End-of-Life Choice, Death with Dignity, Palliative Care and Counseling

Posts Taggedend-of-life consultation

False ‘Death Panel’ Rumor Has Some Familiar Roots

From the New York Times, Friday, August 14, 2009:

The stubborn yet false rumor that President Obama’s health care proposals would create government-sponsored “death panels” to decide which patients were worthy of living seemed to arise from nowhere in recent weeks. 

But the rumor – which has come up at Congressional town-hall-style meetings this week in spite of an avalanche of reports laying out why it was false – was not born of anonymous e-mailers, partisan bloggers or stealthy cyberconspiracy theorists.
Rather, it has a far more mainstream provenance, openly emanating months ago from many of the same pundits and conservative media outlets that were central in defeating President Bill Clinton’s health care proposals 16 years ago, including the editorial board of The Washington Times, the American Spectator magazine and Betsy McCaughey, whose 1994 health care critique made her a star of the conservative movement (and ultimately, New York’s lieutenant governor).

 There is nothing in any of the legislative proposals that would call for the creation of death panels or any other governmental body that would cut off care for the critically ill as a cost-cutting measure. But over the course of the past few months, early, stated fears from anti-abortion conservatives that Mr. Obama would pursue a pro-abortion, pro-euthanasia agenda, combined with twisted accounts of actual legislative proposals that would provide financing for optional consultations with doctors about hospice care and other “end of life” services, fed the rumor to the point where it overcame the debate.

A pending House bill has language authorizing Medicare to finance beneficiaries’ consultations with professionals on whether to authorize aggressive and potentially life-saving interventions later in life.

“I guess what surprised me is the ferocity, it’s much stronger than I expected,” said John Rother, the executive vice president of AARP, which is supportive of the health care proposals and has repeatedly declared the “death panel” rumors false. 


Faith Leaders Condemn Health Care Distortions

Facts Dispel Myths Surrounding End of Life Consultation

Sister Simone Campbell, Executive Director, NETWORK National Catholic Social Justice Lobby, Aug. 4, 2009: “NETWORK…supports provisions in H.R. 3200 that allow Medicare to pay doctors for patient visits when the patient has requested a visit to talk about advanced directives for care. This policy promotes clear communication in families and helps to ensure that everyone is aware of a patient’s wishes. The anti-healthcare reform advocates have latched onto this provision in order to spread lies and fear among vulnerable populations….Lies and distortions have no place in the dialogue about the change….NETWORK supports the truth of families talking together about a loved one’s end of life wishes. This is a family value that should be supported, not demonized.”

Rev. John H. Thomas, General Minister and President of the United Church of Christ, August 4, 2009: “Giving patients the opportunity on a regular basis to discuss with their physicians the values and choices they want to inform health care decisions is an important component of good medical care. This is good for doctors who want to provide the best care for their patients, for families when they must make difficult decisions about loved ones, and for patients who want their religious values and moral perspectives respected.”

Joe Volk, Executive Secretary of Friends Committee on national Legislation, a Quaker organization, August 4, 2009: “While many patients have filed ‘living wills’ to set out their wishes as they approach the end of life, it is not always possible for patients to anticipate changes in their health status or in medical treatments for their conditions. Authorizing consultations for patients with their physicians about the range of options available to them at all stages of care is a sensible and respectful measure – one that preserves the dignity and individuality of the whole person….[S]ome detractors are mischaracterizing this simple and sensible provision. It certainly does not coerce or limit individual patient’s choice in any way. It does…put the patient at the center of her or his care, through all the stages of life.”


Health-care reform: Distortions doom end-of-life counseling

From the Seattle Times
Sunday, August 16, 2009

IN the end, sensible end-of-life counseling proposals in health-care reform had to be dropped, because too few Americans bothered to understand what was being proposed.

From a practical standpoint, consultations must be removed from the legislation to save more-pressing elements of reform. Willful distortions of optional end-of-life counseling spiraled out of control. This is not a proud moment in American politics.
Financing beneficiaries’ optional consultations about a range of end-of-life care is a good idea. Families need it. Patients benefit.

