Politics Killed Medicare Ruling on End-of-life Planning, the Audacity of Honesty

We learned this week from the New York Times that the Obama administration reversed a new Medicare regulation that covered annual end-of-life counseling for Medicare recipients. Remember, this is a Medical ruling that Obama didn't approve in the first place (Section 1233 of H.R. 3200) but one that was recently implemented by Dr. Donald M. Berwick of the Centers for Medicare and Medicaid Services.

Implemented on January 1, the Medicare rule reversal was announced Jan 4 and officials cited "procedural reasons" for the change.

Procedural reasons? From Sarah Palin's "Obama death panel" (2009) meme to the Speaker of the House, John A. Boehner's claim we would be on a "treacherous path toward government-encouraged euthanasia" it doesn't take a leap of faith to say that the Obama administration largely caved to political pressure.

Granted, this writer has a bias concerning end-of-life planning and advance directives:

Being a relatively new widow of some months, I made the decision to end life support for my 45 year-young husband some months ago. Against anyone's choice - lacking advanced directives - he was resuscitated three times, "brought back to life," the doctor said.

Jim had, had a massive cardiac arrest and endured several minutes without oxygen, maybe eight, ten or more elapsed. Originally, the paramedics slow-boated on performing this medical marvel believing him deceased initially, or so it appeared.

Yet, within 24-hours after emergency heart surgery, a nurse advised me that "he would not want to live in this condition," that of being in an anoxic coma with myoclonic seizures 24/7, basically. Perhaps such a healthcare professional should be reported to the American Medical Association as being a Nazi of sorts, but his glassy eyes spoke of a more humane intent.

Within days the overwhelming medical evidence trumped internal conflicts and hope for miracles. The call to end life support was made and the final hours proved a more calloused environment than I had expected.

Natural death took five hours once the respirator was removed, due in part to "successful cardiac surgery." Aside from loved ones though, there was no counseling, no spiritual or financial guidance (a man of the cloth and few words showed up briefly), no shoulder to cry on...just a sterile, dimly lit hospital room.

For a moment I shuddered as I envisioned my or a lone elderly person's passing while a nurse is sitting at her desk begrudging her paperwork and the physician is only to be called when it's time to make the official declaration.

I had the physician paged anyway to ensure that the medical information was reliable. It did not compute that my Jim could breathe on his own and not be considered alive with some chance of recovery. Legally, he could not be pronounced brain dead due to a particular mild reflex action. Yet, again I was reminded of his prognosis and that the death process taking hours rather than minutes was not unusual. The remaining hours I let the love of my life know it was OK to go where he belonged and apologized that we kept him waiting in this state.

How does this account serve as more than one woman's therapy, to openly speak on this? Because, had my husband put his end-of-life wishes, as I knew them, in writing, the decision to undo what modern medicine achieved --a heartbeat, may haunt less, if not have been preempted altogether. It is a lesson others may learn second-hand.

Why overturning the Medicare ruling on end-of-life counseling is wrong and what we can learn from it:

People tend to put unpleasant decisions off, let alone those dealing with our own mortality. Improved attention to advance directives should encourage both family members and patients to become more proactive and prepared. This doesn't require a bill to work. Patients, loved ones and physicians bear responsibility to make the issue a priority, fostering both discussion and planning on advanced directives.

Unlike eleventh-hour clinical discussions or when the victim doesn't have a say, patients and loved can make informed decisions in advance, seek second opinions, resolve disagreements and make peace with these choices.

Politicians, shame on you

As long as patients can direct end-of-life decisions - and there were no provisions to the contrary in the Medicare ruling - the politics surrounding the controversy are largely unjustified, if not harmful.

Even if the ultimate goal of the "death panel" was to save "wasted" tax-dollars on medical procedures, this is nothing new and insurance companies deny and postpone life-saving and quality-of-life based treatment daily. This unfortunate problem requires demanding solutions.

Hospice care has risen significantly in the last years, a trend which began before Obama's healthcare reform agenda. Cutting back on end-of-life care costs could save the country a lot of money, to the tune of 700 billion a year by some estimates, reported Reuters last year, yet it is not so evil to recognize that reality.

Regardless, it is irresponsible of any public official to fuel the fear of seniors and the disabled by leading them to believe that if they become too ill they will be encouraged by this government to shorten their life.

At least one health insurance poll by Kaiser indicates that 30 percent of Americans age 65 and over believe that the new healthcare law (as it was) will allow the government to decide their end-of-life care.

What is almost as offensive as the misinformation on end-of-life counseling is for the Obama reversal to have been cited for "procedural reasons."

Source:
U.S. Alters Rule on Paying for End-of-Life Planning
http://www.nytimes.com/2011/01/05/health/policy/05health.html?scp=1&sq=medicare%20planning&st=cse

Weighing Medical Costs
http://www.nytimes.com/2009/12/23/health/23ucla.html