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In another great end-of-year surprise, the Obama administration has quietly restored a key element of health care reform. As part of new regulations for Medicare, doctors will be paid to provide patients with counseling on end-of-life care. This will allow people to have an informed conversation with their doctor as part of routine maintenance care, making decisions while calm and lucid that will aid in any care-giving necessary in the case of an accident or terminal disease.

You may remember the flap that terminal moron Sarah Palin created when this provision was included in the health care reform bill. She and the rest of the right-wing noise machine invented the phrase "death panels" and tried to terrify the country that medical care funding would be cut off for people who had terminal diseases. Even though this was a transparent lie, Congress removed the end-of-life provisions from the bill to ensure passage.

Bravo! to the Obama administration for using the rule-making process to find another way to ensure that all aspects of quality care are funded. Special thanks to Oregon's own congressman Earl Blumenauer who helped craft the original proposal and supported the new regulation. It's very sad that Blumenauer has asked people to keep quiet about the regulations, fearing a backlash, and sadder still that the backlash has begun. (This link randomly selected from the screeching found by searching "end-of-life care" on Google Blogs.) Now that the wingnuts are screaming death panels again, it is important for informed, rational people to face them down with the facts.

End-of-life care decisions are very important and should be made (and updated routinely) with your physician as part of regular care. I have first-hand experience in the value of such provisions. When my grandfather was terminally ill, everyone involved in his care - family, doctors, his retirement community, hospice - knew what he wanted and expected. Even though he was mostly lucid and communicative up to the end, it was a true blessing to have the key decisions made in advance so we could spend our last days with him in loving conversations and reminiscence, not wasting time on decisions he and my grandmother had already made. When he finally was so sick that he couldn't communicate anymore, we were able to honor his wishes and provide the care he wanted.

If you haven't thought through these difficult issues and created the necessary legal and medical documents, I strongly encourage you to do so, for everyone's sake. If you hear the fear-mongering, please refute it with the clear, compassionate facts.

(cross-posted from The Solipsistic Me)

Originally posted to RBHSOregon on Sun Dec 26, 2010 at 11:55 AM PST.

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Comment Preferences

  •  Tip Jar (16+ / 0-)

    Everyone's been nice to me, the way that Vincent Price would be with midnight coming on. -Peter Blegvad

    by RBHSOregon on Sun Dec 26, 2010 at 11:55:03 AM PST

  •  death is easy (6+ / 0-)

    poverty is hard

    fact does not require fiction for balance (proudly a DFH)

    by mollyd on Sun Dec 26, 2010 at 12:31:08 PM PST

  •  It's hugely imporant, says this doc. (11+ / 0-)

    Without this change, we are dooming thousands of families to utterly preventable anguish.

    It works like this:
    Unless you have had a detailed discussion with your primary care doctor about what you want and don't want when it comes to end-of-life care, and unless you have this documented in some form recognized by the State you reside will have little if any influence over what will happen to you if you suffer a life-altering illness or injury.

    The medical system in America will always default to 'maximum treatment' in life-threatening situations, no matter how miniscule your chance of meaningful survival or functional recovery. Your horrified loved ones may be left to watch impotently as a hospital spends a million dollars keeping your brain-dead corpse nominally alive after a catastrophic stroke or traumatic brain injury, even if the likelihood of recovery is effectively nil. Oh, and they'll get the bill for your care. Or, you know, your closest relative may be that distant cousin who really hates you and instantly tells the doctors that, yes, she really really would want you to pull the plug. Right now. Really. Just sayin.

    You can avoid all this anguish by discussing the issue with your doctor (or nurse practitioner, PA etc) and documenting your preferences. But without this change, it is difficult if not impossible for your doctor to get paid for the 30-45 minutes required (minimum) to do it justice. And since primary care nowadays is a high-volume, low-margin 'piecework' business, I will be out of business very quickly if I do the right thing here but don't get paid for it.

    It's a big deal.

