Read My Lips

It’s Not a Death Squad

Thousands of people are protesting the health care plan being considered in Washington for all the wrong reasons. They are zeroing in on the section on end-of-life issues and promoting the idea that the provision means the government will be telling people when to die.

Sarah Palin is one of the most out-spoken, and perhaps influential, people stirring up this frenzy. In her blog and elsewhere she uses rhetoric that doesn’t enlighten. It just stirs up emotion. This is from a commentary about her blog:

Palin was quick to note that the health care plan could make decisions regarding anyone at the end of their life, which might include her baby. She believes her parents and baby will have to leave it in the hands of Obama’s “death panel” to determine whether they are worthy of receiving health care. This is certainly not something anyone would want to face or see their loved ones experience.

The truth about that provision is that the government would provide funds to educate people about the importance of making end-of-life decisions and using Advance Directives and Medical Power of Attorney documents to make their wishes known. This isn’t something we are comfortable talking about, but tough questions need to be asked and answered.

If you have cancer and are 80 years old and have a heart attack, do you want full resuscitation. