End-of-Life Choice, Palliative Care and Counseling

Who Is Against People Making Their Own Health Care Choices?by Barbara

Back

Opponents of health care reform are eager to kill legislation and fear is their favorite weapon. Their newest scare tactic, oddly, is the threat that patients will be able to make choices about the end of their lives. For over a decade, Compassion & Choices has been improving care and advocating for patient choice at the end of life (most Americans agree that’s a good thing).

Writers in the Wall Street Journal and Forbes magazine, a barrage of comment from bloggers in opposition and statements from GOP leaders all condemn a small section in HR 3200. That provision provides Medicare reimbursement for doctors to talk with their patients about their wishes for end-of-life treatments like feeding tubes and artificial ventilators. Commentators tell a scary story about how these conversations are “required every five years” and will “push seniors” toward a decision to shorten life.

These claims are false. The only thing required is that Medicare reimburse, once in a five-year span, doctors who have this vital conversation with their patients. Consulting together, the doctor and patient can prepare a Physician’s Orders for Life-Sustaining Treatments (POLST). Making a conversation a covered benefit might encourage doctors to bring up the subject. Is that a bad thing?

Most of the people I know would be thrilled to have their doctor ask about their values, beliefs and preferences for care. Some patients might decide they’d like to die peacefully if they are terminally ill or permanently unconscious. Another patient will decide to utilize every kind of life-sustaining therapy as long as medically possible. The conversation protects either decision. The purpose of talking about these things is simply to empower people and make sure their wishes are heard.

If Medicare pays doctors to discuss choices with seniors, will doctors coerce them into an early death, as Representative Boehner claims? Only someone with a deep distrust of doctors caring for their patients or seniors choosing for themselves would believe this. Paying a doctor to have this conversation with patients empowers the patient and offers them choices. The real scary story is what can happen when a person falls into a persistent vegetative state and no one knows what choice they would make if they could still speak for themselves.

The thought of becoming empowered with information and the ability to make health care decisions for ourselves does not scare people. Studies show patients want that information. What scares us is the thought of being trapped in a situation whether other people, perfect strangers — maybe even politicians — might take our choices away and make decisions for us.

Most people believe individuals themselves are the best decision-makers when it comes to these very personal, private healthcare choices. In November 2005 Pew Research Center found a whopping 84% of Americans approve of letting patients themselves decide about extraordinary treatments to prolong life.

Many seniors have a “living will” expressing their preferences (and people of any age could find themselves unable to speak for themselves). Why is coverage for this conversation important? Laws vary from state to state. Having specific documents in order may be necessary to make sure your wishes are carried out and that the loved one you would choose is empowered to act on your behalf (In New York, for example, a spouse or other family member does not have that power unless they are documented as your health care proxy).

Re-enforcing your decision by discussing it with your doctor makes it more likely your wishes will be followed. Solid research shows that people who talk with their doctor about end-of-life wishes are more likely to have those wishes honored, and more likely to experience a peaceful, pain-free death when the time comes.

This legislation encourages communication, promotes choice, compensates doctors for important care and empowers patients. Opponents of health insurance reform won’t be able to derail a bill by scaring people with the right to make their own important life decisions.