End-of-Life Choice, Palliative Care and Counseling

At the Threshold of Equality and Freedomby Barbara

Back

Our nation has arrived at a fateful moment in the debate over health insurance reform. More than sixty years after Harry Truman recognized the health of all Americans as a public responsibility, we stand on the threshold, closer than ever to transforming our health insurance system into one that cares for all citizens and honors patient choice.

To step over that threshold we must acknowledge the current system divides us arbitrarily into haves and have-nots and only through united support for each other can we achieve our greatness. Health insurance reform can bring America closer to our ideals of equality and freedom if it offers affordable coverage to all, expands choices and puts each of us in charge of our health care decisions.

At Compassion & Choices, we focus on better care and informed decision making for patients facing the end of life and their families. We fight bills that would force patients to endure futile, invasive treatment against their will. We help clients with advance directives, local service referrals, and pain and symptom management. We were happy when legislators from both parties sponsored a provision to reimburse doctors whose Medicare patients ask to discuss end-of-life choices. This is the now famous Section 1233 on page 425 of House Bill 3200.

When seniors tell their doctor what treatments they would want or not want in a given situation, they protect their families from struggles over decisions about life-sustaining treatment if they became unable to speak for themselves. They protect their families from the kind of strife the Schiavo family endured.

So when patients express their decisions to their doctors, who stands to lose? The same people we saw demonstrating on the lawn of Terri Schiavo’s hospice. Notorious anti-choice radical Randall Terry and others who would dictate private decisions for others: radicals who want to impose their religious beliefs on all Americans. Let’s be honest, a medical-industrial complex that profits from extraordinary treatments even when they are harmful, painful and futile also benefits when a dying patient’s wish for a peaceful end goes unspoken.

Opponents of health insurance reform are now spreading distortions – including outrageous lies about the government encouraging seniors to end their lives and death panels euthanizing people with disabilities.

No facts support these horror stories. Even Fred Thompson, who first made these claims on his radio show, now admits, “Is this a conspiracy to kill off granny? No. Will seniors be forced to make decisions they don’t want to make? No.” Regardless of the facts however, many people embrace these fears and cling to these myths. We shouldn’t be surprised. Change of any kind is inherently frightening.

And what we’re talking about is a profound change, from a system where bosses and insurance executives decide who gets health care coverage to one where each of us gets to choose; from a system where pharmaceutical representatives have first access to doctors to one where patients do. Having an opportunity to speak for ourselves on the most basic questions of life and death liberates us from dependence on others to dictate what is right for us.

Freedom is the change that feeds the fear. When we have a greater voice in health care, the traditional voices of authority lose their power over us. Note that when opponents acknowledge the truth, as Fred Thompson does, they still oppose patients discussing end-of-life choices with their doctors. The possibility that Americans could have a direct discussion with their doctor, unencumbered by issues of job or status, void of interference from medical vendors and without a requirement to follow the opinion of religious authorities, is a threat to all those who favor an authoritarian model of medical care.

We are passing through a sweltering August of discouragement, but must look ahead to the invigorating cool of a shaded haven, where our health care system might offer equality of access and freedom of choice and where patients – not profits — come first. It is within our sight; the door stands open. But those who fear progress stand in the way. By intimidation, with seeds of doubt and fear they are trying to bar our entry. This autumn, walking shoulder to shoulder, we can, we must cross that threshold.