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msnbc.com contributor
updated 12/29/2010 2:09:45 PM ET 2010-12-29T19:09:45

Watch out! The "death panels" are back. They are going to be used by Obama and his horde of federal health reformers to make sure that if you are old, very sick and go into a hospital, you will never return.

So goes the line of utter malarkey put forward with a straight face and Twitter finger last year by Sarah Palin, who notoriously and ridiculously coined the term "death panels" to vilify efforts to legislate paying doctors to talk with Medicare patients about their health care options if they become terminally ill. Her critique worked. The provision to pay doctors for the time involved to talk about end-of-life care for older Americans was dropped from the health reform bill.

But it has come back, this time in the form of regulations to be issued on Jan. 1 by the Department of Health and Human Services. If an elderly person is offered a chance to do advance care planning by their doctor and wants to do so, then Medicare will pay the doctor for the time involved.

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Some conservatives and right-to-lifers see rationing afoot. They think encouraging these discussions is simply a way to get old folks to save the federal government money by slyly tricking them into saying that they don’t want a lot of medical care if they are terminally ill. Not only are they wrong, they are dead wrong.

Talking with your doctor about what you want to happen and who you want to make decisions for you if you become terminally ill is something every American, young and old, should do.

If you want aggressive care to the very end then you need to say so. If you don’t want to be kept alive with technology should you have a deadly cancer that does not respond to treatment then you need to let your doctor and your family know.

Story: Obama enacts end-of-life plan that drew 'death panel' claims
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Few people are comfortable with the topic of death. Some, like Sarah Palin, seem to think that if they pull the covers over their head the Grim Reaper will go away. Not so. Each of us will face end-of-life decisions if not for ourselves then for our family or friends.

Anything, including Medicare money, that can encourage doctors, many of whom do not want to have this conversation with their reluctant patients, to do so is a sound, moral and prudent policy.

No one is telling you what you must say. No regulation says that you cannot insist that everything possible be done. No bureaucrat is whispering in your doctor’s ear to spin the conversation toward insuring your premature demise.

You can change your mind at any time about your views and wishes including during your time in a hospital, nursing home or hospice. Nothing is locked in stone by having this initial conversation about what you want and who you want to make decisions for you if you cannot do so.

If Terri Schiavo taught us anything, it was that you need to specify to your doctor and family who should make decisions for you about your medical care if you are unable to communicate.

If the political conversation over death panels and advance care planning has taught us anything, it is that Washington, D.C., is not the place to talk about end-of-life care — your doctor’s office is.

Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.

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