrictive requirements of pain policy boards, and 5) to mandate honoring of patients' advance directive choices.17

The Carolinas Center for Hospice and End of Life Care got my attention in 2003 after a bill to criminalize assisted suicide was introduced in North Carolina. This C-SP was working with the Center for Practical Bioethics in KC to promote the NC legislation. The bill had four lengthy exceptions which would have legalized certain forms of euthanasia. Under its exception language the starvation/dehydration/terminal sedation scenerio could not be prosecuted.

After committee hearings, seven revisions, and much lobbying, when the bill draft was changed to incorporate the Michigan language enacted to stop Kevorkian, the Carolinas Center for Hospice and End-of-Life Care withdrew their support, claiming that the revised language would have a "chilling" effect on pain management. The bill died in committee in 2003 .....

Until this spring.... when a bill titled "Unlawful to Assist Another to Commit Suicide" was introduced in NC. The exception language is back again which makes the bill unacceptable. The ban does not apply to withholding or withdrawing medical treatment. And, it is unlawful to overuse medications only when the intent is to kill. Since intent is always hard to prove beyond reasonable doubt and medical treatment is not defined, these exceptions are very large loopholes.

Together with the POLST paradigm which passed in NC in 2007, this ban on PAS with its exceptions move the "third path" toward their goal --- to legalize death hastening with full immunity from criminal prosecution. Unfortunately, several states have already passed both of these two bookend pieces of legislation.

Check out the Coalition to Transform Advance Care!

Slide 15 -- C-TAC member organizations

We call your attention to this new coalition which has been "under the radar" these last couple of years. The Last Acts Partnership people have come together again for round two by forming a new, much larger coalition to manage the news media. The director of Center for Practical Bioethics and a former head of AARP joined forces with a former chairman of Partnership for Caring to form the Coalition to Transform Advance Care. Keep your eye on C-TAC!

C-TAC is a unique group of 120 members or "stakeholders" across the world of healthcare including the same five groups that we identified at the beginning of our talk.18 This new "third path" juggernaut is deep into our society, working to "create change in normative and expected behavior regarding advance illness", working to change our moral sentiments and avoid any future "death panel" hysteria.19

They talk about "Patient-centered" Decision Making, but their argument is more like The Tragedy of the Commons. Whose autonomy is it anyway?

The traditional understanding of medical decision making was based on a patient/family consultation with the specialist or general physician who was trained to "DO NO HARM". Today we hear more about informed consent and that it leads to patient-centered decision making. We hear that palliative care is about matching the care provided to what a patient wants.

However, if you read carefully what they say, the Interdisciplinary Team (IDT) is trained to find consensus based on "communitarian" ethics -- a mini-version of bioethics. Decisions are based on what is the greatest good for the community, rather than the good of the patient!20

According to the principles of communitarianism, if there are social consequences or the community suffers from allowing people to obtain the service they want, then someone has to say "NO!"

Listen to what the current president and CEO of the National Quality Forum, Dr. Christine Cassel, had to say in 2007 about managing medical resources for the population's health, rather than the individual's health.21 "Physicians must be committed to managing medical resources. This responsibility is controversial largely because it can be seen as in conflict with the more traditional altruistic commitment of the physician to the patient..." She continues, "The fee-for-service model does not allow physicians to affect where saved resources go, so why would they try to avoid costly interventions in the name of helping other patients?..." It's the old Tragedy of the Commons argument.

Now, this year in the same journal JAMA, the command is more emphatic. Rationer-in-Chief Dr. Ezekiel Emanuel gives physicians the ultimatum.22 "Physician autonomy and leadership can only be affirmed if accompanied by acceptance of responsibility and accountability. Unless physicians want to be marginalized -- unless they are willing to become just another deckhand-- they must accept and affirm that they are responsible for controlling health care costs."

A friend recently reminded me of Judge Robert Bork's comment in Slouching Towards Gomorrah where he wrote "It is ironic that our supposed 'freedom' to choose death has made it far easier for others to choose our death as the autonomy is often theirs, not ours."

A quick look at Caregiving -- one more community lever to change society!

In a recent interview with the Center for Practical Bioethics Dr. Joanne Lynn calls for more community involvement. According to Lynn, "We have overinvested in medical care. We have had the wrong set of priorities. What we need is more community volunteers to give companionship, food and keep people safe." Lynn argues that hospice manages those who die within a short period of time, but our system lacks a well-funded program to address those with multiple chronic conditions.23 (The expensive ones!)

She is saying that better quality healthcare means more community healthcare organizations and fewer hospitals!

