Priorities

“Before the hubbub,” as Senator Mark Warner, Democrat of Virginia, put it on Thursday, he was promoting the idea of government incentives intended to help Americans decide on medical care at the end of their lives.

After the hubbub — that is, after the recent controversy over so-called death panels — advisers asked if Mr. Warner wanted to end his initiative. He did not, and instead went ahead this morning with a town hall meeting in Arlington, Va., devoted to a topic that has roiled other lawmakers’ forums this month.

“Keep it civil,” said C. Douglas Smith, the executive director of the Virginia Interfaith Center, as he introduced Mr. Warner.

His admonishment was unnecessary, even two days after an area congressman’s forum was disrupted by protesters opposed to the end-of-life proposals. Mr. Warner’s audience at Resurrection Lutheran Church was a smaller, supportive group of mostly older constituents, including ministers, priests, rabbis, hospice care workers and at least one physician, all sympathetic to the notion of government assistance to help Americans plan for their final days while they still can and to train caregivers to help.

Recent remarks by some elected officials have been “embarrassing, outrageous” and “based on ignorance and a horrible effort to simply scare and frighten people,” Mr. Warner said. He named only former Governor Sarah Palin, Republican of Alaska, who wrote that Democrats’ health care plans would create “Obama’s ‘death panel.’”

At issue mainly is a provision in a pending House health care measure. Much like Mr. Warner’s separate proposal, it would have Medicare and Medicaid reimburse health care providers for counseling individuals about palliative care, living wills and advance directives — written instructions about the care they want when death is near. Mr. Warner’s bill also would extend the government programs’ coverage for hospice care to 18 months from six months and would allow patients to receive curative treatments as well as palliative care.

Like most of the 22 people who questioned him or made statements, Mr. Warner had a personal angle on the issue. His mother is among the estimated 70 percent of Americans who, he said, have no directives for care in their final days is. After more than a decade with Alzheimer’s disease, she is incontinent and unable to speak or feed herself.

Countering the critics of end-of-life incentives, Mr. Warner emphasized that the proposals would not limit anyone’s choices or care; an individual would be free to request aggressive treatment to be kept alive, or none. And, he added, the proposals are not aimed at saving the government money by encouraging quick deaths.

“I’ve never seen an issue that’s generated so much misperception and misinformation,” he said.

For just that reason, however, Father Gerry Creedon, a Catholic priest, suggested jettisoning the issue for now lest it “jeopardize” a broader health care measure. Mr. Warner, in answer to another question, acknowledged that end-of-life incentives were “unfortunately” in danger of being dropped amid the recent controversy.

A bipartisan group in the Senate Finance Committee already has dropped the idea from a health bill it is trying to draft, according to a Republican negotiator, Senator Charles E. Grassley of Iowa. At his own public meetings this month, Mr. Grassley said the issue had given rise to talk that the government would “pull the plug on grandma.”

In an interview after the meeting here, Mr. Warner said he had not decided whether he would seek to add an end-of-life provision if a health care bill comes to the Senate floor this fall without one. He said that he and a Republican sponsor of similar legislation, Senator Johnny Isakson of Georgia, have agreed to discuss the matter when Congress returns to work in September after its summer recess.