This pisses me off. I have a few right wingers in my family who like to forward me the latest FoxNews/Sean Hannity/Rush Limnaugh spewage via email. Making the rounds right now is the meme that page 425 of HR 3200 (Obamacare) contains a provision that will "lead to government encouraged euthanasia of the elderly". First of all it's a false accusation. Second, what sort of sick twisted world do we live in where honest dialogue between opposing political ideologies is not only rejected, but proscribed as a source of weakness? Why does the truth always have to be manipulated to meet a political agenda?
Here's the truth. There is a provision in the bill that would require Medicare to cover an end-of-life consultation between a palliative care specialist and an elderly individual. In other words, if you are in the twilight of life, but still of sound mind, you have the option of consulting with your geriatrician or palliative care specialist about things such as living wills, DNR status, and asserting your durable power of attorney. This a good thing. Any hospital-based physician who works in this country would welcome reform that better prepares patients mentally and legally for their inevitable decline. I can't tell you how many times a month I find myself seeing a demented patient in the ICU on pressors, intubated, gorked out, sustained solely by machines and no one knows what to do, no one in the family is prepared to "make the big decision" because no one ever thought to ask the patient when she was lucent: what do you want us to do when you're deathly ill and are unable to make decisions for yourself?
Close to 30% of Medicare spending on the elderly occurs in the last six months of life. And it's all wasted. These are futile cases, invariably. But it goes beyond the pure cost. The suffering and emotional angst of family members is immeasurable, as they watch a loved one transformed into something unrecognizable.
This bill is not about euthanasia. It rather represents an initial attempt to confront our mortality on our own terms, while we still have the intellectual capacity to articulate what it is we want done prior to the onset of the inexorable decline of our minds and bodies. Death is not something to run from. We ought to stop ignoring it, putting it off until it's too late. If anything, I think the language in the bill is not strong enough. We need to mandate the legal documentation of our end-of-life wishes. As soon as one contracts a terminal illness, or hits age 65, then make it law to file official DNR, durable power of attorney, and living will documents. It's the socially responsible and humane thing to do....