RWJ infused over $200 million into the caregiving industry. In 2001 alone the Foundation gave $112 million to develop Faith in Action (FIA) which trains community volunteers who are available to offer free respite care to family caregivers, home care and other supportive services. In 2008 Faith in Action became the National Volunteer Caregiving Network but the goals are the same. They especially wish to work with faith-based communities so look in your Church bulletin. Here's what you might find:

Slide 16 -- Church bulletin

One of the "third path's" strategies is to "mobilize" family caregivers to apply pressure for policy reform. National standards for the caregiving industry are popping up all over the place. Just last month the US Department of Labor mandated that "direct care" workers must be paid the minimum wage.24 California is considering a law that would require all home care aides to be certified and licensed to meet government guidelines.25 What we need to think about is whether all this political activity in the caregiving industry will benefit the patient. Or will the increase in the cost of regulated caregiving make families be more willing to concede to the pressures of palliative care?

Here is one way Alinsky-like community health rationing is hidden in the Affordable Care Act.

After the Affordable Care Act passed in 2010, Dr. Joanne Lynn spent one year in Colorado advising the Colorado Foundation for Medical Care to build power with emphasis on collective action. Experiences community organizers convened to "organize for health," to help community-based organization throughout the country apply for new federal grants.26

$500 million in the Affordable Care Act has been allocated to the Community-Based Care Transition Program (CCTP). CCTPs are government-approved partnerships between acute care hospitals and community-based organizations. Since October of last year hospitals are being taxed for readmitting certain medicare patients within 30 days of discharge. The main purpose of CCTPs is to keep patients from "bouncing back."

There are currently 102 CCTPs. These programs seek to standardize the way people move across care settings using a trained "community supports navigator" (CSN) who coaches the patient and family to make sure the patient has decided on goals of care, and who looks for "red flags" when the patient's condition worsens so as to notify a palliative care team. Note: This navigator is specifically hired by the CCTPs and is different from the one in the news this week that navigates the exchanges for patients.

Here's how the Alinsky-like rationing comes in. The CCTPs are paid a flat rate per beneficiary served, but the CCTP is able to allocate funds WITHIN the target population as they wish, determining who will get more services and go the hospital and who will get less and be referred to palliative care. These CCTPs will have access to your Electronic Health Records from which to guide their decisions. As Dr. Joanne Lynn said, "These are organizations with CLOUT!"

Listen to how Daniel Callahan, a major "third path" proponent, described a problem back in 1983: "Denial of nutrition, may, in the long run, become the only effective way to make certain that a large number of biologically tenacious patients actually die," … And (he observed that) a "deep seated revulsion" exists over the prospect of withholding or withdrawing nutrition and hydration.

In late 1984, a story appeared in the New York Times. It is important because it described how both wings of the right-to-die movement and emerging bioethics think tanks such as the Hastings Center, led by Daniel Callahan, were working TOGETHER to change attitudes and behavior…working to change the culture…painting the issues in terms of compassion versus technology.27 We have described how all of this has played out to you today in some detail.

We ask you to carefully examine the new field of palliative medicine that has a planned set of triggers to initiate an IDT consultation, downplays the curative power of technology, gives us more federal bureaucracy with access to our electronic health records to categorize the population, employs lavish use of morphine, and times our death based upon a team-coached decision.

Palliate means to reduce violence of a disease. Palliative care used in the right hands can make the patient experience more tolerable. Palliative care should enhance the remainder of each individual's life, not rush them to death.

If you are being offered palliative care today, the chances are that it is the (CAPC) version. The number of professionals practicing the old palliative care is in decline. Soros- and RWJ- funded people have established the guidelines and regulations for palliative care as it is officially practiced now. Each day physicians, nurses, chaplains and social workers are being exposed to their propaganda and then required to practice it.

We pray to the Holy Spirit and to St. Joseph that this message falls on fertile ground. We are all called to become better informed. People who want to understand will be like watchmen in the night, guarding and defending their loved ones from stealth attacks in the final chapter of life.


1 "Palliative Care: A Cure for Meaningless Suffering" featuring Diane E. Meier, MD, FACP, video at http://www.vnacares.org/health-care-services/end-of-life-care/madison-deane-initiative [Back]

2 "Conclusion: The 1990 and beyond" (Chapter 6, p. 175), A Merciful End: The Euthanasia Movement in Modern America, Ian Dowbiggin, Oxford University Press, 2003 which cites Humphry and Clement, Freedom to die, 190; author's telephone interview with Timothy Quill, 2001 [Back]

3 "Partnership for Caring-- The Voice for the Dying", by Karen Orloff Kaplan and Ira Byock, Choices, vol 7, No 4, Winter, 1998 [Back]

4 http://web.archive.org/web/2001062207225/http://www.soros.org/death/george_soros.htm [Back]

5 http://web.archive.org/web/20070210230310/http://www2.soros.org/death/news1.htm [Back]

6 http:web.archive.org/web/20030716044919/http:www.lastacts.org/la_la_ala/la_abt_conf-d.htm [Back]

