CHICAGO, May 29, 2012 — I am dying. I don’t have an incurable illness or suicidal thoughts, although with three teenagers those thoughts have flitted through my mind occasionally. At 48, I am not old; I am snuggling nicely into middle age. But make no mistake. I am well aware that I am dying. And so are you.
For several generations now, society has drilled into us the fact that we need to make things as easy as possible for those we leave behind. Buy life insurance, draw up your will, establish who gets the kids. Some people even pre-plan their funerals. My decision to be reincarnated as a mangrove tree was met with delight by my family.
So we live our lives as gloriously as possible and make arrangements for when we are gone. But not a lot of attention is paid to the actual dying itself. Assuming the teenagers don’t drive us all to jump in front of a freight train (don’t go with a passenger train; it’s not fair to make all of those people wait for hours while you get scraped off the tracks), chances are your death is going to involve an illness. The number one cause of death in America is still heart disease, but if you manage to avoid that, there are various cancers and other things waiting in the wings.
How Would You Like to Die?
A patient, alone
In 2010, the health reform bill suggested we start thinking about how we would like to die. At your first Medicare check-up, your physician would have been encouraged to discuss with you whether you see yourself dying at home or in a hospital. Do you want all efforts made to save your life, regardless of the expected outcome or would you rather receive palliative care and slip away? There are no right or wrong answers. There are as many different answers as there are people who need to answer them.
When the end is near, everyone is distraught. Everyone is scared. No one is thinking clearly. Once a terminal diagnosis is made, the brain immediately shifts gears. You have a deadline, literally. Every decision from that point on takes on tremendous urgency. You don’t have the luxury of time to discover and think through all of your options. Better to give it all some thought now while you do have that luxury.
Former Alaska governor Sarah Palin didn’t see it that way. She decided that presenting patients with information and options, allowing them to make informed decisions before they were under the gun, was health care rationing and got people all worked up about “death panels.” Republicans quickly jumped on the bandwagon. The measure faced the GOP death panel and was announced unfit for future consideration.
Massachusetts Set to Approve So-called Death Panel
Until last week.
Why hasn’t the ruckus blown the roof off the Mass. state house?
Last week, the senate in Mitt Romney’s beloved Massachusetts passed Bill S.2260, designed to improve health care and reduce costs. Amendment 121 reads in part:
“(c) If a patient is diagnosed with a terminal illness or condition, the patient’s attending health care practitioner shall offer to provide the patient with information and counseling regarding palliative care and end-of-life options appropriate to the patient, including, but not limited to: (i) the range of options appropriate to the patient; (ii) the prognosis, risks and benefits of the various options; and (iii) the patient’s legal rights to comprehensive pain and symptom management at the end of life.”
The death panels are back.
Unfortunately, this bill puts the end-of-life care discussion off until a terminal illness or condition is diagnosed rather than initiating the conversation while everyone is thinking clearly. Other than that, however, all of the “death panel” conditions are there.
Back in 2010, many people, especially GOPers out to discredit Obama, accepted Palin’s conclusion that because the consultations occur when a patient’s health changes significantly and because it was included in a cost-reducing measure (both of which also apply to the Massachusetts bill), the government was going to ration health care. The outcry against the plan and its supposed “death panels” was shocking, divisive and strong.
The Silence Is Deafening: Why?
So where’s the outcry in Massachusetts? Why have we not been barraged with pictures of Massachusetts senators pointing fingers and screaming about health care rationing and those ubiquitous death panels? Why isn’t the GOP attacking the Massachusetts senate the way they did the President? Is it OK to have death panels for Bostonians but not for New Yorkers? Or Alaskans?
At the very least, why was there no outcry from the Massachusetts Republicans? There was no debate. There were no objections. Why did the transparency of information that so divided the country two years ago cause absolutely no controversy in Massachusetts?
According to Massachusetts state Sen. Richard Moore (D), “People in Massachusetts are smarter than everywhere else.”
Dr. Lachlan Forrow, director of ethics and palliative care at Beth Israel Deaconess Medical Center, has a slightly more humble explanation. “The national controversy about death panels…is completely misguided,” Dr. Forrow states. “In Massachusetts we can unite and show how to do it right.”
Whether the Massachusetts House approves the bill next week doesn’t matter. Whether we ever see a federal version doesn’t matter, either. The point is that someday, someone is going to have to make decisions about your end-of-life care. You, or they, should have as much information about your options as possible, and some idea of how you feel about it all. That is how “transparency of information” helps.
When those aforementioned teenagers start proclaiming “It’s my life!” the standard answer around here is “Then take responsibility for it.”
Guess what? It’s your death, too. Maybe it’s time to take responsibility for that as well.
To contact Julia Goralka, see above.
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