Regional
(2009-11-16)
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GREELEY, CO
(KUNC) -
Overhauling the nation's healthcare system now shifts to the Senate where its future is less then certain. KUNC commentator Dr. Marc Ringel says it's also true of a provision in the recently passed house bill that would offer end-of-life counseling.
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Detractors have pinned the label of "death squad" on a program that would pay physicians for taking the time to discuss end-of-life decision making in their offices rather than at their patients' death beds. The death squad discussion is a particularly hateful example of the punching and counter-punching that's been going on in this year's round of health reform non-dialogues. As of writing this piece, the end-of-life counseling provision is, somewhat against the odds, still alive and kicking in the health reform bills that are before Congress.
Based on my own experience with dying people and their families, I have no doubt that compassion lies at the heart of such a program, just the opposite of the cold calculated effort to kill off the weak and infirm that the shouters of "death squad" allege. The goal is to give patients and their families the knowledge and insight that would empower them to decide, when appropriate, against accepting medical care that would accomplish little more than to prolong suffering.
Avoidance of unnecessary suffering, would be the primary outcome of consistent end-of-life counseling. As an added benefit big cost savings would undoubtedly be realized because simple measures to keep a dying patient comfortable cost a whole lot less than aggressive interventions that may eke out a few extra hours, days or weeks of miserable existence.
A report published last month in the New England Journal of Medicine underlines just how badly we do at making medical decisions when there's little or no hope of getting better. The researchers followed 323 nursing home patients with advanced Alzheimer's disease. Healthcare proxies, mostly trusted family members who had assumed the heavy responsibility of making medical decisions for their demented loved ones, were also included in the study.
During the 18 month duration of the project, more than half of the subjects died. Pneumonia, other illness with fever, and eating problems accounted for most of the deaths. Forty percent of all patients experienced shortness of breath and equally as many endured pain during this period, with an even higher likelihood of suffering among those who died. Miserable or not, terrible prognosis or not, four out of ten of the patients who passed on were subject, in the last three months of life, to hospitalization, emergency room visits, IV therapy or tube-feeding.
Keep in mind that these are people at a stage of dementia which has left them: not knowing the name of their spouse or even sometimes their own name; unaware of recent experiences and events; needing help dressing and toileting; probably incontinent; subject to hallucinations, uncomfortable delusions, and persistent compulsive behaviors such as shouting or hand-wringing; and, if they are mobile at all, likely to wander and get lost in the most familiar of circumstances. Those patients whose proxies had a good understanding of expected complications and poor prognosis were much less likely to be put through trips to ER and hospital and feeding by vein or tube.
Nevertheless, a program aimed at educating and empowering people and their loved ones to make better end-of-life decisions while they still have the ability to do so, is labeled a "death squad". It makes me wonder if some of our public figures don't themselves suffer with paranoid delusions.
© Copyright 2012, KUNC