7 "Fixing America's Hospital Crisis, Newsweek, October 9, 2006 at http://www.msnbc.msn.com/id/15175919/site/newsweek/ [Back]

8 See "UK strategies for palliative care" by Llora Finlay, J R Soc Med, 2001; 94: 437-441 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282181/ [Back]

9 Transforming Death in America: A State of the Nation Report, Prepared for Last Acts by Margaret Metzger, J.D. and Karen Orloff Kaplan, M.P.H., ScD, June, 2001, Washington, D.C., Figure 1, p. 7 at http://web.archive.org/web/20030817094653/http://lastacts.org/files/publications/stateofthenation.pdf [Back]

10 "The Development, Status, and Future of Palliative Care" by Diane Meier (Chapter 1), Palliative Care: Transforming the Care of Serious Illness, March 2010 at http//rwjf.org/files/research/4558.pdf [Back]

11 Clinical Practice Guidelines for Quality Palliative Care, Third Edition, National Consensus Project for Quality Palliative Care, 2013, www.nationalconsensusproject.org. See http://www.hpna.org/multimedia/NCP_Clinical_Practice_Guidelines_3rd_Edition.pdf. Also see www.qualityforum.org and [Back]

12 National Quality Forum, www.qualityforum.org; Institute for Healthcare Improvement www.ihi.org referred to on p. 55 of "The Development, Status, and Future of Palliative Care" by Diane Meier (Chapter 1), Palliative Care: Transforming the Care of Serious Illness, March 2010 [Back]

13 http://belburyreview.com/wp/electronic-health-records-guiding-physicians-toward-best-practices/#.Ul5hH3LD9Mw and http://belburyreview.com/wp/using-health-records-to-segment-society/#.Ul5ha3LD9Mw [Back]

14 "Using Population Segmentation to Provide Better Health Care for All: The 'Bridges to Health' Model", by Joanne Lynn, Barry Straube, Karen Bell, Stephen Jencks, aned Robert Kambic, for Center for Medicare and Medicaid Services, U.S. Department of Health and Human Services, The Milbank Quarterly, Vol. 85, No. 2, 2007, pp. 185-208. [Back]

15 http://www.getpalliativecare.org/resources/clinicians/ [Back]

16 For a list of C-SPs see Appendix 2 in "Community-State Partnerships to Improve End-of-Life Care: A National RWJF Program, published October 14, 2004 by RWJF at http://www.rwjf.org/content/dam/farm/reports/program_results_reports/2004/rwjf69596 [Back]

17 "Community-State Partnerships -- Championing End-of-Life Care Policy Change" State Initiatives in End-of-Life Care, Published by the Midwest Bioethics Center in coperation with Last Acts and supported by The Robert Wood Johnson Foundation [Back]

18 http://advancedcarecoalition.org/our-members/ [Back]

19 See "C-TAC Hosts DC Conference" at http://belburyreview.com/wp/c-tac-hosts-dc-conference/#.Um-KeXLD9Mw [Back]

20 See Dianne Irving's "What is Bioethics?" at http://www.all.org/abac/dni010.htm for bioethicist Daniel Callahan's statement on the importance of communitarianism: "The Hastings Center's Daniel Callahan conceded in the 25th anniversary issue of The Hastings Center Report celebrating the "birth of bioethics," that the principles of bioethics simply had not worked. But not to worry, he said, we might try communitarianism now: 'The range of questions that a communitarian bioethics would pose could keep the field of bioethics well and richly occupied for at least another 25 years'." For Callahan's quote see Daniel Callahan, "Bioethics: Private Choice and Common Good," Hastings Center Report (May-June 1994), 24:3:31 [Back]

21 "Managing Medical Resources Return to the Commons?" by Christine Cassel, MD and Troyen Brennan, MD, JD, Journal of the American Medical Association, June, 13, 2007, Vol 297, No 22 [Back]

22 "Will Physicians Lead on Controlling Health Care Costs?" by Ezediel Emanuel, MD, PhD and Andrew Steinmetz, BA, Journal of the American Medical Association, July 24/31, 2013, Vol 310, No 4 [Back]

23 See video of Lynn's interview at the Center for Practical Bioethics at http://www.youtube.com/watch?v=yJszGpAq1WQ [Back]

24 http://belburyreview.com/wp/new-dept-of-labor-ruling-minimum-wage-for-home-health-in-all-50-states/#.UnFhf3LD9Mw [Back]

25 http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB322] [Back]

26 See Joanne Lynn's series of short videos on the Care Transitions Program Initiative at http://www.youtube.com/watch?v=qb46VHuaJLA&list=PLBCFE9967989A6F5E [Back]

27 "It's a ripple-in-the-pond effect. You've got to change attitudes and behavior, not legislation." Statement of A.J. Levinson, executive director of Concern for Dying, "Movement Seeks to Advance Rights of the Dying", New York Times, Dec 12, 1984 [Back]