When It Comes To End-Of-Life Decisions, Which Of These Two Women Do You Trust?

Posted on | February 14, 2011 | 5 Comments

Mike Magee

When 2008 GOP VP candidate Sarah Palin came out with her “death panels”, most of us who had worked with and advocated for “Living Wills”, “Advanced Directives” and end-of -life discussions never thought she would be taken seriously, even though there was a past history to this distortion.(1)

We thought the governor’s remarks would fall flat. They were totally and wildly inaccurate.  And main stream newspapers thoughout the heart of America reacted immediately. Here’s a sampling collected and aired in the American Medical News at the time (2):

End-of-life discussions are useful
“In truth, there are no “death panels” in the proposed legislation to overhaul the health care system. HR 3200, the main proposal in the U.S. House, makes periodic, voluntary end-of-life discussions with your doctor a covered expense under Medicare (Sec. 1233). In truth, Republicans supported such discussions in Medicare proposals when George W. Bush was president. That’s it. No euthanasia, no arbitrary decisions about who should live or die, no mandatory anything.” Miami Herald, Aug. 20, 2009

Distortions doom end-of-life counseling
“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.” Seattle Times, Aug. 16, 2009

Resuscitating the “end of life” talk
”There’s a larger failing involved here: Many doctors shy away from the “facts of death” conversation not only because Medicare doesn’t cover it, and the subject is painful, but also because they’re not sure how to broach the topic. They often have little or no training in geriatrics. Between 2005 and 2030, the number of older adults in the United States will nearly double, but most doctors, right now, aren’t required to demonstrate the competence in geriatrics that they’re required to demonstrate in, say, pediatrics and obstetrics.”
Oregonian, Aug. 10, 2009

Stop distortion: There’s no “death panel”
“End-of-life care is a difficult issue, but one Americans should discuss — with family members, attorneys and doctors. Especially doctors. They will likely be involved in end-of-life care, if it becomes necessary. They should be compensated for consulting with patients on the issue. That is what the House legislation strives to allow: consultation. It’s not about death panels. It’s about planning, which is important for individual patients and the health-care system as a whole.”
Des Moines (Iowa) Register, Aug. 14, 2009

Debunking the “death panels”
“After the “birthers,” now come the “deathers.” Just as there were those who believed, in the face of all evidence, that President Barack Obama’s birth certificate was a fake and that he was not really native-born, there are those who believe, all evidence to the contrary, that his health care reform encourages, even requires, euthanasia.”
Ventura (Calif.) County Star, Aug. 13

In truth, health professionals made a huge mistake in believing that logic, knowledge, and well established professional practice would easily counteract Palin’s irresponsible actions, reinforced at the time by (now presidential candidate) Newt Gingrich, Senator Charles Grassley and a host of surrogates and professional amplifiers. A simple check of top google searches at the time (with “death panels” beating all comers) should have forecast what happened next. The fact that the bill wouldn’t require patients to receive counseling sessions, nor would it require a doctor to offer one didn’t matter. Nor that it simply modified Section 1861(s)2 of the Social Security Act, defining what services Medicare will pay for and allowing a patient receiving an end of life counseling session from a doctor or health care practitioner, to have Medicare pay for it.  No matter. Within weeks, the proposed coverage was gone.

The reality? Palin’s intrusion into well-established medical terrain had not received an adequate counter-punch from health professionals around the country. In anticipation of round two, that’s begun to change. No one has been more vocal than the American Medical Association’s Chair of the Board, Ardis Dee Hoven MD. Here’s part of what she had to say in an editorial (3) on  January 24, 2011:

“Discussions about end-of-life care are on the front burner again, as they should be, given health system reform, our critical updating of medical education requirements and our aging population.

But they are on the front burner for the wrong reason. After being left out of the health reform legislation, new regulations suggested that physicians offer — and be paid for doing so — annual discussions with Medicare patients about end-of-life care. The discussions were to be voluntary, not mandated. Then, just five days into the new year, that provision of the regulation was rescinded.

The people in Washington have done a great disservice to America’s seniors.

Despite many Americans’ general unwillingness to recognize the inevitability of death, every physician should be prepared to talk with patients about what sort of care they expect during their final days, and to update that conversation periodically.

This is called “practicing good medicine.” It is not a mechanism to inappropriately limit care or access to care. As these discussions take preparation, thought and time on the part of physicians, they are also something for which doctors should be paid.

We all recognize that conversations about and planning for the end of life can be difficult to initiate. Patients often wait for physicians to broach the subject. Physicians, on the other hand, can be leery of raising the issue, afraid that it might frighten patients or their families.

In fact, it can do just the opposite. This kind of discussion and planning actually can be empowering. It is not about a list of treatments — yes or no — but about how a person wants the end of his or her life to unfold. Because it puts the patient in charge, a sensitive, patient-led discussion on expectations and preferences concerning end-of-life care can be of tremendous importance in easing stress, depression, anxiety and even pain for patients in their final days.”

Dr, Hoven and the AMA deserve our thanks for speaking up now. But if they think this is enough to prevent Sarah Palin, Newt Gingrich and a host of Presidential hopefuls from shamefully “riding Death Panels” again in the 2012 Presidential Election, they are sadly mistaken.(4) And if they wait any longer, they will once again yield medical ground to non-medical political opportunists. What should Medical, Nursing and Hospital Associations do right now? Three things:

1. Organize a cross-sector coalition of health professionals, insurers, hospitals, employers and long term care providers who are like minded on this issue.

2. Coordinate a comprehensive communications plan including active engagement of health professionals and their patients, and begin the plan immediately.

3. Develop and fund an active response team that will “call out” those who try to “ride” this issue a second time.

We underestimated these people the first time around. For that we can be forgiven. But if we let them get away with it a second time, that will indeed be unforgiveable.

For Health Commentary, I’m Mike Magee.
References:

1. Rutenberg J, Calmes J. False “death panel” rumors have some familiar roots. NYT. August 13, 2009. http://www.nytimes.com/2009/08/14/health/policy/14panel.html

2. American Medical News Editorial: What editorial writers are saying about end-of-life discussions. Aug. 31, 2009. American Medical News, http://www.ama-assn.org/amednews/2009/08/31/edsa0831.htm

3. Hoven AD. End-of-Life talks difficult but shouldn’t be avoided. American Medical News. January 24, 2011. http://www.ama-assn.org/amednews/2011/01/24/edca0124.htm

4. Glendinning D and Sarver KM.  White House death panel’s health proposals to get second look in Congress. American Medical News. January 3, 2011.
http://www.ama-assn.org/amednews/2011/01/03/gvsc0103.htm

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