(1/5/2011 - See update to this post below)
You've taken tender loving care of that old jalopy for decades but you just know its time is limited. Is it worth replacing the tires? Would a new transmission keep it alive for another dozen years? What are the chances something else would go wrong with it?
You've got a decision to make - and you need someone who knows about these old jalopies who can help you understand your options and help you make your own decision about the end of your old jalopy's life.
But who can do that for you? Who is the best person to give you that advice? Who else really understands your jalopy and your concerns about it?
The best person to help you understand your options will be the mechanic who has taken care of that old car for all these years. You'll still have to be the one to determine whether you're more interested in the quality of the ride than the length of time the ride lasts - but again - your mechanic will be the one to help you figure that out.
And so it is with our doctors - our body mechanics - the people who have helped us maintain our health and fix health problems for longer than anyone else, and who have that understanding about what the issues are we deal with. They are in the best position to help us know what our options are. Of course, we are still the ones to make the decisions.
Now I'll ask you to think back to early 2009, when that now-infamous email began making the rounds telling us that healthcare reform would produce "senior death panels." That if we approved healthcare reform, it would mean that senior Americans would be (in effect) sentenced to early deaths.
We learned then, that the very people who had the most money to lose (insurers, pharmaceutical companies) were the ones who were trying to scare us. They were assisted in large part by Republicans Sarah Palin and John Boehner who would look for anything at all to make a good service sound dangerous. In fact, there is no such thing as a death panel.
But we also learned how they could get away with making that up. There was a provision in the original proposal (removed before it was passed last March) that said that if patients asked to have their end-of-life options explained to them, and their doctors then explained advance directives including DNRs or living wills, then those doctors could be reimbursed for that service. Seems fair, doesn't it?
All very benign, actually. But doused with gasoline and flaming matches by those who were afraid of losing their meal tickets if healthcare reform passed. They knew the public could be fooled into believing twisted facts - and - we did.
So, because our fellow members of the American public became so enraged, the reimbursements for end-of-life counseling were removed from the legislation that was passed in March 2010, before it was passed and signed into law.
Now, fast forward nine months - and as of January 1, 2011 - that possibility of counseling from your doctor WILL be a service you can take advantage of, if you are a Medicare patient. In the remarks he made about this new regulation, President Obama said (via the New York Times):
"Advance care planning improves end-of-life care and patient and family satisfaction and reduces stress, anxiety and depression in surviving relatives," the administration said in the preamble to the Medicare regulation, quoting research published this year in the British Medical Journal.
Patients should cheer this development. This is a provision that most definitely addresses our quality of life. We have too often heard stories about people who are kept alive, not because they will find any quality to their lives, but because science has a method to do so. The longer we stay alive, whether we want to or not, the more money is made from our illness.
Which is why it is ludicrous to believe that our own doctors would want to do away with us prematurely! By insisting that our doctors be the ones who do the counseling, we are ensuring that we will get the most objective information. They are rewarded for helping us understand. They "lose" when we are gone. If they are going to err in any direction, they will err by recommending treatments that might extend our lives - not those that might bring us to the ends of our lives.
It's time to appreciate and embrace this new regulation that will allow us to talk to our doctors about our end-of-life decision-making. As an added bonus, it is bound to improve our communication with our doctors - and that can only be a good thing.
• Learn more about advance directives and end of life decision-making.
• Learn more about medical decision-making.
• See what Politifact had to say about senior death panels - 2009's "Lie of the Year"
• New 12/30/2011 - from Forbes Magazine - The Death Panel Boogeyman
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Update 1/5/2011 - this reversal seems to have been reversed, according to the New York Times. Supposedly, the reversal is due to a procedural question. We shall see.
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Obama appoints Donald Berwick aka “Dr. Death Panel” using recess appointment to head Medicare and Medicaid
Dr. Death Panel quotes include:
“The decision is not whether or not we will ration care – the decision is whether we will ration with our eyes open.”
“Any health care funding plan that is just, equitable, civilized and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional.”
No wonder Obama didn’t want Congress to question him in an open hearing.
Bravo, Trisha. Very well put.
The absolute irresponsibility of our public officials continues to stun me as they ratchet up the rhetoric when it comes to health care. The ability to speak with your doctor about your end of life choices and options is essential. As a patient advocate, I have witnessed the spouse and family members struggle to make life and death decisions for their loved ones. Without the benefit of prior discussions, the spouse or children who are left to make the decision are caught in a torrent of guilt, doubt and stress, trying to decide what is right for their loved one.
We believe in autonomy in our country. Fundamentally we as patients have the right to chose what kind of end of life treatments we want and we make those decisions based on our own personal values. As with everything else in healthcare, if the patient is not educated about all their options, including the option not to treat or to cease treatment, there cannot be informed consent. Patient Advocates protect the rights of the patients. And the right to informed consent is a basic right.
Hmm-It seems like anyone can twist the facts.
Of course patients/families should exercise the right they already have to discuss end of life issues with their physicians and other healthcare providers. As an emergency room nurse and an intensive care nurse I have seen this done almost everyday in my practice for many years.As advocates,we need to focus on giving each patient/family member the info they need,as they need it.
I have never seen it denied when it was presented to them or when it was asked for. I’ve never known anyone to be charged for it.
As a Marketing professional with limited experience in the hospital setting, you may not have seen this but that does not mean it doesn’t happen. Can we do better? Certainly and we are learning.
Are there going to be fewer “life-saving” procedures offered to older,sicker Americans? Probably. And there are both positive and negative ways to look at that. Pragmatism will
often rule over emotion as we seek a balance in “affordable healthcare.”
I think the best we can do for our clients is to keep it personal, not political.
@Susie: Your politics are showing in your opening and closing sentences.
I am also a RN with ER and ICU experience. How many times have you had an ER patient with no Advance Directive, POA for healthcare or any relative even to give verbal directions for the pt’s wishes? How many times have you had to perform chest compressions on someone so elderly and frail that that you can feel the ribs detach from the sternum, because they had not had that talk with their family and primary provider BEFORE they got to the ER or ICU? How many times have you walked away from a unsuccessful code on such a pt feeling angry and sick, like you had just participated in elder abuse for robbing this person of a respectable death?
Point being, this necessary discussion will most likely be facilitated if it is encouraged by reimbursement to primary providers and it takes place in the more comtemplative and less stressed environment of the provider’s office and NOT the ER or ICU.
Of course my politics are showing. It has become a political discussion. The article itself is political. And I have no problem with that. I thought this was a forum for discussion that would include opposing opinions.Trisha, if I am wrong about that, please let me know.
Anyway, you are assuming that if a person has an end of life discussion with his providors and family, he/she will, of course, agree with you and decide against heroic efforts. Remember,they have a choice, and some(many) people discuss and still choose to do “everything.” You may disagree and feel disgusted and angry with their choice and that you have to do CPR on someone you think should die. It’s your job, even if you disagree.
I have disagreed with the choices of some of my patients,after they have a full discussion with their doctor and family but I have never been reluctant to carry out their wishes. I agree that all patients should be encouraged to discuss end of life issues. Related to that issue is the possibility of not offering some treatments to some people who will not fall into certain parameters(like not offering dialysis to people over a certain age). There will be a group of professionals charged with determining parameters. In practice, we know that these things make some sense but when it comes down to an individual, some people are not going to be happy. They may call the afore-mentioned group a “death panel.” when that individual is denied a certain treatment.
At any rate, these are things that should be discussed, in a friendly fashion, so that we can all learn and make better choices personally, professionally and politically.