Friday, August 14, 2009

Healthy Choice

Who would have thought that health care would have been the topic that replaced Michael Jackson on 24/7 news? Here we are at the end of the summer, and the cable news shows are chock full of clips of explosive “town hall” meetings, the President campaigning like it was October 2008, and all kinds of experts or advocates being interviewed.

One aspect of the debate garnering much attention in recent days is the “death panels” that critics charge would be included in government-backed health care plans. The fear is that some impersonal set of bureaucrats will “pull the plug on Grandma.” If nothing else, the fuss highlights our general misconceptions about life and death. I am not an expert on health care, but I do know something about death.

When I was doing a unit of Clinical Pastoral Education at a Veterans Administration hospital over a decade ago, one of the assignments we were given as chaplains was to discuss end of life issues with patients (as if we could avoid it) and ask them to consider completing advanced directives. These documents provided guidance to medical staff about the patient’s desires. For example, if a patient made a DNR—“do not resuscitate”—choice, they would not be put on a ventilator when they could no longer breathe on their own. Such decisions were to be made in consultation with family, friends, medical staff, and the chaplains, but the patient made the choice. Was this a “death panel”?

When my mother was diagnosed with cancer several years ago, she was in the hospital for various procedures including surgery. Every time she was admitted, she was asked if she had a “living will” which gave instructions about her choices related to extreme life continuation measures. We discussed this as a family and with consultation of her physicians. I guess this was a “death panel.”

My mother died at home in the bedroom next door to where I am writing this blog. Her cancer had recurred and was more widespread. The decision not to pursue further treatment was made in consultation with her oncologist. Her last days were made easier by caring hospice workers. These professionals—both medical personnel and chaplains—eased her pain as well as helping the family to understand the dying process. I continue to be thankful for their efforts.

My point here is that institutions have been making us part of the decision-making process about end of life issues for years. There are organizations in place, like hospice, to give us support when treatment is no longer feasible. A pending House bill has language allowing Medicare to finance beneficiaries’ consultations with professionals on whether to authorize aggressive and potentially life-saving interventions later in life. Though the consultations would be voluntary, and a similar provision passed in Congress last year without such a furor, some elected representatives are calling for such provisions to be dropped “because of the way they could be misinterpreted and implemented incorrectly.” This decision would negatively impact Federal support for hospice programs which provide a touch of sanity and dignity at the end of life.

Death is a reality. Too many people seemed to have missed that part of the instructions. The only way that any of us will escape that reality is divine intervention not legislative mandate. Our elected representatives could help in the process by providing the resources so that we can make wise choices about when to accept that reality. That seems a healthy approach to me.

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