The Truth About Death Counseling
By Charles Krauthammer
WASHINGTON -- Let's see if we can have a reasoned discussion about end-of-life counseling.
We might start by asking Sarah Palin to leave the room. I've got nothing against her. She's a remarkable political talent. But there are no "death panels" in the Democratic health care bills, and to say that there are is to debase the debate.
We also have to tell the defenders of the notorious Section 1233 of H.R. 3200 that it is not quite as benign as they pretend. To offer government reimbursement to any doctor who gives end-of-life counseling -- whether or not the patient asked for it -- is to create an incentive for such a chat.
What do you think such a chat would be like? Do you think the doctor will go on and on about the fantastic new million-dollar high-tech gizmo that can prolong the patient's otherwise hopeless condition for another six months? Or do you think he's going to talk about -- as the bill specifically spells out -- hospice care and palliative care and other ways of letting go of life?
No, say the defenders. It's just that we want the doctors to talk to you about putting in place a living will and other such instruments. Really? Then consider the actual efficacy of a living will. When you are old, infirm and lying in the ICU with pseudomonas pneumonia and deciding whether to (a) go through the long antibiotic treatment or (b) allow what used to be called "the old man's friend" to take you away, the doctor will ask you at that time) what you want for yourself -- no matter what piece of paper you signed five years ago.
You are told constantly how very important it is to write your living will years in advance. But the relevant question is what you desire at the end -- when facing death -- not what you felt sometime in the past when you were hale and hearty and sitting in your lawyer's office barely able to contemplate a life of pain and diminishment.
Well, as pain and diminishment enter your life as you age, your calculations change and your tolerance for suffering increases. In the ICU, you might have a new way of looking at things.
My own living will, which I have always considered more a literary than legal document, basically says: "I've had some good innings, thank you. If I have anything so much as a hangnail, pull the plug." I've never taken it terribly seriously because unless I'm comatose or demented, they're going to ask me at the time whether or not I want to be resuscitated if I go into cardiac arrest. The paper I signed years ago will mean nothing.
And if I'm totally out of it, my family will decide, with little or no reference to my living will. Why? I'll give you an example. When my father was dying, my mother and brother and I had to decide how much treatment to pursue. What was a better way to ascertain my father's wishes: What he checked off on a form one fine summer's day years before being stricken; or what we, who had known him intimately for decades, thought he would want? The answer is obvious.
Except for the demented orphan, the living will is quite beside the point. The one time it really is essential is if you think your fractious family will be only too happy to hasten your demise to get your money. That's what the law is good at -- protecting you from murder and theft. But that is a far cry from assuring a peaceful and willed death, which is what most people imagine living wills are about.
So why get Medicare to pay the doctor to do the counseling? Because we know that if this white-coated authority whose chosen vocation is curing and healing is the one opening your mind to hospice and palliative care, we've nudged you ever so slightly toward letting go.
It's not an outrage. It's surely not a death panel. But it is subtle pressure applied by society through your doctor. And when you include it in a health care reform whose major objective is to bend the cost curve downward, you have to be a fool or a knave to deny that it's intended to gently point you in a certain direction, toward the corner of the sick room where stands a ghostly figure, scythe in hand, offering release.
12 comments:
This is the most fact filled and unbiased post I have ever read on this blog. Im proud of you Joe...
Only problem is these sessions are VOLUNTARY! Still more misinformation.
The bottom line is it will be up to a group of bureaucrats what level of care you will receive.Now you can call them end of life council or a death panel it really doesn't matter it won't be up to you and your family and that's the issue.
My father died recently after three months of hospitalization and rehab. He had a living will, and every time he was readmitted to the hospital they asked him what his desire was, and asked us what our desire was as a family. I totally agree that a living will and durable health directive is of little value in those situations. However, my friends mother was in end state dementia and had lost her ability to eat. My friend was basically put on a guilt trip over starting a feeding tube. To my way of thinking her mother's death was naturally occurring, the good lord was taking her home. To start a feeding tube would be interfering with the nature of things and artificially keeping her alive. My friends children talked her out of the feeding tube and let their much beloved mother and grandmother finally find peace. I've changed my durable power of attorney to state that under no circumstances do I want a feeding tube if I have dementia or any other non-treatable condition that will not allow me to continue living at home. I hope my children will honor my wishes no matter what the medical profession recommends.
Yea a living will was not necessary in your experience. But you're case is dwindled by those that it is in fact necessary. In order to ensure their dieing wishes are adhered to.
Why is no one talking about a simplified HC plan:
1) gov. handles cost of preventing care/regular checkups (cheapest portion of health care cost and something we all need)
2) each american must have supplemental insurance (take higher health cost off the backs of tax payers)
3) supplemental insurance covers tragic accidence/terminal illness/end of life care etc. (cover your own butt in case of emergency, maintain a market of over 200 million customers for the insurance companies)
4) subsidize premiums for the poor
Any critiques?
Why not just tweak it instead of trashing the health care we have now it's still the best in the world. I guess because the socialist don't have complete control over our lives with the current plan.
Well said 9:16 a.m. Let it be known that some health care professionals will be truthfull with your loved ones estimated time left to suffer, while others, knowing there is no cure & time is very short will encourage the feeding tube be put in & causing you to feel guilty because, as told you by them, "You don't want to let them starve to death." I know , I watched this be done in my own family with the loved one in stage #4 of Cancer & nothing but total blood coming from the bladder, a battle they'd fought for 2 yrs!!
So, the feeding tube was put in by one of the cancer Doctors. Nice little bonus that day for him! Hotspice told us , you only are feeding the cancer, not the patient , but our part of the family had no say, as that belonged to the nearest relative.
Two days later-----the person passed away.
Many are not educated on the "end of life " ALL NEED TO BE! I shall never ever be able to forgive that Dr for encouraging the feeding tube for HIS PROFIT!!
I think it's Great that they want toinform people what their options are towards the end of their lives!! Many do not know & are ignorant to what happens as the body prepares itself to die. You do not feel starvation if not given a feeding tube!!!! You go into a state of euphoria as the organs start to shut down!! God sure knew what he was doing when he made us-----Most just need to find out the facts for themselves.
I think it's a great idea to be informed & let people know what their options are. America has read something into this that is just not there!
I think it's great to take control over peoples lives or deaths when there most vulnerable and no longer productive to society so let bureaucrats decide when they die. F@#$ Obama and I'm willing to give my life to stop it !
Having been in medicine for more than 40 years, I know of no dr. who would not discuss end of life choices with patients in need.
While they may discuss this in a matter of fact way with family or the patient involved.,it's contained in a regular visit, and billed for calling it whatever it takes. However, no meeting with dr. goes without remuneration. There's a billing code somewhere that can be used.
When it's between Dr. and patient that's great but when you add a government panel in the discussion who's goal is to save money what do you think they're going to do.
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