Promoting End-of-Life Discussion

The leap from providing Medicare coverage for end-of-life discussions between physicians and patients to euthanasia achieves a unique level of preposterousness.

“This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law,” House Minority Leader John Boehner, R-Ohio, and Rep. Thaddeus McCotter, R-Mich. said in a statement last month.

As emphasized by the legislators and the Obama administration, this measure is designed to promote these discussions, not mandate them. End-of-life discussions between physicians, patients, and their families are important in ways that most people inexperienced with death fail to comprehend: the current process of dying can be very emotionally painful and financially expensive when the desires of family members do not match the desire of a patient who cannot communicate (e.g. comatose, delirious, severely aphasic, etc.). The most sensitive and caring doctors I have worked with (who happen to be excellent arbiters of end-of-life discussions and decisions) hate situations where a spouse or child pushes to “have everything done” for a patient, resulting in months or years spent in a twilight daze with tubes and wires in every orifice and exposed blood vessel. Some of these physicians have submitted to me the observation that when critically ill patients are able to communicate their wishes in situations where the physician and the patient both understand that he is unlikely to recover an independent livelihood (away from advanced medical and nursing care), 99% of these patients will choose a comfortable, quiet and not prolonged death (withdrawing support). The hasty decisions of the spouse or child, then, seem to draw more from a selfish desire to “keep” the loved one “alive” in any shape or form. These situations occur very frequently, putting enormous financial strains on the family (after the prolonged hospitalization) and the health care system (thus overall reducing services that could be provided to other patients). In many ways, the advancement of life support technologies and techniques has outstripped our country’s philosophical and cultural maturation regarding death: we still want to live forever, but we don’t know what life is.

End-of-life discussions, when occurring outside of the setting of an acute and critical illness, should not be rushed, but they should be emphasized. Given the extreme shortage of time that physicians are able to provide to patients and their families, a great deal of medical care surrounds activities that are billable. Adding a financial incentive to offering end-of-life discussions can make these discussions more of a reality when desired.

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