NEW YORK TIMES: Jeb Bush Proposes Requiring Medicare End-of-Life Directives
As originally appearing in The New York Times


MANCHESTER, N.H. — Jeb Bush, defending his efforts to keep alive Terri Schiavo, a brain-damaged woman, when he was governor of Florida, suggested on Friday that patients on Medicare should be required to sign advance directives dictating their care if they become incapacitated.

A similar proposal by President Obama — that doctors should be paid to advise patients on end-of-life decisions — became a political firestorm in 2009, when Sarah Palin, the former Alaska governor and vice-presidential candidate, claimed that the legislation would give bureaucrats the power to decide if some frail or disabled people were deserving of medical care. The assertion was shown to be false.

In 2010, Medicare tried to add a regulation that would permit “voluntary advance care planning” during yearly checkups. But after an uproar, President Obama’s administration pushed to drop that provision.

Mr. Bush’s suggestion that advance directives be required under Medicare showed how much public opinion has shifted on the subject since.

Speaking at the “Politics and Eggs” forum in Manchester, an important stop on the circuit for presidential candidates, Mr. Bush, a Republican, was asked about his handling of the case of Ms. Schiavo, which was a flash point in the culture wars during the presidency of his brother, George W. Bush.

Ms. Schiavo’s husband wanted her feeding tube removed, but her parents wanted to keep it in place. A law Jeb Bush signed that allowed him to weigh in on the case was ruled unconstitutional.

“It was one of the most difficult things I had to go through,” Mr. Bush said. “It broke my heart that we weren’t successful in sustaining Terri’s life.”

He added: “I don’t think I would change anything. I stayed within the constitutional responsibilities, or authority, that I had.”

However, Mr. Bush said, “In hindsight, the one thing that I would have loved to have seen was an advance directive where the family would have sorted this out” before courts became involved.

“I think if we’re going to mandate anything from government, it might be that if you’re going to take Medicare, you also sign up for an advance directive where you talk about this before you’re so disabled,” Mr. Bush said.

Speaking to reporters after his address, Mr. Bush was asked two questions he has faced frequently: was he a moderate, and how would he separate his views from those of his father and brother, who each served as president?

Things are different from “when my brother was up here in 1999, and certainly like light years away from the ’80s, so ideas need to be about the future and I’ll get a chance to do that,” Jeb Bush said.

Comparisons with his father and brother, he said, were “not particularly relevant.”

And when a reporter asked about the fact that people think he’s a moderate – “Why, pray tell?” Mr. Bush interrupted – he replied that his record in Florida, as the Schiavo case showed, was conservative.

“What’s accurate is, I am who I am,” Mr. Bush said. “I’m not angry. I’m not trying to divide, I’m trying to persuade. Perhaps moderate in tone is misinterpreted as moderate in beliefs.”

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