Thursday, July 31, 2014
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Should You Get to Choose Your Own End-of-Life Care?

Getting old can mean having to face wrenching medical decisions. Some can arise even before you get sick. For instance, which treatments would you want and which would you not want if your health has deteriorated and you are unable to make choices on your own?

Should You Get to Choose Your Own End-of-Life Care?

By guest blogger Robert Field:

Getting old can mean having to face wrenching medical decisions. Some can arise even before you get sick. For instance, which treatments would you want and which would you not want if your health has deteriorated and you are unable to make choices on your own?

You can make this decision in consultation with your doctor by planning in advance while you are still capable of choosing. The alternative is to leave matters to chance or to lawyers and judges to hash out in court.

All states let people plan end-of-life medical care ahead of time by signing advance directives and living wills. These are documents that tell those who treat you, and your family, what you do and don’t want. They also let you designate a family member to make decisions on your behalf when you can’t. About a third of Americans have them.

Without these documents, if may be difficult for anyone to know for sure what treatments you wish to receive if your condition deteriorates. Disputes can arise that sometimes end up in court. Remember Terry Schiavo? Once there, the treatment that is ordered could lead to prolonged suffering that you would have chosen to avoid.

Many people who would like to plan their medical care beforehand don’t know that advance directives and living wills are available. Over the past several years, Congress has taken steps in response. For example, since 1992, the government has required hospitals and nursing homes to discuss them with new patients and to help with the process.

In 2008, Republicans in both houses of Congress, led by Senator Johnny Isakson of Georgia, backed legislation requiring doctors to discuss end-of-life planning with new Medicare patient. The idea had broad bipartisan support and was endorsed by much of the medical community. It made its way into a draft of the health reform bill, which would have authorized Medicare to reimburse doctors for the time involved.

That was before the cries of “death panels” were heard from health reform opponents. They alleged a backdoor effort to encourage euthanasia. While the medical community remained behind the counseling provision, Republican support quickly evaporated, and it was stripped from the final bill.

Last month, the Obama administration tried to revive the idea by quietly slipping it into proposed new Medicare regulations. The proposal was short-lived and was withdrawn within weeks. In all likelihood, the administration backtracked out of fear that end-of-life planning could become a political flashpoint in upcoming debates over health reform repeal.

This is extremely unfortunate. Americans deserve all the help they can get in facing the wrenching medical decisions that can come with old age. And doctors need all the help we can give them in assisting their elderly patients.

Those who turned this medical imperative into political fodder could end up causing untold suffering for countless patients and their families. For all of our sakes, let’s hope that emotions over health reform settle down and the bipartisan sanity that had prevailed on end-of-life care reemerges.

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About this blog

Check Up covers major health events in our region and offers everything from personal health advice to an expert look at health reform. Read about some of our bloggers here.

For Inquirer.com. Portions of this blog may also be found in the Inquirer's Sunday Health Section

Robert Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
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