Death: Let's talk about it

Our view: Despite 'death panel' hysteria, end of life discussions are a good idea

December 28, 2010

Death and dying are not easy topics to talk about, but discussing them with your doctor is a good idea.

That, in brief, is what new Medicare regulations set to go into effect Jan. 1 are saying. The rules allow doctors to get reimbursed for holding voluntary end-of-life discussions with patients during annual checkups.

Not so long ago such end of life discussions were pilloried by Republicans and a few Democrats as a precursor to "death panels" — groups supposedly created by the health care reform legislation being considered at the time that would decide whether the elderly or infirm should be able to get needed medical care. That was patently false, but it had an effect.

The original language in proposed national health care reform legislation offered reimbursement for doctors to talk to their patients once every five years about whether they wanted an all-out effort to prolong life in all circumstances or whether they would prefer palliative care, hospice care and other less invasive services. Given recent research indicating that for some conditions, hospice actually prolongs life more than aggressive treatment (and with a much better quality of life), those are conversations worth having.

The obvious effect would be to give patients more control over their health care decisions, even in circumstances when they couldn't speak for themselves. But those who wanted to defeat reform (and President Obama) at all costs managed to convince much of the public that the provision would put bureaucrats, not patients or doctors, in charge of deciding who warranted treatment. In the face of such opposition, Congress promptly dropped the idea.

But where Congress failed to act, the Obama administration is stepping in through the federal rule-making process.

Soon during annual checkups doctors can, if their patients are willing, have a discussion about setting up an advance directive to tell medical professionals what to do if patients are too ill to make medical decisions. That's hardly a radical idea or a precursor to socialized, rationed medicine. In fact, the idea of having doctors and patients voluntarily discuss end of life procedures mirrors Medicare policy put in place during the George W. Bush administration, according to the White House. A leading critic of the original language, former New York lieutenant governor Betsy McCaughey, recently told The Wall Street Journal that she is satisfied with these new regulations.

Now that the new Medicare rules are in place, politicians should clam up and let doctors and patients hold private, sensible talks about this sensitive topic. It makes sense to have end of life discussions early, before a patient is incapacitated and family members are emotionally distraught. Whether a patient facing serious illness chooses to slow the progress of a disease rather than attempting to cure it or opts for aggressive treatment, having talked through the options increases the chances that the wishes of the patient will be honored.

Part of living on this earth is deciding how, when our time comes, we wish to depart it. Instead of trying to grab headlines with bogus charges, politicians should let these guidelines rest in peace.

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