True Obedience to Governing Authorities

 As Christians, we are commanded by God to submit to the governing authorities.  (Romans 13:1-7, I Peter 2:13-14, Titus 3:1-2).  However it is clear that these commandments do not apply when it means disobeying commands from God’s word.  For Americans, it does not mean they must always obey unconstitutional laws and orders.  There is great deal of confusion about this in the church today. The leaders of my own church have accused me of putting the Constitution above God.  I am not saying that Christians should go out of their way to disobey unconstitutional orders, engage in violence or protest in the streets about it.  But the commandments in Romans 13:1-7, I Peter 2:13-14 and Titus 3:1-2 do not mean that we must obey the authorities when they give orders beyond the scope of the authority that has been given to them. 

God’s Word does not teach that we are to submit to those who have authority.  The direct object of the verb “submit” (or “be subject to”) is “authorities” or “human institution”, not the person who has the authority.¹ Pay close attention to the wording of I Peter 2:13-14 (ESV).  A person is not an “it”.

Be subject for the Lord's sake to every human institution, whether it be to the emperor as supreme, or to governors as sent by him to punish those who do evil and to praise those who do good.

At that time, the emperor was supreme.  This means that the institution of the emperor took precedence over all the other governing authorities within the empire.  More to the point, according this commandment, subjection to the authority of the emperor was to take precedence over all the other governing authorities within the empire.  God did not say that subjection to all authorities is to be “as supreme”.  Subjection to the authority of governors is qualified by the phrase “as sent by him”, where the word “him” obviously refers to the emperor.  It is very clear that this means that the commandment to be subject to the institution of governors applies only when they are acting under the authority of the emperor, not when they are acting on their own accord. If God had meant for us to obey every order from everyone in authority without regard to what authority they have been given, then the words “supreme” and “as sent by him” are completely meaningless and misleading.

When the people asked for a king in I Samuel 8, God granted their request.  That does not mean the king would be perfect or that people should put the king above God.    It is not a contradiction to say that the people chose to have a king as supreme, while also saying that God established the kingship and its supremacy. 

The American people asked for a Constitution to be their supreme authority and it was approved by their legitimately elected representatives just as the same as laws (e.g. laws against drunk driving) were properly approved in more recent times. 

This Constitution, and the Laws of the United States which shall be made in Pursuance thereof; and all Treaties made, or which shall be made, under the Authority of the United States, shall be the supreme Law of the Land; and the Judges in every State shall be bound thereby, any Thing in the Constitution or Laws of any State to the Contrary notwithstanding.

U.S. Constitution, Article VI, Clause 2

It is not a contradiction to say that the people chose to have a constitution as supreme, while also saying that God established it.  That does not mean that the Constitution is perfect, inspired by God as the Bible is, or that it is to be put above the Bible.  But it is the supreme authority in the same way as the king of Israel was in I Samuel 8 and as the emperor was in I Peter 2:13-14.  If this is not so, then who (or what) is the supreme in America today?  When did God grant Supreme Court justices, presidents, governors, health departments, etc. authority that is above the Constitution?  Is the phrase “as sent by him” in I Peter 2:13-14 completely meaningless for us today?

It is God’s will that we obey the authorities according to what has been given to them by the Constitution (and other laws pursuant to it).  Who are we to say that God can’t do that?  I’m not going to put God in a box and say that he can’t set up a government with a constitution as supreme.  I’m not going to tie his hands and say that it is always his will that we regard the governor the same as an emperor.  People are not above the law.

When the Jews accused Paul of violating the law, he did not submit to their authority (or to that of Felix or Festus).  Instead, he appealed to the supreme, who was Caesar.  If Paul could do this, then there is certainly nothing wrong with Christians appealing to the Constitution (or other laws) when those who have civil authority overstep the authority that has been given to them.  It makes no difference whether it be because of a violation of the separation of powers or any other limitation of power in the law. I suggest reading Acts 21:27-25:11. 

Most people recognize the fact that governing authorities have geographical limits to their power.  For example, if the prime minister of England were to give an order, most of all of us would agree that it would not be sinful for an American to ignore the order while not on British soil.  According to the law, the power of the prime minister of England does not extend to the United States.  Christians need to realize that other legal limitations on the power of the governing authorities are just as relevant.

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

U.S Constitution, 10th Amendment

This enumeration of rights shall not be construed to impair or deny others retained by the people, and all powers, not herein delegated, remain with the people.

Ohio Constitution, Article I, Section 20

In the United States, every American citizen is a “governing authority”.  If you do not believe this, then you should not vote.  Every time you vote, you are wielding civil authority which can impose, increase, eliminate or ease restrictions on other citizens or penalize them for disobeying.  If we are to completely obey every person who has civil authority without regard to the scope of authority given to them by law, then we must obey any order given by any citizen just as if that citizen were a governor or President of the United States. God is a God of order, not chaos.  Without respect for the scope of authority in the law, subjection to it is impossible and the command to do so is essentially meaningless.

When Jesus told his disciples to “observe whatever they tell you” in Matthew 22:3, it is obvious that he did not intend for it to be an absolute.  Jesus said, “…beware of … the teaching of the Pharisees and Sadducees.” (Matthew 16:12) 

When the scribes and Pharisees asked Jesus to show them a sign, he refused to give them what they asked for. (Matthew 12:38-39, 16:1-4)  When asked by what authority he did “these things”, he refused to answer. (Luke 20:1-8)

The ruler of the synagogue gave the people a clear and direct order:  "There are six days in which work ought to be done. Come [to the synagogue] on those days and be healed, and not on the Sabbath day." (Luke 13:14) But Jesus did not refrain from healing people on that day, which is a clear violation of the order. He said, "Is it lawful on the Sabbath to do good or to do harm, to save life or to kill?" (Mark 3:4)  This clearly indicates that, when it comes to rules that ought to be obeyed, it is the real law that counts, not rules of the Pharisees. 

When they accused the disciples of violating handwashing laws and for picking grains on the Sabbath, Jesus rebuked the scribes and Pharisees, not his disciples. (Matthew 12:1-2, 15:1-2, Mark 2:23-24, 7:1-5, Luke 6:1-5)  The disciples could have obeyed these orders without sinning.  (There is nothing sinful or unscriptural about washing your hands before eating or refraining from picking grains on the Sabbath.) 

Luke 5:29-30 says, “And Levi made him [Jesus] a great feast in his house, and there was a large company of tax collectors and others reclining at table with them.  And the Pharisees and their scribes grumbled at his disciples, saying, ‘Why do you eat and drink with tax collectors and sinners?’” According to several sources I have read, the Pharisees did have a rule forbidding eating with sinners.  (The justification was that if you eat food that was not tithed, then you are guilty of violating the commandment to tithe.)  It is very clear from Luke 5:29-30 that Jesus not only violated the scribes’ and Pharisees’ rule, but he approved of his disciples doing it as well.  I see no evidence whatsoever in the Scriptures that Jesus’ statement in Matthew 22:3 went beyond the lawful authority that was given to the scribes and Pharisees.

If out of fear of the government, we allow them to infringe on our rights to worship as we please while exceeding the limits of their authority, we will lose our freedoms. If the government were to ban Bibles overnight, Christians might resist.  But what if the government slowly infringes on our rights little by little, making it more and more difficult to spread the Gospel little by little?  At what point will we stop giving in? The effect is the same regardless of the motives of the politicians.

Just as there were hundreds of rules of the scribes and Pharisees, there are countless laws, statutes, ordinances, precedents, regulations and orders given to us today by our elected (and unelected) officials in our government.  The Internal Revenue Code alone has 7500 pages. To tell people that they have to obey all of them, even the ones that are unconstitutional, is to place a huge burden on them.  If you don’t even attempt to obey (or even read) all these yourself, then how you can you tell other people that they have to without hypocrisy?  The hypocrite obeys rules that are popular, get a lot of media attention, or that make themselves look righteous.  The truly righteous man obeys the legitimate laws diligently and quietly without regard to how well known they are or how well they are being enforced. (c.f. Colossians 3:22)

Finally, besides the “as sent by him” qualifier, there is also another qualifier written into the passages on governing authorities.  We are only required by these commandments to submit their authority when it is “to punish those who do evil and to praise those who do good”.  When their mandates punish people for doing good or reward them for doing evil, they are acting outside the authority that God has given them and such mandates can be ignored.

In summary, the doctrine of “obey the person, not the authority” is dangerous, overly rigid, burdensome, and untenable and ignores scriptural qualifiers and counterexamples.  We are to submit to all governing authorities within their jurisdiction, but we are not to regard all of them “as supreme”.

¹ To illustrate this principle, suppose that a woman is governor of a state.  The woman’s husband is required to submit to the authority of the governor just as any other citizen of the state.  But he is not required to relinquish his role as head of his household.  If his wife tries to use her authority as governor to usurp her husband’s authority, God does not require him to submit to her orders in that regard.  On the other hand, she is not required to submit if he tries to use his authority to in a way that interferes with her official capacity.  Each authority has its own dominion (i.e. there is a biblical “separation of powers”) so that there is no conflict or confusion about it. 

Obama's Dishonest Propaganda

Obama said, “Ultimately, I’m confident that the Supreme Court will not take what would be an unprecedented, extraordinary step of overturning a law that was passed by a strong majority of a democratically elected Congress…judicial activism or a lack of judicial restraint — that an unelected group of people would somehow overturn a duly constituted and passed law.”

It is not at all “unprecedented” that the Supreme Court has struck down Federal laws on the basis that they are unconstitutional.  It has happened over a hundred times.  Obama later said that he was only talking about overturning laws on the basis that the Commerce Clause does not grant Congress the authority to pass a certain law since Wickard v. Filburn.  Again, this is not unprecedented, nor should it be.  Obama is basically saying that 10^th Amendment should have no application whatsoever. 

He is not saying that other parts of the constitution can’t be used as basis for striking down laws, just the linchpin of the entire Constitution.  For example, he is perfectly fine with allowing the courts to strike down the Defense of Marriage Act, as evidenced by his recent decision to order the DOJ to stop defending its constitutionality in court.

Whether or not judges should be allowed to “strike down” laws is another matter, but certainly judges should not take part in enforcing a blatantly unconstitutional law.

Notice Obama says that it is overturning a law passed by Congress which is so unprecedented.  This is despite that the 10^th Amendment which ensures that the majority of powers belong to the states and despite that it is usually when state or local laws are overturned that there is the most outcry from the religious right, and usually justifiably so.  The only problem with the religious right is that, not knowing the Constitution (or not caring about what it says) often unwittingly advocate unconstitutional centralization of power in Washington because of some position on a moral issue which they want to be enforced.  Furthermore the religious right is often very complacent about unconstitutional laws which were passed by the left a long time ago.  They either think that it is unreasonable that these should be overturned because they don’t think of them as being leftist policies or they themselves are really somewhat leftist.  For example, if it is unconstitutional for the federal government to force us to buy Obama-approved health insurance, how can it not also be unconstitutional for them to force us to pay into Medicare or Socialist Security?  People just don’t think critically and/or are ignorant of the Constitution.  But Obama clearly wants both the left and the right to remain ignorant of the Constitution and especially the 10^th Amendment.

The Unconstitutionality and Dangers of the Individual Mandate

Hat tip to Jack Painter, founder of the Indian Hill Tea Party for an excellent analysis of the arguments for the constitutionality of the individual mandate portion of the Patient Protection and Affordable Care Act.  This is the most comprehensive piece which I have seen on the subject.  He examines the angles being used to try to pass the individual mandate off as being constitutional, the dangers of such arguments, and argues for the uniqueness of the mandate in the legislative history of the United States.

Here is the link:

http://www.indianhillteaparty.org/files/RemarksToUCLawClass03-12-2011.pdf

Rand Paul and the Civil Rights Act of 1964

The liberal news media is jumping on Rand Paul for his comment about the 1964 Civil Rights Act. He is saying that he opposes the portion of the bill which forbids business owners from refusing to do business with people on the basis of race, though he himself is against such racial discrimination, has no plans to introduce legislation to repeal it, and supports the other portions of it banning discrimination by the government. So what’s the deal with this? Is he right or wrong? What does the Constitution say? What does the Bible say? Does this it give American more or less freedoms? Has this well-intended legislation caused more harm than good?

The Bible teaches that governments are instituted by God among men to punish evil. But there is clear evidence from the Scriptures and in practice that it is impossible to punish every evil act. One would find it hard to find a definitive set of Biblical rules that would distinguish those acts which should be punished in way that would include racial discrimination.

The Tenth Amendment to the Constitution clearly indicates that Congress has only powers which have been delegated to it by the Constitution. Why have a 14^th amendment, then? Why say in the 14^th amendment that Congress has the “power to enforce the provisions of this article” if they could enforce it without that language being added? Why not just pass it as a federal law in Congress? Why try to pass an Equal Rights Amendment if this already what the Constitution says??? Liberals like Chris Matthews of Hardball understand this, but they believe it is impractical to follow the Constitution that closely. (Yet some liberals like Rachel Maddow take this position and then complain about the government violating the Constitution in other instances.)

Though there are a lot of amendments which give Congress the authority to act in matters of civil rights, there is clearly is no place in the Constitution which grants the Congress to make anti-discriminatory laws against private citizens. Unlike Rand Paul, I would go further and say that they don’t even have the authority to ban racial discrimination by state and local governments*, though I would favor a Constitutional amendment which would ban this practice.

As Rand has pointed out (being silent on the above arguments, unfortunately) such legislation against business owners deprives them of the free use of their property. The moment the legislature begins to say, “you can only use your property how we want you to use it”, you no longer own your property. Even though such discrimination is a damnable sin, the passage of this legislation continued a precedent which allows the government to take away your property any time they think that you are “using it for evil”. This is clearly tyrannical.

The portion of the Civil Rights Act which applies to the citizens has clearly done more harm than good. If you knew that a business owner was a racist, why would you want to patronize his establishment anyway? If it were not for this law, you could easily boycott businesses owned by racists, because you would know it before you walk through the door. But because of this law, you don’t always know. The liberals put less faith in the people to convince their fellow citizens to repent of such behavior, than in civil government. What should be done with these racists? Put them in jail? Do you think that that is really going to do anybody any good? The government’s definition of what is “equal treatment” has been extended to absurdity, forbidding barbers from having male customers only or charging them less.

Ever since he was beaten up by some black kids as a kid, my now deceased uncle hated black people. He was a landlord and rented only to whites. After the Civil Rights Act passed, he was forced to rent to blacks. This made him even more embittered and it seemed harder to change his mind. He never repented. Since the Bible teaches that he who hates his brother is a murderer, and that murderers will be tormented in hell forever, it seems unlikely to me that my uncle will escape this judgment.

*Section 1 of the 14th amendment prohibits a state from “deny[ing] to any person within its jurisdiction equal protection of the laws.” This would, I suppose, prohibit states from passing laws which would deny blacks from being able to go to a certain school, drink from a certain drinking fountain, or getting a certain job. (Even though it was dumb, I don’t see why they wouldn’t be allowed to have “separate but equal” accommodations under this language.) Section 5 would give Congress the right to enforce “equal protection” against the states. Even though I agree with the “equal protection” principle (and I oppose the “separate but equal position”), I don’t believe that Congress should be given the authority to enforce it on the states in this way (to see a better way click here), and I don’t believe that 14th amendment was properly ratified. Also keep in mind that the original constitution prohibited both the states and the Congress from passing bills of attainder, i.e., laws which punish a a certain person or certain group of people.

Articles of Freedom, part 11

It’s been a while since I’ve written about the Articles of Freedom. I left off a few weeks ago at Article 9, so now I will go on to Article 10, the text of which follows my comments.

Here is my plan on this issue (monetary policy):

1. Immediately repeal or nullify all legal tender laws except for gold and silver coins at the state level.

2. All contracts made in Federal Reserve Notes, past, present and future would remain legally valid except securities purchased from the Federal Government and currently held by the Federal Reserve Banks would be declared void.

3. Abolish the Federal Reserve and its Board of Governors by repealing the Federal Reserve Act.

4. It may be necessary to temporarily fold portions of the Federal Reserve System into the Treasury Department. Federal Reserve notes will continue to pass out of existence as bank loans are paid off.

5. Increase the Federal production of gold and silver coins.

The CC09 plan doesn’t specifically have all things, but I agree with everything they say in this Article 10. It is also worth noting that as Federal Reserve Notes are phased out, the federal income taxes should be phased out as well--laws indicating that transactions in gold or silver coins should be exempt direct, unapportioned taxes.

ARTICLE 10.

MONEY AND ARTICLE 1 OF THE CONSTITUTION

A. REMEDIAL INSTRUCTIONS TO CONGRESS

1. The Congress of the United States, in the exercise of its power authorized by Article I, Section 8, Clause 5 of the Constitution for the United States of America, “[t]o Coin Money, regulate the Value thereof, and of foreign Coin,” shall enact a statute:

(a) establishing a National Advisory Commission on Alternative and Competitive Currency, and

(b) calling upon each of the several States to establish their own State Advisory Commission on Alternative and Competitive Currency.

2. That the sole purpose of the said Advisory Commissions shall be to study and recommend the means by which each State individually, and the several States and Congress collectively, can promote the adoption by both the several States and the United States, as rapidly as possible, of an economically sound and Constitutional alternative and competitive currency, which shall:

(a) consist exclusively of silver and gold, the units to consist of 371.25 grains (troy) fine silver and 371.25 grains (troy) fine gold, which shall be subject to transfer from one party to another in both an electronic form measurable in any number of units, as well in tenths, hundredths, and thousandths of a unit, and the form of coins (whether of traditional or nontraditional shapes) of convenient weights consisting of multiples of the units or common fractions thereof;

(b) gradually be introduced as the media of exchange in all of the financial transactions of the governments of each of the several States and of the United States, so as in a measured manner to minimize and finally supplant the use in such transactions of Federal Reserve Notes or bank balances payable in those notes to the maximum degree possible consistent with the general welfare; and

(c) eventually supplant the use of such notes or balances in all private monetary transactions within and among each of the several States to such degree as the free market determines economically appropriate.

(d) That the National Advisory Commission shall be composed of the following persons: {…here shall be listed the proposed members of the Commission…}.

3. That, within thirty (30) days from the effective date of the said statute, the National Advisory Commission shall submit to Congress a report containing complete and specific drafts of all such legislation as may be necessary and proper for Congress to enact in order to guarantee that the citizens of each State may employ an alternative and competitive currency in all of their private economic transactions free from any form of taxation, reporting, or other regulation by the United States or any agency thereof, or by any State or agency thereof, that increases in cost, hinders, deters, discourages, delays, or renders cumbersome the use of such currency, or the consummation of transactions in which such currency is the medium of payment, in comparison to the same use of, or the consummation of similar transactions involving, Federal Reserve Notes or bank balances payable in such notes.

4. That, within thirty (30) days of its receipt of the National Advisory Commission’s report submitted pursuant to Paragraph 2, ante, Congress shall enact such legislation as will achieve the goals set out in that Paragraph.

5. That, within ninety (90) days from the effective date of the said statute, the National Advisory Commission shall submit to Congress a report containing complete and specific drafts of all such legislation as may be necessary and proper for Congress to enact in order to achieve the goals set out in Paragraph 2, ante, for the Government of the United States.

6. That, within sixty (60) days of its receipt of the National Advisory Commission’s report pursuant to Paragraph 5, ante, Congress shall enact such legislation as will achieve the goals set out in Paragraph 2, ante, for the Government of the United States.

B. REMEDIAL INSTRUCTIONS TO EACH OF THE SEVERAL STATES

1. That the Legislature in the exercise of its reserved power under Article I, Section 10, Clause 1 and the 10th Amendment, as well as other provisions of the Constitution for the United States, shall adopt a currency, other than that emitted by Congress, for use in all the financial transactions of the State. These shall by statute establish an Advisory Commission on Alternative and Competitive Currency for the State, the purpose of which shall be to study and recommend:

(i) the means, including all necessary State legislation (and where appropriate legislation that authorizes direct and independent action by units of Local government), by which the State can adopt an economically sound and constitutional alternative and competitive currency, consisting exclusively of silver and gold, initially for use in all of the financial transactions of the State’s government, thereby minimizing the use in such transactions of Federal Reserve Notes or bank balances payable in those notes, and eventually to supplant the use of such notes or balances in all private economic transactions within the State to the maximum degree possible for the benefit of its citizens; and

(ii) such legislation as may be necessary and proper for the State to enact in order to guarantee that the citizens of the State may employ such alternative and competitive currency in all of their private economic transactions free from any form of taxation, reporting, or other regulation by the State or agency thereof, that increases in cost, hinders, deters, discourages, delays, or renders cumbersome the use of such currency, or the consummation of transactions in which such currency is the medium of payment, in comparison to the same use of, or the consummation of similar transactions involving, Federal Reserve Notes or bank balances payable in such notes.

2. That the Advisory Commission shall be composed of the following persons: {…here list the proposed members of the Commission…}.

3. That the Advisory Commission shall, within sixty (60) days from the effective date of the said statute, submit to the Legislature a report containing complete and specific drafts of all such legislation as may be necessary and proper for the Legislature to enact in order to achieve the goals set out in Paragraph 1, ante.

4. That the Legislature shall, within sixty (60) days from its receipt of the drafts of legislation submitted by the Advisory Commission pursuant to Paragraph 3, ante, enact such legislation as will achieve the goals set out in Paragraph 1, ante.

C. RECOMMENDED CIVIC ACTIONS BY THE PEOPLE

WHEREAS, Article I, Section 10 of the U.S. Constitution specifies that “No state shall… make anything but gold and silver coin tender in payment of debts” and understanding the Federal Reserve is a private banking cartel whose effect has been to reduce the value of the dollar approximately 96% since its inception, Continental Congress 2009, in the interest of economic liberty:

1. Encourages networks of like-minded individuals to increasingly buy hard money coinage to use among their communities with the goal of increasing financial independence, and

2. That the aforementioned individuals, upon having established trade procedures in said hard money, shall be prepared for the replacement of the unconstitutional Federal Reserve upon its failure or abolition.

(from Articles of Freedom, the Works of the Continental Congress 2009)

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Will H.R. 3200 Encourage the Euthanizing of the Elderly?

I'm not saying that it will or it won't. But I have copied the disputed portion (section 1233) of H.R. 3200 here so that you can decide for yourself. This portion may not be the only one which is a reason to be alarmed with respect to this issue, so if you think it worth your time, you can read the other 1000+ pages at the link provided below. (But even if you do this, there is no guarantee that this will be the final version of the bill.)

I do not not need to read this for myself in order to know that I must oppose H.R. 3200 and all other federal controls over healthcare (except regarding benefits of active military personel and veterans) and because I know that this is unconstitional under the 10th amendment. But this is for the benefit of those readers who may care about the elderly, but who have a broad interpretation of the scope of the constitutional powers granted to the Federal Gov't or simply don't care whether or not the Constitution is violated.

http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.3200:

H.R.3200

America's Affordable Health Choices Act of 2009 (Introduced in House)

---

SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.