  •  Thanks for the diary (7+ / 0-)

    There was a lengthy article on the front page of the Houston Chronicle this morning about this very subject.  IMO the first part of the article was written in a manner giving an impression to the short attention span of uninformed readers that somehow the administration was "sneaking in" the dreaded "death panels".  
    IMO, it is disgusting the way the MSM insists on feeding the appetites of freepers, redstaters and crazies like Beck and Palin forcing them to break out their tinfoil hats (as if they ever put them up in the first place).

  •  There are worse things than dying... (12+ / 0-)
    As a healthcare provider...I am a nurse practitioner...I daily work with patients and their families.  I was a staff R.N. for many decades before I became a nurse practitioner.  What I learned as a staff nurse was that there are many...many,many,many...things that are worse than dying.  When all quality of life is gone, when all signs of cognition are gone and when the only stimuli provided to a patient are painful ones...blood draws, etc...then it is time to allow God and the universe step in.

    It is very important for family members to understand the above.  Wish that I were better at expressing what is obvious to those who know.

    After all, for progressives, taking one for the team is desirable, but all too often at present, we are taking one from the team.

    by El Tomaso on Sun Dec 26, 2010 at 12:37:24 PM PST

    •  Nicely put (5+ / 0-)

      and thank you. Don't worry about fancy word choices, just keep telling this story. It's important for people to hear from someone who saw a lot of first-hand suffering.

      Everyone's been nice to me, the way that Vincent Price would be with midnight coming on. -Peter Blegvad

      by RBHSOregon on Sun Dec 26, 2010 at 12:43:58 PM PST

      [ Parent ]

    •  Thinking such matters through, deciding while (5+ / 0-)

      still coherent and explaining to ones family and medical providers is part of being an adult for crysakes.  Those who flap around like fish out of water on this subject are usually the same ones who have solid religious notions about the afterlife.  I've never understood why they can long for the Rapture but don't want to discuss death from more mundane causes.
      This is an important diary.  Thanks for getting it out today.

    •  People just don't want to be responsible even for (1+ / 0-)
      Recommended by:
      El Tomaso

      people they love.  They want someone else to make the decision and so if you really love your family, help them out.  I stood by and watched this situation with my own family, they just were not strong enough to make the hard decisions.  Fortunately I had no qualms about it and we had good doctors and nurses that would answer questions honestly if asked.  The problem is that someone has to ask them the hard questions, they will not volunteer the information.  

      "New TSA slogan: can't see London, can't see France, unless we see your underpants."

      by lakehillsliberal on Sun Dec 26, 2010 at 09:55:56 PM PST

      [ Parent ]

  •  More cowbell! (1+ / 0-)
    Recommended by:
    El Tomaso

    "Education is dangerous - Every educated person is a future enemy" Hermann Goering (NRSC?)

    by irate on Sun Dec 26, 2010 at 01:06:36 PM PST

  •  "Death panels" - galling ignorance! (6+ / 0-)

    Many people are not prepared for the late in life decisions which can be made, so as to spare oneself and one's family from unnecessary anguish.
    What happens when the politically radicalized idiots prevent informed decision making?
    Gladys, an ailing woman in her late 80s, phones 911 or hits her alert button, or someone else finds her in medical distress, with the result that I and my fellow volunteers answer the call. We find the frail old lady in cardiac arrest. She has numerous pre-existing conditions, we've wondered when her last call will come. She's never learned about advanced directives and living wills. Her recent months have been a series of ambulance calls and hospitalizations for COPD and congestive heart failure, and she has been and is surely dying. In her place, most of us would want a peaceful, inevitable passing. But she doesn't have any advanced plans in place.

    So my partners and I find her, and as one of the crew runs for the defibrillator, another gives her rescue breaths with a bag-valve-mask, and I lace my fingers as I lean my 250 pounds over her and start the chest compressions which, except when we fire the defib, will continue as we load her and roll her to the unit and race to town, I'm pressing still as I clamber into the ambulance with her. She is frail from osteoporosis. I can feel cracking under my hands, but cardiac arrest is more critical than broken bones. Rather than taking her inevitable leave peacefully, as she might have chosen if she had the facts, she is sprawled over my gurney as I keep up the compressions, and she will die after having her sternum and some ribs broken under my hands. At some point, I am no longer saving a life, I am desecrating a corpse.

