We need to talk about end-of-life medical care.
Confronting the inevitability of death and what we want doctors to do, or not do, to prolong the time we have left is difficult. The conversations are uncomfortable. Not to do so, however, means someone else must make the choices, ones that can tear families apart and leave those left behind feeling guilty about the decisions made.
The profound issues surrounding how we die deserve a spot high on the nation’s agenda. And doctors and other appropriate health care providers should be reimbursed for the time they spend helping patients understand their options for end-of-life care. When the issue first arose in the debate over the Affordable Care Act, opponents of the bill scuttled all meaningful debate with the incendiary and misleading term “death panels.”
But death won’t be ignored. And nor should how we die. The issue has resurfaced, this time with doctors and private insurers in the lead. Some insurance companies have begun reimbursing doctors for end-of-life counseling. The American Medical Association has created billing codes for those end-of-life discussions and shared them with Medicare and Medicaid officials reportedly weighing whether those public programs should cover the service. Those are hopeful signs of progress.
This is not about denying anybody lifesaving care. The objective should be to help people decide what they want the goal of medical treatment to be as the end nears.
Some will want doctors to use every means to keep them alive as long as medically possible. That choice should be respected. This is the way many Americans die now — in hospitals enduring procedures, drugs and surgeries, often oblivious or in debilitating pain.
But terminally ill people should know they have other choices. For example, they could opt only for treatments that would help them live as fully as possible, enabling them to spend their last weeks and months free of pain and discomfort and remain lucid enough to share the precious time left with loved ones. The goal chosen will dramatically affect treatment decisions, quality of life and the cost of care.
Individuals and their families make these decisions every day, but often when death is imminent, which is one of the most stressful times imaginable. They should have the opportunity to weigh the difficult choices and have their questions answered by an experienced professional before that fateful time arrives.
There are bills pending in Congress that would authorize Medicare to pay for the counseling. It is unlikely any of them will pass in a Congress still at odds over whether the Affordable Care Act should be repealed. Fortunately, the private sector is leading while the government dithers. But unless Medicare gets on board, the 50 million elderly Americans who rely on the program for their health care will be denied this important service.
Being armed with the information to make confident treatment choices when the end approaches would allow those dying to take control of what’s left of their lives.
With the successes of modern medicine, it can seem there’s a fix for anything that ails us. Accepting our fate when there isn’t can seem like surrender. It’s not.
