It may be possible that the country is close to turning the corner with its attitude toward end-of-life care.
The appropriate use of palliative and hospice care has long been hampered by a reimbursement system that essentially discourages their application in an effective and systematic manner. Any chance of making palliative care more accessible through the Affordable Care Act has been steamrolled by the political debate over the fictional notion of Medicare death panels.
But two influential forces recently made separate cases for giving seriously ill patients the information they need to make reasonable decisions about the kind and amount of care they want.
The Institute of Medicine last month came out with a number of recommendations that would seek to expand the use of palliative care in a 506-page report, "Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life."
And whether by coincidence or planning, yesterday a book on the subject, "Being Mortal," by noted author, Harvard professor and surgeon Atul Gawande, was released.
It would not be absurd to wonder if the one-two punch of the IOM's scientific standing and Gawande's familiarity on Capitol Hill and on living room TVs might be enough to nudge the country down the hill toward giving palliative care the role it deserves.
Ideally, the IOM report would be enough to spur Congress and the president to create incentives for health care to offer more palliative care, when appropriate. The clinical evidence for palliative care to improve quality and reduce costs is strong, but is unlikely to resonate with most people. Advance directives can help, and the AHA offers some background (PDF download) on the matter.
But Gawande's book has the power to spread the word on the power of palliative care to the masses (i.e. through television). On Monday, in an appearance on "The Daily Show", Gawande said he had some concerns about his own patient interactions. "I wrote the book in part because I'm a cancer surgeon and I didn't feel I handled things very well," Gawande told Jon Stewart. And then when his father was discovered to have a tumor on his brain stem and neck, they adopted a measured approach, agreeing to surgery and radiation, but eventually deciding to stop chemo when it was limiting his father from being the person he wanted to be.
Yet, getting to that point took a lot of conversation, Gawande says, and patients, their families and their doctors usually don't take the time to have them.
Similarly, the IOM report outlines the various ways that patients, clinicians and policymakers can improve end-of-life care, says David Walker, co-chairman of the IOM committee that produced the report and a former U.S. Comptroller General.
Walker says that a key to improved used of palliative care is the removal of the "perverse incentives" in health care reimbursement to treat patients until the day they die.
Executives at UnityPoint at Home, part of UnityPoint Health, agree that a lack of reimbursement makes it difficult to provide the palliative care that's needed and at a more basic level employ qualified clinicians who can provide it. Nonetheless, Unity Point officials see palliative care as an integral part of its patient care offerings. "Palliative care could be and should be available at the time of a serious diagnosis," says Lori Bishop, executive director of Clinical Transformation and Palliative Care, UnityPoint at Home.
The officials encourage patients to consider what such things as chemotherapy will do to their lifestyle and how that would differ if they did nothing.
As Walker says, the end goal is about "empowering the individual."