The Truth About Death CounselingWe start off with a wonderful premise. Let's get rid of the fire-breathing moron -- we can start with Palin then add in virtually all of Fox News, virtually all of the Washington Post editorial page, at least two-thirds of all Republicans and the whole fringe-lunatic crowd exemplified by the birthers, the Limbaugh audience, etc. I estimate that to be close to thirty-percent of all Americans.
By Charles Krauthammer
Friday, August 21, 2009
Let's see if we can have a reasoned discussion about end-of-life counseling.
We might start by asking Sarah Palin to leave the room. I've got nothing against her. She's a remarkable political talent. But there are no "death panels" in the Democratic health-care bills, and to say that there are is to debase the debate.
We also have to tell the defenders of the notorious Section 1233 of H.R. 3200 that it is not quite as benign as they pretend. To offer government reimbursement to any doctor who gives end-of-life counseling -- whether or not the patient asked for it -- is to create an incentive for such a chat.Any reimbursement, for anything, has the potential to create an incentive and over-use of the resource, whether it's "end-of-life counseling," antibiotics or an MRI. Which gets me to my "just so" MRI story: Six months ago my wife had a very mildly sprained shoulder. Twenty years ago they'd have put her in a sling and told her to take aspirin for the pain. This time they wanted to MRI her.
I strenuously objected to the MRI because it was clear there was no bonafide medical necessity and I didn't want to play "insurance denial" roulette and be stuck for a pointless, unnecessary $5,000 procedure. A procedure necessitated, not because there was anything seriously "wrong" with my wife that would require this procedure, but in great part because hospitals require their doctors to "make their numbers" for these kinds of tests. Woe to the doctor who doesn't make his quota and marginal (and I'm being charitable in my wife's case) cases are frequently referred. Anyway, she didn't get the test and after about a month-and-half she was better -- just like you'd expect from a very mild shoulder sprain.
And this goes on, through-out medical care. It's not just my wife. It's not just my grandmother who would have preferred to die (and was committing slow suicide in any case) instead of being kept alive by respirator, etc., for almost two months as she just started failing, system after system. The reality of over-medicalization is rampant in the medical industry. It's at all levels and we know it! So, does anyone in their right mind think that doctors are going to forgo lucrative, reimbursable medical treatments for a crappy "Death-With-Dignity" consult?
So, to pretend, as is implied by Krauthammer, that it would create an irrational, abusive incentive in lieu of bonafide medical care is laughable. Virtually all of "for profit" medicine has these problems. As does most everything when money gets attached to it.
But, of course, that's not the only fear-monger that Krauthammer has...:
What do you think such a chat would be like? Do you think the doctor will go on and on about the fantastic new million-dollar high-tech gizmo that can prolong the patient's otherwise hopeless condition for another six months? Or do you think he's going to talk about -- as the bill specifically spells out -- hospice care and palliative care and other ways of letting go of life?I think it would be frank. And I do not believe that the doctor would fail to sell a whirl-about in his "new million-dollar high-tech gizmo." I think it's absurd to think that the doctor who is either trying to preserve a life, or callously generating billings as so many do, is going to withhold this information. The first wouldn't because of his/her overwhelming ethical persona. The second because he's a greedy ass like so many doctors and no way would he fail at the chance to up his billings.
Which gets me to my ex-mother-in-law. She died of a particular glial cell carcinoma. This cancer is known to be 100% fatal within two-months of diagnosis and is usually fatal within one-month. There is no know cure and surgery, chemotherapy, etc., have not shown to be effective.
From the day of diagnosis to her death was less than thirty days. The doctors, knowing nothing would work, still flew her to Arizona from her hospital in Reno. They scooped out a huge chunk of her brain and she was, after a week, sent home to die. She didn't die with dignity. She didn't die any later. She died with a substantial loss of motor control, including her bladder and bowels, and he husband had to change her diapers for the last two weeks of her life as she laid there and died in her own piss and shit.
So don't pretend, at least to me, that doctors don't perform "health care" for any purpose but to to bill. These doctors knew it wouldn't work. But they did know they could collect as my ex-mother-in-law was on medicare. That she died, in her piss and shit unable to control her bowels was obviously of no matter. They got paid for a pointless surgery on an incurable, aggressive cancer.
So, by this point I think rational people can see Krauthammer's argument is self-defeating. It's really a dishonest slight-of-hand where he constructs a strawman medical professional who will fore-go other, more lucrative, options to hop on the "death counseling" boat. It's simply ludicrous. But if that wasn't enough fear mongering for you, he goes for other fear-mongering by attacking people through primal horrors:
No, say the defenders. It's just that we want the doctors to talk to you about putting in place a living will and other such instruments. Really? Then consider the actual efficacy of a living will. When you are old, infirm and lying in the ICU with pseudomonas pneumonia and deciding whether to (a) go through the long antibiotic treatment or (b) allow what used to be called "the old man's friend" to take you away, the doctor will ask you at that time what you want for yourself -- no matter what piece of paper you signed five years earlier.Nobody says you can't revoke this course of action. A living will is not an unbreakable contract with suicide. To pretend so is intellectually lazy and dishonest. But beyond that, this is what (those of us who are rational) envision beyond the rest of the crappy strawman and ghostly death images of Krauthammer's fevered imagination:
This past spring, the Death with Dignity Act was widely recognized and lauded for being a safe, compassionate law providing comfort and peace of mind to terminally ill adults. The Oregon Department of Human Services’ (DHS)11th annual report detailing usage of the Oregon Death with Dignity Act demonstrates that this praise is well deserved.This is what we're talking about Charles. Having a say in how you go. Without noisome, meddling relatives or the State sticking their noses into our last decisions, for whatever petty or noble reason they believe. Death-with-dignity is an on-going issue and nothing written by Charles, or any of the other right-wingers, is anything but the bogeyman spectre of the right-wing.
This year’s statistics are largely in keeping with the data collected over the past 10 years. 88 people received ODWDA prescriptions in 2008, and 60 people died under the terms of the Act. The typical participant was 72, college educated, and suffering from cancer. Over the years, participants have listed quality-of-life issues as their main reasons for using the Act, and this year was no different. The top concerns included an inability to participate in activities that made life enjoyable, loss of autonomy, and loss of dignity.
There were some categories in which the statistics made a more noticeable shift. In 2008, 98% of patients were enrolled in hospice care, which is a significant increase from previous years when hospice enrollment was at 86%. In addition, in 2008 more patients had private health insurance (88%) than in previous years (63%).
The report also indicates that the dire predictions of Death with Dignity opponents have not materialized. This year, as in all previous years of the Act’s usage, there was not a single report of coercion, abuse, or misuse of the law. For the 11th year in a row, Oregon’s Death with Dignity Act has proven to be a safe and effective law. Read DHS’ report and table.