The death panel canard has so completely taken over the debate over health care reform this week that even President Obama had to stop and assure the country that nobody planned to “pull the plug on grandma.”
Though the death panel’s origins lie in dishonest brokers like Betsy McCaughey and Sarah Palin, Obama addressed the allegation almost as if it were raised in good faith. “It turns out that I guess this arose out of a provision in one of the House bills that allowed Medicare to reimburse people for consultations about end-of-life care, setting up living wills, the availability of hospice, et cetera.”
That’s basically been the extent of the debate. “Death panels!” vs. “No! Not death panels! End of life counseling!” And though the latter claim is the accurate one, it doesn’t really give you a sense of just how standard a practice these “death panels” already are among clinicians.
“I’m a medical oncologist so I deal with cancer patients,” said Dr. Emad Ibrahim, a southern California doctor who’s been in practice for 11 years. “Many patients are terminal or could become terminal over the course of their care.”
“We routinely do counseling and advise patients on advance directives.”
An advance directive is a legally binding document, prepared by a patient, providing guidance to doctors and friends regarding treatment preferences in the event that an illness or injury makes real-time decisions impossible. Directives are most commonly drawn up by sick and elderly patients, but they’re a standard part of estate planning, and any adult can file them with family members and doctors at any time. There’s no standard document–lawyers can draft them for clients, doctors can provide patients with a form, or individuals can follow their states’ protocols and write them up themselves.
“We always prefer to counsel before somebody gets in trouble because the worst time to discuss these issues is in a crisis,” Ibrahim told me. “Doing it early allows the family to discuss it with their loved ones.”
AMA President J. James Rohack put it this way: “These are important discussions everyone should have so they are fully informed and can make their wishes known. That’s not controversial, it’s plain, old-fashioned patient-centered care.”
“We counsel patients a lot when they are seriously ill regarding end of life,” Ibrahim says. “A patient who has advanced cancer for instance,” might be advised that while a chemotherapy regimen could briefly slow the illness, other drugs would do more to ensure comfort during the final days. “That,” he said, “would not be appropriate if somebody has a curable disease, but many patients will choose to rely on comfort medicine, pain, oxygen, even hospice care.”
And, he adds, doctors are already being reimbursed for these sorts of sessions by private insurers–which have somehow been spared the death panel charge–as part and parcel to the provision of care.
“I’m not aware of how [insurers] address this specifically, but if we provide extended counseling, then we can be reimbursed for it,” he said.
“It entails a large amount of time and effort. It’s a significant part of our job…. Not doing that for a patient with terminal illness would be inadequate care.”
