End Of Life Discussion Is Not Health Care Rationing

The term ‘Death Panels’ has been thrown around since the first draft of the new health care bill emerged.  In that bill, section 1233 originally stated that Medicare beneficiaries were entitled to one visit with their primary care provider every five years to discuss end of life issues.  Not a bad idea but, honestly, every five years may mean that some people would never make it to their PCP for the discussion.

After an enormous wave of outrage over the idea of rationing and death panels emerged, the section was apparently scrapped.   Then, with the passage of the PPACA in the wee hours on a cold November Saturday night, it re-emerged, but with an annual option instead, as a Medicare benefit.  Beginning January 1, 2011, Medicare patients and their providers can sit down and talk with dignity, their individual thoughts about end of life issues, and the provider will be paid for such a discussion as part of the patient’s annual physical examination.

In the past, we providers more often than not have come face to face with this issue in hallway discussions, not with the patient but with their families.  And as you can imagine, families facing those issues with no clear guidance from the patient feel the full burden of making those life and death decisions when they and the patient are the most vulnerable.  The decision is an informed one but covered with layer upon layer of emotion and doubt, multiplied by the number of family members present.  Even if the patient had a discussion with their spouse or loved ones prior to the current critical illness, doubting Thomas’ in the family, some who haven’t seen dear “uncle John” in twenty or more years thrust a dagger of doubt and guilt, saying you’re just trying to kill him.  What a needless burden to leave to family and friends.

Consider that one third of all Medicare dollars are spent on chronic health care related expenses in the last two years of a person’s life.  Many of those dollars are spent on hospitalizations which merely prolong dying and not prolonging life.  And consider the concept of “quality of life”. Is it quality of life to lie in a hospital bed with a catheter in your bladder to drain urine,, a tube in your rectum to collect stool so the skin on your buttocks doesn’t break down into an open wound, an IV in your arm for antibiotics, sedatives, analgesics, amnestics, etc.,, a tube down your throat to breathe for you, hands and feet tied so you can’t pull out any of your tubes, lines or wires, another tube passed down through your nose to feed you?  All the while one slips in and out of consciousness as family and friends sit at the bedside, weeping and wringing their hands hoping for a full recovery.  If that’s your idea of quality of life, you can have it, at whatever cost to family, friends, Medicare, whomever.

In the best of worlds, all of us would have the discussion of what we, as patients and dignified human beings, would want in the event of critical or catastrophic illness.  We would write those thoughts and wishes down, sign it, have it notarized and kept with all of the other important papers we keep.  Having an end of life discussion is not rationing, but it is a very rational thing to do.

Be sure to have your end of life discussion and decide how, and with what dignity, your last days will be like before someone else decides for you.

Doc B

My opinion is free.
Advice is worth exactly what you pay for it.

Addendum 3/22/2011

A recent post I read at the Health Care Blog caught my attention. It was looking at the new Medicare benefit allowing patients to discuss end of life issues with their physician and have the physician to be able to bill for that discussion. The article by David E. Williams entitled, here, here, here.


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