Wednesday, March 14, 2012

The reality behind "death panel" rhetoric

In a moving piece recently published in the Annals of Internal Medicine, surgeon Mark Vierra describes his emergency room encounter with a man dying from colorectal cancer. Called to discuss possible surgery for a perforated bowel, Dr. Vierra sadly observes that despite the patient's grim prognosis, he and his wife "had not discussed limits on his care, how far to carry things, what to do when the treatment stopped working, or when the end was in sight." They had not had any of these discussions with their primary care physician or either of his oncologists. After Dr. Vierra reviews the options and the patient's wife chooses hospice care, he reflects on the wide gulf between the reality of end-of-life decision-making and the damaging political rhetoric of "death panels":

I should not have been called to see this patient. Decisions like the one we had to make that day should have been made among friends and family or in the company of his family physician or oncologist, at a time when he was awake and at his best, when he was not in pain, and he could remember who he was and he could explain to those he would leave behind how he wanted to be remembered. To have to make such decisions the way we did that day—counseled by a stranger in the sterile alcove of a busy emergency room—is not what any of us would want. That it turned out the way it did, I believe, was fortunate. It would have been so easy for the powerful momentum of modern medicine to have carried his broken body into the operating room and from there to the ICU, where he would be nurtured by the finest medical technology and the clinical compassion of strangers.

Recently, we have been warned that government “death panels” would knock us off. The provision in the new health care legislation, which said that private, end-of-life discussions between a patient and his or her physician would be reimbursable every 5 years, somehow became a sinister governmental strategy to kill us quickly and save resources. It disappeared from the President's health care legislation, was quietly added back as a Medicare provision, but disappeared again when the new Medicare guidelines came out. Can this sensible, thoughtful proposal really be so objectionable? ... Every one of my patients is going to die one day. Like it or not, I should have these conversations earlier, more often, and more comfortably. If that makes me part of a death panel, well, I suppose I can live with that.


Amen.

2 comments:

  1. The Annals story reminded me how often I used to see patients with end-stage cancer, typically on a weekend or late at night, who'd never had a talk with their usual doctors about their wishes.

    Thanks for posting this.

    ReplyDelete
  2. The article is unfortunately behind a paywall. Articles such as this should be available free of charge. I wanted to link to this to share with friends and family, but, I guess unlike the editors of AIM, only a small number of them are physicians...

    ReplyDelete