End-of-Life Choice, Death with Dignity, Palliative Care and Counseling

Archive for August, 2009

Jack Rice: The Truth about ’Death Panels’

In light of conspiracy theorists claiming that heath care ’death panels’ are coming, Jack Rice invited Barbara Coombs Lee, President of Compassion and Choices, on the show to dispel those rumors and set the record straight about end of life. Follow the “READ MORE” link below to listen to the interview.

That this kind of charge, this hysteria and hyperbole, was ginned up so quickly and caught people’s imagination is quite remarkable. It speaks to the fact that it’s hard to talk about death and hard to acknowledge that we’re all mortal. Tapping into these deep fears and telling scary stories is the height of political cynicism. None of it is true.

This is a bipartisan issue. Up until recently everyone was on board – Republicans, Democrats – with the idea that families shouldn’t be drawn in to Terri Schiavo – like disputes. We should take precautions against them by making our views clearly known to the people who love us and to the doctors who will be caring for us when we’re terminally ill and can’t speak for ourselves. The POLST (Physician Orders for Life Sustaining Treatment) legislation has very broad support among members of Congress and mainstream organizations like the AARP, unions and seniors’ groups. Then it was as though a need arose to discredit it and to stoke fear.

And it’s scary to think that someone else is making decisions for you. No one wants that. We want, everyone wants, people to make decisions for themselves. That’s what these consultations are about.

Click on the “Play” button (triangle) to hear Jack Rice speaking with Barbara Coombs Lee:

New Study Finds End-of-Life Counseling Improves Quality of Life for Patients

 A new study reported in the current issues of the Journal of the American Medical Association (JAMA) found that patients and their families benefit from having end-of-life counseling. The study showed that offering such care to dying cancer patients improved their mood and quality of life. The patients who got the counseling also lived longer, by more than five months on average. “This study confirms the benefits of end-of-life counseling, as have other studies. It’s shameful that opponents suggest that such counseling is harmful,” said Compassion & Choices President Barbara Coombs Lee.

The new study involved 322 patients in New Hampshire and Vermont who had been diagnosed with terminal cancer. Half were assigned to receive usual care. The other half received usual care plus counseling about managing symptoms, communicating with health care providers and finding hospice care. The study showed that the patients who got the counseling scored higher on quality of life and mood measures than patients who did not.

“Recently, an idea took hold that it’s highly dangerous and tyrannical to encourage
doctors to talk with patients about what kind of treatments they would want if they were
terminally ill and unable to speak for themselves. This notion is false. It’s time to admit
that talking about death won’t kill you, but not talking about it may increase unnecessary
suffering,” said Coombs Lee.



False ‘Death Panel’ Rumor Has Some Familiar Roots

From the New York Times, Friday, August 14, 2009:

The stubborn yet false rumor that President Obama’s health care proposals would create government-sponsored “death panels” to decide which patients were worthy of living seemed to arise from nowhere in recent weeks. 

But the rumor – which has come up at Congressional town-hall-style meetings this week in spite of an avalanche of reports laying out why it was false – was not born of anonymous e-mailers, partisan bloggers or stealthy cyberconspiracy theorists.
Rather, it has a far more mainstream provenance, openly emanating months ago from many of the same pundits and conservative media outlets that were central in defeating President Bill Clinton’s health care proposals 16 years ago, including the editorial board of The Washington Times, the American Spectator magazine and Betsy McCaughey, whose 1994 health care critique made her a star of the conservative movement (and ultimately, New York’s lieutenant governor).

 There is nothing in any of the legislative proposals that would call for the creation of death panels or any other governmental body that would cut off care for the critically ill as a cost-cutting measure. But over the course of the past few months, early, stated fears from anti-abortion conservatives that Mr. Obama would pursue a pro-abortion, pro-euthanasia agenda, combined with twisted accounts of actual legislative proposals that would provide financing for optional consultations with doctors about hospice care and other “end of life” services, fed the rumor to the point where it overcame the debate.

A pending House bill has language authorizing Medicare to finance beneficiaries’ consultations with professionals on whether to authorize aggressive and potentially life-saving interventions later in life.

“I guess what surprised me is the ferocity, it’s much stronger than I expected,” said John Rother, the executive vice president of AARP, which is supportive of the health care proposals and has repeatedly declared the “death panel” rumors false. 


Faith Leaders Condemn Health Care Distortions

Facts Dispel Myths Surrounding End of Life Consultation

Sister Simone Campbell, Executive Director, NETWORK National Catholic Social Justice Lobby, Aug. 4, 2009: “NETWORK…supports provisions in H.R. 3200 that allow Medicare to pay doctors for patient visits when the patient has requested a visit to talk about advanced directives for care. This policy promotes clear communication in families and helps to ensure that everyone is aware of a patient’s wishes. The anti-healthcare reform advocates have latched onto this provision in order to spread lies and fear among vulnerable populations….Lies and distortions have no place in the dialogue about the change….NETWORK supports the truth of families talking together about a loved one’s end of life wishes. This is a family value that should be supported, not demonized.”

Rev. John H. Thomas, General Minister and President of the United Church of Christ, August 4, 2009: “Giving patients the opportunity on a regular basis to discuss with their physicians the values and choices they want to inform health care decisions is an important component of good medical care. This is good for doctors who want to provide the best care for their patients, for families when they must make difficult decisions about loved ones, and for patients who want their religious values and moral perspectives respected.”

Joe Volk, Executive Secretary of Friends Committee on national Legislation, a Quaker organization, August 4, 2009: “While many patients have filed ‘living wills’ to set out their wishes as they approach the end of life, it is not always possible for patients to anticipate changes in their health status or in medical treatments for their conditions. Authorizing consultations for patients with their physicians about the range of options available to them at all stages of care is a sensible and respectful measure – one that preserves the dignity and individuality of the whole person….[S]ome detractors are mischaracterizing this simple and sensible provision. It certainly does not coerce or limit individual patient’s choice in any way. It does…put the patient at the center of her or his care, through all the stages of life.”


End-of-life Conversation Provision Fact Sheet

Seniors want to protect their loved ones from struggling with end-of-life decisions
because they aren’t clear on what Mom or Dad would want. If someday they can’t speak for
themselves, they want their families and their doctor to be clear about their values and
choices. Individuals are the best decision-makers when it comes to these very personal,
private health care choices. The Pew Research Center found 84% of Americans approve of
letting patients themselves decide about extraordinary treatments to prolong life.

Fact: Advance planning consultations are a completely voluntary, not mandatory.
Fact: No one will be forced to sign an advance care directive.
Fact: The consultation provision is endorsed by the Providence Health System, a Catholic
health care provider.
Fact: Only a doctor or nurse practitioner can provide counseling.

STUDIES: End-of-life discussions decrease suffering and distress for patients and loved ones
“The worst outcomes were seen in patients who did not report having these
conversations. By acknowledging that death is near, patients, caregivers, and physicians
can focus on clarifying patients’ priorities and improving pain and symptom management.”

Hospice patients live longer
“This study provides important information to dispel the myth that hospice hastens
death and suggests that hospice is related with the longer length of survival by days or
months in certain terminally ill patients. This extra time might be particularly important to
patients and their families, as it may allow some people to use the end of life as a time of
resolution and closure.”

End-of-life discussion only taking place about half the time
“Many patients diagnosed as having metastatic lung cancer had not discussed
hospice with a provider within 4 to 7 months after diagnosis. Increased communication with
physicians could address patients’ lack of awareness about hospice and misunderstandings
about prognosis.”