(a) Medicare-

(1) IN GENERAL- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended--

(A) in subsection (s)(2)--

(i) by striking `and' at the end of subparagraph (DD);

(ii) by adding `and' at the end of subparagraph (EE); and

(iii) by adding at the end the following new subparagraph:

`(FF) advance care planning consultation (as defined in subsection (hhh)(1));'; and

(B) by adding at the end the following new subsection:

`Advance Care Planning Consultation

`(hhh)(1) Subject to paragraphs (3) and (4), the term `advance care planning consultation' means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:

`(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.

`(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.

`(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.

`(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).

`(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

`(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include--

`(I) the reasons why the development of such an order is beneficial to the individual and the individual's family and the reasons why such an order should be updated periodically as the health of the individual changes;

`(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and

`(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).

`(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State--

`(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and

`(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).

`(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that--

`(I) ensures such orders are standardized and uniquely identifiable throughout the State;

`(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional's authority under State law) may sign orders for life sustaining treatment;

`(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and

`(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.

`(2) A practitioner described in this paragraph is--

`(A) a physician (as defined in subsection (r)(1)); and

`(B) a nurse practitioner or physician's assistant who has the authority under State law to sign orders for life sustaining treatments.

`(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).

`(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.

`(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.

`(5)(A) For purposes of this section, the term `order regarding life sustaining treatment' means, with respect to an individual, an actionable medical order relating to the treatment of that individual that--

`(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional's authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;

`(ii) effectively communicates the individual's preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;

`(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and

`(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.

`(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items--

`(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;

`(ii) the individual's desire regarding transfer to a hospital or remaining at the current care setting;

`(iii) the use of antibiotics; and

`(iv) the use of artificially administered nutrition and hydration.'.

(2) PAYMENT- Section 1848(j)(3) of such Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting `(2)(FF),' after `(2)(EE),'.

(3) FREQUENCY LIMITATION- Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended--

(A) in paragraph (1)--

(i) in subparagraph (N), by striking `and' at the end;

(ii) in subparagraph (O) by striking the semicolon at the end and inserting `, and'; and

(iii) by adding at the end the following new subparagraph:

`(P) in the case of advance care planning consultations (as defined in section 1861(hhh)(1)), which are performed more frequently than is covered under such section;'; and

(B) in paragraph (7), by striking `or (K)' and inserting `(K), or (P)'.

(4) EFFECTIVE DATE- The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2011.

(b) Expansion of Physician Quality Reporting Initiative for End of Life Care-

(1) Physician'S QUALITY REPORTING INITIATIVE- Section 1848(k)(2) of the Social Security Act (42 U.S.C. 1395w-4(k)(2)) is amended by adding at the end the following new paragraphs:

`(3) Physician'S QUALITY REPORTING INITIATIVE-

`(A) IN GENERAL- For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.

`(B) PROPOSED SET OF MEASURES- The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A) and would be appropriate for eligible professionals to use to submit data to the Secretary. The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.'.

(c) Inclusion of Information in Medicare & You Handbook-

(1) MEDICARE & YOU HANDBOOK-

(A) IN GENERAL- Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall update the online version of the Medicare & You Handbook to include the following:

(i) An explanation of advance care planning and advance directives, including--

(I) living wills;

(II) durable power of attorney;

(III) orders of life-sustaining treatment; and

(IV) health care proxies.

(ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including--

(I) available State legal service organizations to assist individuals with advance care planning, including those organizations that receive funding pursuant to the Older Americans Act of 1965 (42 U.S.C. 93001 et seq.);

(II) website links or addresses for State-specific advance directive forms; and

(III) any additional information, as determined by the Secretary.

(B) UPDATE OF PAPER AND SUBSEQUENT VERSIONS- The Secretary shall include the information described in subparagraph (A) in all paper and electronic versions of the Medicare & You Handbook that are published on or after the date that is 1 year after the date of the enactment of this Act.