Death panels

There's been a lot of talk/distortion about "death panels" and how the government is plotting to kill your grandmother. Here's a reality check and thoughtful discussion among some respected doctor friends (names removed because I lifted this exchange off Facebook without asking):

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Counseling on End-of-Life Issues
Today at 3:44pm

Counseling on end-of-life issues is a good thing, an important thing. Do you want to be on a ventilator for two weeks to two months, possibly intermittently conscious, only to experience a tube down your throat, lines snaking in and out of your body, unable to speak to voice your pain or desires? Do you want someone pounding on your chest, probably breaking your ribs, only to bring you back from the edge of death, without knowing if they brought you back in time for your brain to have survived the process, in all likelihood becoming a vegetable who will eventually drain whatever's left of your family's financial resources? I know there's an inherent bias in the way I've presented these end-of-life issues, but at least it highlights the fact that it's a decision not to be taken lightly, to be seriously weighed, and certainly not ignored or to be fearful of. I know the way our society views death as something large and scary rather than just a natural part of life predisposes us to avoiding these issues altogether, but it's important, and part of why it makes sense for it to be part of any health care reform bill in our near or distant future.

Certainly not a death panel of any sort. That's just silly, an obscene, fantastical distortion of the truth. It's like saying that prenatal counseling was comprised of a panel of people who would decide if they were going to take your baby.

Updated 7 hours ago · Comment · Like / Unlike · Report Note

Commenter#1
Yes but- don't you think REQUIRING people to sit through this type of counseling is violating their basic rights? I mean- people aren't required to sit in on counseling regarding how serious a decision it is to have a baby, or whether or not they should have a baby, or the option of abortion. That's a very personal decision and one that people vary WIDELY on in terms of their views and values. And the end of life counseling is being proposed for people later on in years, middle aged, correct? But accidents that could lead to the emergency trauma actions you are describing above, or to a vegetable like state, could occur at any time of life. Why not make people go through this kind of counseling as soon as they are old enough to understand it- like 12 or 13? I just think this kind of counseling really seems like it is designed to encourage people to strongly consider ending their life once they get old or too expensive for the health care system.
6 hours ago

Commenter#1
Should we force parents of children with disabilities or diseases to go through counseling about ending their child's life? Seems like a similar thing to me.
6 hours ago

Commenter#2
It is not "violating" anyone's basic rights. It is putting people in control of their life so that if a time comes when they cannot make decisions we know what they would have wanted.
5 hours ago

Commenter#3
seriously, it's not violating their rights because odds are you will have to engage in this discussion at some point. it's far better that i take place in a placid environment that is not as emotionally distressing as an intensive care unit, and it's better to have it with a doctor you know, rather than someone who is meeting you and your family for the first time in a difficult setting. this is not a right to life issue as the people who are exploiting this as a talking point want others to believe.
4 hours ago

Commenter#4
Question. Would patients be required to have this counseling under one of the proposed plans or would it just be covered if they choose to have the counseling?
4 hours ago

Commenter#5
It only has to be offered. No obligation to attend. The VA has a similar requirement and many vets decline the discussion all the time.
3 hours ago

Commenter#6
Ending life is different than prolonging death.

If it were required for all hospital admissions, maybe even all PCP visits, I wouldn't be opposed. Making a family member decide whether to pull the plug on you or not is a horrible thing to put them through. More often than not they choose full code because who wants to live with the thought of killing off their parent? Then you're stuck with a patient slowly knocking off organ systems one by one over the course of a couple weeks, maxxing out on pressors...memorable way to go. Plus you have the family sleepless every night or sleeping in the ICU waiting room 'cuz they don't know when the patient's gonna finally succumb to death. Great experience for them.

That and the decision to not define preferred intensity of care costs more, and results in less patient's-family satisfaction

http://www.harvardscience.harvard.edu/medicine-health/articles/end-life-conversations-associated-with-lower-medical-expenses
2 hours ago

Commenter#7
Making it optional (and covered) seems fair. Practically, it would help a lot families make these difficult decisions ahead of time, especially with the future patient/family member's input. Given the likelihood that more will opt for ending life (compared to the current families-in-the-waiting-room situation described above), overall it will probably save more money for the families and the greater health care system.

Requiring people to go through this counseling however, may be stepping on some toes; some people simply don't want to make these decisions nor are they ready. This requirement piece is key, I think. I'm still not clear whether it's an issue here.

No doubt in certain places there have been some bizarre distortions about this issue. And that's unfortunate.
52 minutes ago