Death panels, advance directives and end of life


OK. This whole issue of talking about dying with your doctor becoming some kind of death panel has gone from ludicrous to bizarre. Here are the details. Addressing end-of-life planning with health care professionals – and having insurance pay for it - was enacted by Medicare beginning January 1 of this year. This is what it says:Voluntary advance care planning means, for purposes of this section, verbal or written information regarding the following areas:(i) An individual's ability to prepare an advance directive in the case where an injury or illness causes the individual to be unable to make health care decisions.(ii) whether or not the physician is willing to follow the individual's wishes as expressed in an advance directiveThis language was supposed to be part of the original health care act. But some folks jumped on it as a way to kill off granny, and it was dropped like a hot potato. On Sunday The New York Times reported on the new Medicare funding, saying it would "pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life sustaining treatment." I like the NYT, but I object to the the way that sentence reads because it sounds like doctors will get paid if they convince patients to die, which is not the case at all.The whole idea is to pay health care professionals for their time to have discussions about end-of-life care. (But calling it end-of-life planning is evidently the problem, so now we'll call it advance care planning. The story went on to quote Elizabeth D. Wickham, executive director of LifeTree, which describes itself as a "pro-life Christian educational ministry." I don't know where they dug her up, but she goes on to say that end-of-life counseling would encourage patients to forgo or curtail care, thus hastening death and that "patients will lose the ability to control treatment at the end of life."I don't know how we got from discussing end-of-life care to losing the ability to control how we die, but that is so backwards it makes me laugh. Folks, I have had an advance directive that deals with my end-of-life choices for a number of years. An advance directive is simply a document that gives the person more control over how he or she will die -- not less. Through this document, I have told my doctors that I do not want to be kept alive on machines, do not want a feeding tube inserted in the event I am in a coma, and do not want heroic measures taken if I cannot make a decision for myself. Through this document I have taken the responsibility for those decisions off my child. And get this: If doctors don't have an advance directive about what patients want, they are required to do everything they can to keep them alive. If the patient has no family, that means they could spend years on a ventilator until they die. If they have family who will make that decision, it often means days or weeks of agonizing, lengthy (read costly) discussion until they can get the whole family to agree on the next move.I have chosen what I do and don't want for the end of my life. And as to those nasty doctors making people stop treatment and die, right now cancer patients are stopping treatment because they can't afford it, according to the Kaiser Family Foundation. So why don't we look at the cost of health care -- that's the real death panel. And unless you have figured out a way to beat death -- no matter your age -- you might want to have an advance directive to control how you die.

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