Monday, August 31, 2009

Death Panels - now really!

A friend recently sent me an article from a conservative ethicist. The author was very concerned with end of life counseling. He repeatedly referred to the pervasive "culture of death" making headway in our society, trying to tie this issue to the abortion debates. There is a book and several articles discussing the alleged culture of death. Actually I ran into this when my own father was dying at age 94 after 5 years in a nursing home. He had said repeatedly that he was ready to go and wanted no artificial measures to prolong his life. Initially he stopped eating, then after a week stopped drinking and slipped into unconsciousness. Per his wishes we elected to have no IV fluids or tube feedings. He was offered fluid sips and had excellent mouth care to help diminish any sensation of thirst. If he appeared uncomfortable, small doses of morphine seemed to help. Fortunately I was able to sleep on a cot in his room and was with him at the end. It was a sad but good feeling that I had, that is until a friend told me, "well, you're just going to prevent care for these old folks, starve them and leave them out there to die." I was flabbergasted by the insensitivity and accusatory nature of the comments.

As I met with a senior group the other night to give an end of life planning talk, one fellow came in early and asked, "Is this where the death panel meets?" Then he laughed and said, "The whole things crazy isn't it. How can those idiots believe what they're saying."

Hospice associations, ethicists, and large physician groups have spoken out against this kind of willful political gamesmanship. The problem is that there is a segment that believes the hype, and the lies are being promoted to undermine the needed rational discussions about health care reform. The logic that physicians discussing end of life planning are somehow in a conspiracy to promote euthanasia simply doesn't fly. The program I present helps to clarify an individual's values, advises how to talk to loved ones and their personal physician, and how to get their ideas down on paper. Especially important for everyone is to have someone close to your heart as the "durable power of attorney for health care decisions." This person can speak for you and be an advocate when you are no longer able to. Research is showing that people in hospice care are actually living longer than predicted. Hospice is a Medicare benefit, thus a government program. Hospice is loved by patients, families, nurses, volunteers and physicians. This end of life care has no death panels, no government interference - and believe me none would be tolerated. When surveyed, most people with a terminal illness would prefer to die at home with loved ones present and with good palliative care for symptoms.

4 comments:

  1. Hello Dr Jim,

    Found your blog via reading comments in the NY Times. Keep writing! I'm going to start quoting and recommending your thoughtful reflections on the health care system and end of life.

    I'm a former hospice nurse, now full-time writer about health care... you, sir, are a wonderful writer.

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