    Last year, 365 days and two hours ago, Mom labradog died, in our home, with her caretaker and my wife and I at her side, Mrs.labradog murmuring words of love to Mom as I held her angular, translucent old hand in my rather calloused mitt. A month and a half later, my mother-in-law died, in her home around the corner, with two daughters and her housekeeper at her side, quietly slipping away from the same problems that plagued Gladys.

    My m-i-l, and Mom labradog, had the kind of deaths we hope for, after each had learned about and tended to end of life decisions. And I still remember Gladys, and that God-damned cracking, under my hands.

    I'm the plowman in the valley - with my face full of mud

    by labradog on Sun Dec 26, 2010 at 01:08:34 PM PST

  •  Death in America (7+ / 0-)

    I am a medical professional.  And I have come to believe that we as a society need to take a long, hard look at how we treat end of life issues.  We have amazing resources at our disposal for the treatment of illness and the prolonging of lives.  But just because we have a particular tool does not mean we need to use it in every case.  The vast majority of medical treatment -- and expense -- occurs in the last years of life.  We use every means at our disposal to wring out a few more months, or weeks, or days.  But in so doing we often completely ignore questions of dignity and quality of life.

    I am not a religious person.  But I do believe that there comes a point for each of us when it is time to die.  I really think we need to find a way to come to terms with that.

    "We must move forward, not backward, upward not forward, and always twirling, twirling, twirling towards freedom." - Kodos

    by Jon Stafford on Sun Dec 26, 2010 at 01:39:32 PM PST

  •  do this with a doctor you trust (1+ / 0-)
    Recommended by:
    Oh Mary Oh

    My mom died because her doc used her lw as an excuse not to treat her,we tried to sue but couldn't.My sister has COPD AND will not sign  anything.

  •  What a lot of folk do not understand or think (4+ / 0-)

    throuh while there is still time is that, particularly with older people, there is one thing that will always be true. Mom may have a  partial respite from what ails here for a few days or a few weeks after a crisis, but she is never going back to where you remember her before she became seriously ill. With the sorts of things people generally now die of as seniors or nearly so, they can survive, but the strength and energy, the mobility, the laughter may well be things of the permanent past just as much as the sunlight on the day you remember when you remember her that way.

    Once you can accept that, that your choices are where she is now, or worse, or worse than that, or a different worse, the problem of choice is simplified. And doing advance planning helps in bringing such matters into a realistic perspective, her perspective of reality. Both the legal documents which are often essential, and the checking out of nursing homes and hospices so Mom can see and understand her choices and make them.

    You will still, after doing the directives have to fight to make sure Mom's wishes are carried out, as they were at the time she and you last discussed it,  remembering that she does get to change her mind, it being her life.  The fight may be among relatives who 'can't bring themselves' to do what Mom asked for, or who still hold out hope for miraculous recovery, or just don't want to take the responsibility of either deciding to agree with her or the weight of refusing to agree. Or are more worried about the cost than the lady.  Or want to pretend she is not really that sick at all. And medical professionals who make their own decisions and try to force them on families, the "I became a doctor to save lives, not help people die" types. Or the insurance company which tries to limit alternatives they are less at risk for paying for, the nursing home with minimal care rather than the hospital or the hospice or the home care until death comes. Counting days and expenses and approving what fits in their budget and not in Mom's survival or disgnificed death plans.  

    •  Certainly, (0+ / 0-)

      it takes communication and vigilance on the part of the caretakers and other concerned parties. Thanks for pointing out the potential complications. It's always better to have a framework to operate in, though.

      Everyone's been nice to me, the way that Vincent Price would be with midnight coming on. -Peter Blegvad

      by RBHSOregon on Sun Dec 26, 2010 at 04:13:33 PM PST

      [ Parent ]

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