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Monday, October 24, 2016

The low point of the Obamacare debate — and there was much probing of the floor — had to be the “death panel” charge. It was the creepiest in a volley of lies aimed at killing health care reform.

What was the fuss about? A proposal to pay doctors for time spent talking to patients about the kind of care they wanted in their last days. Such conversations would be entirely voluntary.

That was it. That was all. But “death panel” nonsense fueled so much hysteria that the end-of-life consultation benefit — and it is a benefit — was yanked out of the Affordable Care Act bill.

Fortunately, grownups are taking over. A new report for the Institute of Medicine, “Dying in America,” details the insanity that forces aggressive, often torturous, treatments on terminally ill patients who don’t want them — and at great expense besides.

Most Americans say they’d prefer to die at home, but the default in American medicine is to rush the gravely ill to the hospital. There, tubes are forced down throats and stopped hearts resuscitated with electric shocks.

“If you’re on a ventilator in an intensive care unit, you’re usually unable to die at home,” Dr. Edward Martin, head of the palliative care medicine program at Brown University, told me. “You’re likely to die in the hospital on the ventilator.”

That’s why you need to make your wishes clear in advance (even if you’re only 18). You might want every weapon in the medical arsenal thrown at sustaining your life. Or you might want to spend your final days peacefully at home or at a hospice facility, surrounded by loved ones.

An end-of-life talk with a doctor spells out the options. Patients can use it as a basis for filling out an advance care directive — a form listing which treatments they would want or not want. Of course, they may change their mind at any time. And in any case, as long as they can speak, the form is irrelevant.

The authors of “Dying in America” — doctors, insurers, clergy, lawyers, experts on aging, Republicans and Democrats — offer workarounds for the fringe politics that demonized advance care planning in the earlier health reforms. First off, they urge private insurers to cover end-of-life consultations, which many already do.

Several states offer this benefit for their Medicaid patients. The American Medical Association wants Medicare to follow suit.

The report calls on Congress to end the “perverse” financial incentives that rush fragile patients into invasive medical treatments they’d prefer to avoid. Better reimbursements for home health care is one suggestion.

Critics of end-of-life discussions argue the doctors would “push” patients to end their lives prematurely. Why would doctors do that? Where’s the financial incentive in losing a patient?

Meanwhile, there’s evidence that for some very ill people, a palliative approach may extend life longer than industrial-strength medicine. Palliative medicine seeks to prevent or reduce the symptoms of disease — such as pain, vomiting and impaired breathing — rather than seek a cure. For those expected to live six months or less, such care is often delivered by a hospice service, at home or in a facility.

Medical procedures come with risks that are especially high for those in rapidly deteriorating health. Thus, the risks may outweigh the possible benefits. In a study of terminal lung cancer patients, the group that chose hospice care actually lived three months longer than another subjected to hard chemotherapy.

Whenever you think that radical politics have totally tied up the country’s ability to fix the absurdities riddling our health care system, you find gratifying examples of Americans just going ahead and making the repairs. Thankfully, end-of-life planning is becoming a routine part of American health care.

Follow Froma Harrop on Twitter @FromaHarrop. She can be reached at [email protected] To find out more about Froma Harrop and read features by other Creators writers and cartoonists, visit the Creators Web page at

Photo: Martin Wippel via Flickr

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  • Our government does such a great job at managing healthcare. Just look at the veterans administration. We need government managing things they know nothing about and should not be involved in, as per the constitution.

    • johninPCFL

      This is typical: “Coates waited months, even begging for an appointment to have his colonoscopy.”
      The veterans affected appear to be seeking care for non-service related ills. Until the late 1980s, these veterans would have never been seen at all, much less treated.
      Where are you on the prospect of giving back Texas, Californi, Alaska, and the middle states (part of the Louisiana Territory)? After all, the Constitution also says nothing about Federal action expanding the borders beyond the original 13 colonies.

      • I see you have never been to or have been treated at a VA facility. Most of the care sucks. They are really good at throwing pills at problem, but really bad at determining what is wrong. Maybe you should have a clue before you speak.

        • howa4x

          The issue with the VA is a lack of funding facing an overwhelming problem. For years both parties have consistently underfunded the VA. Add to that the longevity of vets and the fact that the Iraq/Afghan war lasted more than10 years pouring critically wounded vets into a system that was already under a strain. Also the movement issue where Vets moved like the rest of the country into the sunbelt with out a VA system ready to handle the flood of patients
          But not all of the VA system is bad since Walter Reed is part of it and of course that is where congress and the president get their care

  • howa4x

    I recently went through my best friends death from stage 4 cancer. I was with him every day and not one doctor told him that there was nothing anyone can medically do to change his condition. So if you though that the medical system can save you then you go through the process. Chemo is very destructive and given to an already weakened person hastens the deterioration. The course of the disease has patients moving in and out of the hospital and he ended up on a vent, which made him hospital bound. the other issue is that most families can’t care for a critically ill person by themselves at home and insurance is not designed to develop the home car system yet. So in my friends case his insurance would only give him days of skilled nursing. Bottom line is to have people die at home you need the home care system to be more resilient, and covered by insurance.
    Lastly it is difficult to watch someone you love die with no medical intervention. My friend bled out and if he was home who in the family could handle that?