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Claims that the Obama administration wants to establish “death panels” to decide who should get care or to encourage euthanasia for older citizens are misleading and do nothing to contribute to the discussion we ought to be having about the care we want at the end of our lives.
At issue is a proposal, now rescinded, to allow Medicare to reimburse doctors for talking with patients every five years about “advance-care planning,” or what care they would want if they became unable to make their own medical decisions.
It makes sense to ask how we're going to expand health insurance to all citizens and cut costs without resorting to some kind of rationing.
But “advance-care planning” does not mean planning euthanasia. It refers to having discussions that lead to filling out living wills and determining who should have your health care power of attorney.
“Patients often receive care they don't want at the end of life,” said Dr. John Barkley, chief medical officer of Hospice & Palliative Care Charlotte Region. “They often die in hospital settings when that was not their wish at all. When you provide informed choices and counsel people as to what those choices are, they often will choose care that is much more in keeping with their goals and desires.”
Often, those choices are less costly: hospice care instead of the hospital ICU, for example. But money is not the point of advance-care planning, Barkley said.
“It's an issue of matching the medical interventions with the patient's wishes,” he said. “It has everything to do with patient choice. It has nothing to do with rationing health care.”
In 2007, my mother lay unconscious in an intensive care unit in Indiana, having experienced cardiac arrest three days after undergoing abdominal surgery. When she “crashed” that night in the ICU, my siblings and I never would have told doctors and nurses not to try to save her.
Yes, she was 87. But before that operation, she had been independent. She lived alone on our family farm, drove her car during daylight on familiar roads and kept busy with lots of friends and hobbies, such as quilting and playing cards.
After the resuscitation, Mom was on a ventilator and a feeding tube. Two weeks later, a neurologist concluded that her brain had gone without oxygen for too long and she would probably never wake up. That's when doctors told us it was time to decide which treatments to continue.
I had talked to Mom about decisions like this years earlier, after my father sustained a brain injury and stayed on a ventilator for six weeks. A neurologist told us that Dad would be a “vegetable,” but he woke up one day, remembered all of our names, and lived four more good years before dying of congestive heart failure in 2001.
That experience made us skeptical about doctors' predictions. But even so, Mom signed a living will indicating that she wouldn't want to be kept alive by extraordinary measures if she was unable to speak for herself. She signed a document giving my sister and me her health care power of attorney.
When Mom eventually developed pneumonia in the ICU, my siblings and I decided, after many emotional conversations and with the doctor's guidance, not to use antibiotics. My sister and I were with Mom when she died.
I believe we made the right decision, and that it's what Mom would have chosen if she could have seen herself in that condition. But it was still terribly difficult. How much harder would it have been if we had not had conversations as a family?
As we debate health care reform, it's understandable that we'll have questions about the details, especially about how we can afford to expand coverage to everyone and still maintain high-quality care. But we shouldn't let scare tactics derail the discussion.
Even if Medicare doesn't pay doctors to talk about end-of-life care with patients, we should be talking with our families now, before there's a crisis. Knowing your options and making choices about the medical care you want in your final days might save money for the health care system – or it might not, depending on your wishes. But it will surely save us all some pain and heartache.
Karen Garloch: 704-358-5078
