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View Diary: Why End of Life Counseling is Imperative (256 comments)

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  •  But don't make it forced counseling... (6+ / 0-)

    which is the point that Kathleen
    Parker made
    in the WSJ, and was posted on the front page here yesterday.

    A simple amendment to H.R. 3200 would do much to cool tempers. All that's needed is specific language saying that these end-of-life consultations are not mandatory -- either for physicians or patients -- and that there would be no penalty, either in coverage or compensation, for declining to participate.

    •  It isn't forced counseling, for God's sake (9+ / 0-)

      All the bill includes is allowing a counseling appointment to be paid for.

      There is no "forced counseling" -- that is another of the lies they are using to frighten people.

      •  Here is a link to the bill (1+ / 0-)
        Recommended by:
        In her own Voice

        http://edlabor.house.gov/...

        Charles Lane in the Washington Post does raise some questions about it here  

        There are three pieces that I would change.  Of course the bill hardly does what the repugs do, but I would change what is after all draft legislation:

        1.  I would not enable someone to sign their living will at the same time that the Doctor counsels the patient.
        1.  I would rather a lawyer do this and not a Doctor/
        1.  The script that the Doctor must follow is far too prescriptive.  

        The bitter truth of deep inequality has been disguised by an era of cheap imported goods and the anyone-can-make-it celebrity myth - Polly Toynbee

        by fladem on Thu Aug 13, 2009 at 07:16:18 AM PDT

        [ Parent ]

        •  The section (0+ / 0-)

          is 1233.

          The bitter truth of deep inequality has been disguised by an era of cheap imported goods and the anyone-can-make-it celebrity myth - Polly Toynbee

          by fladem on Thu Aug 13, 2009 at 07:17:10 AM PDT

          [ Parent ]

          •  OK, I read it. Still no mandatory counseling (5+ / 0-)

            and there is also no "script" that the doctor must follow.

            There is a list of topics that would be covered in such a discussion in order for it to qualify for reimbursement, including requiring the practitioner to provide complete information to the patient and to also give the person information on other community and national resources and groups that they and their family can go to for further guidance and information.

            This list of topics to cover is necessary to avoid fake end-of-life "counseling" by practitioners who have an agenda, such as a religious belief that a person's body should be kept alive at all costs for as long as possible (think Terri Shaivo's family and doctors that would agree with them). Without specific requirements about what information will be included and discussed, too many practitioners would not provide effective or complete information.

            Also, a lawyer is not qualified to help a person make medical decisions, or to write medical orders for care and/or treatment.

            Thank you for the link. I do not have any problem with the way this section is written. In fact I'm rather impressed with the completeness of their thought and the considerations included.

            •  Better if Both Atty and Dr Help Client/Patient (0+ / 0-)

              Also, a lawyer is not qualified to help a person make medical decisions, or to write medical orders for care and/or treatment.

              You can create a health care directive without either, but it won't be as good as it otherwise might be.

              It is intended to be a legally binding document (binding on the health care providers that know about it - it can always be revoked by the patient).

              But it also is intended to give both general principles as well as very specific particulars (if the patient so desires.)

              So one of the best ways to do this is have both involved.  A lawyer to help introduce the concept, interview the client and create a draft.  The draft should then be taken to the person's family doctor and they should go over it.

              During this dicussion, the Doctor should explore any questions or ambiguities he sees, raise other hypotheticals to test and clarify what is written and help amend anything that brings the document closer to what the patient wants.

              This last step is probably not reimburseable right now under many insurance policies or Medicare - thus the proposed amendment.

        •  a family therapist or social worker is the (2+ / 0-)
          Recommended by:
          Ginny in CO, CS in AZ

          one most likely to be called upon to perform this function.

          There is attention being given my profession as a psychotherapist for "end of life" issues--helping individuals resolve conflicts of interest between medical /instituional practices and personal, family, cultural, and spiritual values; balancing the person's needs for autonomy and self-determination with medical protocol as well as ethical and legal concerns; and resolving ethical conflicts in terminal care situations.

          Find your own voice--the personal is political.

          by In her own Voice on Thu Aug 13, 2009 at 09:53:01 AM PDT

          [ Parent ]

    •  The proposed counseling ISN'T mandatory! n/t (6+ / 0-)

      Information is abundant, wisdom is scarce. The Druid

      by FarWestGirl on Thu Aug 13, 2009 at 07:14:22 AM PDT

      [ Parent ]

      •  The only thing mandatory, as I understand it, (1+ / 0-)
        Recommended by:
        FarWestGirl

        is that once the first such session has been held, and the doctor has been told what the patient wants, a similar review session must be offered at least once every five years.

        Personally I think that is wise.  People do change their minds, and not infrequently forget to tell everybody concerned.  For instance, a person may think they want all the stops pulled out to keep them alive as long as possible.  But after going through a long drawn out, and financially devasting death scenario personally, like Terry Schiavo, they may change their mind.  The opposite holds true, they may have had a life and faith changing experience that makes them want to be kept alive in the face of overwhelming odds of survival or quality of life possibilities.   To require them to revisit the issue, once they have put something binding in writing, is only wise.

        •  No, there is no reason it should be (0+ / 0-)

          required by Medicare. Medicare requires facilities to ask if the patient has advanced directives and to offer them infomation if they don't. It is necessary anyway since the hospital would need a copy to be able to carry it out.

          The physicians are likely to bring up another counseling session if there is a change in the person's condition, a new diagnosis, etc. I think they have every right to let their patients know that this is as much a part of their responsibility as ordering a colonoscopy regularly. They are the person who makes decisions about orders that need to be written. It is the physicians practice and conscience that are significantly affected and for a patient to refuse is grounds for the physician to notify them they must find another doctor.

          As we age, the issue becomes more and more apart of our health care.

          Too much sanity may be madness. The maddest of all is to see the world as it is and not as it should be. Don Quixote "Man of La Mancha"

          by Ginny in CO on Thu Aug 13, 2009 at 11:38:05 AM PDT

          [ Parent ]

    •  There is no mandatory health care or counseling. (5+ / 0-)

      Nothing in Medicare is mandatory.  You don't have to see a doctor, or take your medications.  You don't have to make a Will, or provide next-of-kin information.  And you certainly will not be required to fill out a living will, even if provisions for reimbursement to physicians remain in the legislation.

    •  God Damn the Intellectual Retards! (4+ / 0-)

      How can a nation which once had an education system the pride of the entire world produce so many intellectually retarded citizens led by so many gratuitous self-serving liars?  The god damned biggest water carrier for the oligarchy, the WSJ, still allows Karl Rove a regular editorial stump.  Is there not a single media outlet who will state that a voluntary appointment to discuss said matter with your doctor, simply, nothing more, will be paid for by medical insurance.

      As this 'debate' rambles on, the feeling of despair I have regarding my child's future as an American deepens.

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