Can we please talk about death like adults?

July 22, 2013

Rep. Earl Blumenauer still wants death panels.


We need to talk about death like adults. (David Goldman/AP)

Okay, that's a lie. He doesn't want death panels. Here's the honest, though less interesting, lede:

Rep. Earl Blumenauer still wants Medicare to cover consultations between patients and their doctors on the kind of care they want at the end of their life. That's the policy that Sarah Palin called a "death panel" during the 2009 health-care debate. It's also a policy that sounds boring, though commonsensical, when you explain it.

The problem with Blumenauer's legislation isn't that it goes too far. It's that it doesn't go nearly far enough.

Blumenauer's bill would reimburse doctors in the event that their patients want to schedule a visit to discuss end-of-life-care. But everyone on Medicare should have their end-of-life preferences clearly spelled out. That could mean checking the box for "do anything and spend everything to keep me alive.' But it could also mean checking a box for more limited end-of-life care, as that care can be horribly painful and debilitating, even as it offers no real chance of recovery.

This isn't about saving money. It's about compassion. End-of-life care is a nice, bloodless term. But the reality is much more violent:

Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.

In a world where we could discuss end-of-life care like rational adults, the answer here would be simple: In order to receive Medicare, you have to fill out an end-of-life care directive. If you want, you can have a consultation with a doctor about your options. Otherwise, you just make the call on your own.

Either way, your preferences need to be clearly spelled out so that your doctor and your family aren't left guessing about whether they should crack your ribs delivering CPR when it's already clear you'll never leave the hospital again.

But we don't discuss end-of-life care like rational adults. We call optional consultations "death panels." Then, when the patient is lying unconscious and intubated a doctor goes out and asks a scared family member whether they want everything possible done to save their loved one, and of course they do -- who wouldn't want that? And so seniors living out their final days get tortured by the medical system because everyone involved was too afraid to talk about death -- and the occasional ugly realities of end-of-life "care" -- before it was near.

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