Final Acts

By Mary Grayson

The dog days of summer brought some of the loudest and most surprising moments yet

The ongoing health care reform debate has certainly had its twist and turns, ups and downs, and rear-end collisions, but so far nothing about the process mystifies me more than the contentious town hall meetings of August.

I can move past the irony that some of these rowdy events were held in locations where for days thousands of people slept in cars and on the ground in order to secure a place in line to receive free medical care from the voluntary group called Remote Area Medical, but the furor over end-of-life counseling - which apparently to some people is the innocent-sounding code name for ominous death panels - is a stopper.

Paying physicians to inform patients about planning for such decisions as setting up a living will, obtaining hospice care or establishing a proxy to make their health decisions when they are no longer able to so sounds like a good idea to me. As it does to doctors and hospital leaders who have for years promoted such educational measures to the public. And, as you know, ask patients if they have advanced directives and inform them of their right to refuse treatment since what now seems ironically named in the "context" of today's debate the 1991 Patient Self Determination Act.

Perhaps one of the reasons that doctors, nurses and hospital folk see the wisdom in end-of-life counseling is because you have seen all too often the harsh reality of what a lack of such planning by people can result in at the most vulnerable point in their lives. And that is a miserable, unnecessarily uncomfortable death for the patient and suffering and tortuous indecision by family members that can lead to over-treatment for their loved ones. A wise man may not fear death, but a wise man should fear the process of dying.

Some editorial writers penned that end-of-life care planning should never be mentioned in the same context as cost control issues in health care. Linking dying and cost savings, they propose, is what turned up the volume and changed a worthwhile issue that is good for people and for health care into the dark, threatening theater of euthanasia.

But in our world and that of policymakers, the two are linked. A study by the nonpartisan research center the Urban Institute found that Medicare could save $90.8 billion over 10 years by better managing end-of-life care. Another study by Harvard researchers at Dana-Farber Cancer Institute found that the final week of health care cost for 603 patients with advanced stages of cancer who had discussed end-of-life treatment with their doctors was 36 percent lower than for those who did not have such talks.

But what some would consider more important, the same study found that the patients who did not discuss treatment options with their doctors did not live longer, and they had a "worse quality of life" in the final week and were more likely to be in the ICU or on a ventilator.

Yes, it could save money, but it also can save misery.

This article 1st appeared in the September 2009 issue of HHN Magazine.

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