Guest Blogger, Mike Grady MD, returns with his insight into the so-called “death panel.” See Dr Grady’s previous post here.
I recently conducted one of Sarah Palin’s “ death panels” and thought I would let you know how it went. The expression of course comes from Palin’s absurd
delusion that a proposed provision of the President’s health plan would have the government making decisions to deny health care to elderly and disabled citizens. The actual language would have Medicare pay physicians to have voluntary end-of-life discussions with patients at critical junctures in their lives. Nothing more; nothing less.
My conference was a typical one. An elderly patient is admitted to a nursing facility after an extensive hospitalization with uncertainty about his prognosis and whether he will ever be able to return home. The patient, whose capacity to make decisions is limited, and family members are present. There were no government bureaucrats in the room or mandatory discussion guidelines. There was instead a good discussion of diagnoses and the clinical uncertainties involved. Decisions were made and some deferred about resuscitation, re-hospitalization, tube feedings, aggressive vs. palliative care and hospice. All of this was explored in view of the patient’s values, preferences and priorities.
These kinds of conversations are necessary because of the way we die. We do not get old and die; we get old and sick and die, with an average of 5-10 years of disability before our deaths. Advancements in medicine have both prolonged our lives and, in some cases, prolonged our dying. This places us in a position of being able to make choices about how we die. We can make decisions for ourselves and our loved ones that may make the difference between whether that last touch is from a spouse or the hand of someone doing chest compressions; whether the last sound we hear is a whispered good bye or the swoosh of a ventilator; whether the last nutrition we receive is a lovingly offered spoonful or a concoction delivered by a surgically implanted tube in our abdomen.
We are fortunate in Oregon to live in a state that has pioneered end of life care. The Physician Order for Life Sustaining Treatment ( POLST ) form, in particular, developed at OHSU, has served as a useful instrument in focusing the discussions and clarifying the decisions at the end of life.
Palin’s paranoia and its apparent success bode poorly for the important resource allocation decisions we need to make as a society. We cannot afford all beneficial health care. Ideally, we will make these determinations by combining the best medical information with community values in a process that is transparent and protected from the demagoguery that Palin and her ilk currently use to disrupt and poison our national dialogue.
So there you have it, death panels in action. Be afraid, Sarah Palin. We are out there. There are thousands of us. We are physicians, nurses, chaplains and others who believe that patients in hospitals, nursing homes, palliative care and hospice deserve these difficult, time consuming discussions when life is ending or on the horizon.
Michael Grady, M.D.
Dr. Grady is a family physician in Silverton. He can be reached at: firstname.lastname@example.org.
Posted in full on TheZoo with the expressed permission of the author, Michael Grady.
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