But a well-orchestrated rumor campaign ensured this element of the plan could not survive. It became too much of distraction.

The idea that the government would stage death panels cutting care to critically ill patients is an absurdity, perpetuated by conservative publications and a woman, Betsey McCaughey, whose claim to fame is trashing Former President Clinton’s health-care reform.

Sarah Palin joined the frenzy, proving how dangerous she would have been as vice president.
Ironically, the idea for such consultations supposedly came from Georgia Sen. Johnny Isakson, a Republican. Doctors, patients and families will have to wait for a saner moment in the debate to include this important care.

Sometimes, hysteria wins. What a shame for those who may not have access to information that would aid them in making excruciatingly painful decisions.


Hello! We are Mortal! Grow Up and Plan Accordingly!

The Senate Finance Committee may strike end-of-life consultation reimbursement from their version of the health care bill, so maybe the hysteria will die down. But it’s sure to rise again if the provision survives in the House version. Will Congressional leaders summon the courage to deliver an adult response or cave in to hysterical attacks?

It’s remarkable how easy it’s been to gin up a frenzy of fear and anger with scary messages that remind people death is inevitable. Most politicians say they support advance directives for end-of-life planning and encourage their use. At least they did until a few days ago. That’s when the idea took hold that it’s highly dangerous and tyrannical to encourage doctors to talk with patients about what kind of treatments they would want if they were terminally ill and unable to speak for themselves. That’s why the provision to reimburse doctors for the consultation can’t be part of health insurance reform. Apparently this would be the first step to a Nazi regime, where doctors somehow profit from euthanizing their paying patients and panels meet to decree the death of granny and disabled children.

The national dialogue leaped from modest proposal to outrageous hyperbole so fast it’s clear something profound and quite apart from advance directive consultation was at work. International professionals in end-of-life counseling joke that in America people think death is optional. It certainly seems true, to judge by the public’s tantrum after being reminded it ain’t so.

Hello America! We are all mortal! It’s our fate. Adults know this in their hearts and the wisest among us live every day conscious of life’s impermanence. A mature society would have handled this differently.

One of my favorite poets, Edna St. Vincent Millay, wrote, “Childhood is the kingdom where no one ever dies.” Apparently that’s the fantasy some of our national leaders want to promote. “Terry Schiavo will be kept alive even if it takes an Act of Congress!” “No one need ever discuss with their doctors how their life might end.” Such attitudes treat American citizens like children, too young to come to terms with their own mortality. Why should we be surprised to see town hall displays of childlike temper tantrums? Treat people like children and they will act like children.

Playing into America’s pathological denial of death is to treat mature individuals like children, and very young children at that. Researchers and clinicians tell us it’s normal for children 3 to 5 years old to deny death is final. Telling a very young child Granny is “asleep” or “on a long journey” supports the denial. Between five and nine years old children come to accept that death is final, and can think about it’s happening to others. By about age ten a child is usually ready to start thinking about her own death.

National leaders deliberately sparked fear and anger over a consultation about death and sensational media threw fuel on the fire. They would have us remain a nation of five year olds, stuck in an infantile refusal to acknowledge, grieve over, and plan for, our own deaths or the deaths of those we love. For shame. Certainly that’s no way to come into our greatness as a nation. Certainly such stunted psychological and spiritual development is not what it means to be a human, created, as many believe, in God’s image.

No, coming into the fullness of being means living a life of thoughtful judgment and conscious decisions. And that includes decisions about the end of life. Recently the New York Times carried a story of the care and intention with which the Sisters of St. Joseph manage the individual deaths of their aged nuns as the entire order gradually dies out. They are thinking about their dying and they are talking about their decisions. “We approach our living and our dying in the same way, with discernment,” Sister Mary Lou Mitchell told the reporter. “Maybe this is one of the messages we can send to society, by modeling it.”

In Adulthood — a kingdom still distant from our shores — leaders will foster dialogue and pass laws to help their constituents on that very human quest to discern and embrace both life’s sweetness and death’s certainty with a similar quiet grace.