Slaying The “Death Panel” Bull: Patients and Physicians Take Control of End-of-Life Decisions

Mike Magee

This Saturday, April 16, 2011 is National Healthcare Decisions Day – a day set aside to encourage families throughout America to discuss with each other how much care and what kind of care they would like as they approach the end of their lives.(1) Why advanced planning? Because there is a good chance that when the time arrives for each of us to make these decisions, we may lack the decision making capacity to do so. It makes sense to take a moment to let your loved ones know your preferences.

Why do we need a National Healthcare Decisions Day at all? One reason is we tend to procrastinate – especially when it comes to our own mortality. So we all can benefit from a little encouragement. But sadly, we now have the added obstacle of highly politicized organized resistance.

These are the individuals who invented the term “death panels”; who issued solemn warnings that sensitive confidential planning with your doctor could be “a treacherous path toward government-encouraged euthanasia”, and who then doubled-down with media voice box amplifications like “possible first slippery step on the road to state-mandated late-life rationing”.(2,3,4) Yikes!

The result? In the middle of health reform, advanced planning quickly became too hot to politically handle. (5) And yet, sometimes sanity prevails. Out of the ranks of diverse organizations, logic has begun to assert itself. The American Medical Association, the American Bar Association, the AARP, Aetna, United Healthcare, Amedisys, the Catholic Health Association, the VA, and many more have joined hands on a health populist platform, led by a young Virginian healthcare lawyer named Nathan Kottkamp. (6,7,8)

That platform, The National Healthcare Decisions Day, swings into full throttle this Saturday, April 16, 2011. But its’ work is ongoing – increasing awareness, rallying and mobilizing people to communicate and document important healthcare decisions with the people they trust the most – family and physicians and nurses. (1)

They share the facts – and the facts are pretty clear:

According to HHS (9) all healthcare facilities are required to:

Provide information about health care decision-making rights.
Ask all patients if they have an advance directive.
Educate their staff and community about advance directives.
Not discriminate against patients based on an advance directive status.

The U.S. Agency for Healthcare Research and Quality, in a 2003 article (10), “Advance Care Planning: Preferences for Care at the End of Life,” revealed:

Less than 50 percent of the severely or terminally ill patients had an advance directive in their medical record.
Only 12 percent of patients with an advance directive had received input from their physician in its development.
Between 65 and 76 percent of physicians whose patients had an advance directive were not aware that it existed.

The Pew Research Center (11) found:

42% of Americans have had a friend or relative suffer from a terminal illness or coma in the last five years and for a majority of these people the issue of withholding life sustaining treatment came up.
An overwhelming majority of the public supports laws that give patients the right to decide whether they want to be kept alive through medical treatment.
By more than eight-to-one (84%-10%), the public approves of laws that let terminally ill patients make decisions about whether to be kept alive through medical treatment.
Between 1990 and 2005, the use of Living Wills increased up 17 points, from 12% in 1990 to 29%.

But here are the 3 most important facts:

1. While 9 out of every 10 of you say you want to discuss end-of-life care with your physicians, more than 60% of dying patients say they haven’t dicussed this with their doctor. (12,13,14)

2. Organizations can only do so much. It’s your body, your life, your future. You need to open the discussion with your loved ones and your physicians and nurses.

3. The best way to open the discussion is to participate in the National Healthcare Decision Day. Stand up. Speak up. Share this resource with all those you love and cherish. To celebrate life, PRESS HERE.

For HealthCommentary, I’m Mike Magee.

References:

1. National Health Decisions Day. http://www.nhdd.org/
2. USA Today. Editorial. “Our view on healthcare: Nonsense about death panels springs back to life.” 1/6/2011.
http://www.usatoday.com/news/opinion/editorials/2011-01-07-editorial07_ST_N.htm
3. FOX News. “End-of-Life” Counseling Intensifies Health Care Debate.” 8/8/2009.
http://www.foxnews.com/politics/2009/08/08/end-life-counseling-intensifies-health-care-debate/
4. Krauthammer C. “Government by regulation. Shhh. The Washington Post. 12/31/10.
http://www.washingtonpost.com/wp-dyn/content/article/2010/12/30/AR2010123003047.html
5. Pear R. “U.S. alters rule on paying for end-of-life planning.” 1/4/2011. NYT. http://www.nytimes.com/2011/01/05/health/policy/05health.html
6. Hoven AD. AMED News. End-of-life talks difficult, but shouldn’t be avoided. 1/24/2011.http://www.ama-assn.org/amednews/2011/01/24/edca0124.htm
7. American Bar Association. 13th Annual ABA Dispute Resolution Spring Conference. April 13, 2011. Commission on Law and Aging. http://www.americanbar.org/groups/law_aging.html
8. NHDD National Participating Organizations.
http://bit.ly/g8K7y9
9. Center for Medicare and Medicaid, HHS: Advance Directives. http://edocket.access.gpo.gov/cfr_2007/octqtr/pdf/42cfr489.102.pdf
10. AHRQ. “Advance Care Planning: Preferences for care at the end of life.” http://www.nhdd.org/2011/02/ahrq-research-in-action.html
11. Pew Research Center. “More Americans Discussing and Planning End-of-life Care: Strong Public Support For Right To Die.” http://people-press.org/http://people-press.org/files/legacy-pdf/266.pdf

12. Pho K. Politics mustn’t silence end-of-life talks. USA Today. 4/13/2011. http://usat.ly/gvhoeb
13. Fischer S, et al. Advanced care discussions do not lead to death. J. of American Geriatrics Society. 1/20/2010. http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2009.02698.x/abstract
14. Holmes R. At the end of life a costly refusal to talk about options. Wicked Local Action. 9/7/2010. http://bit.ly/dGCFAF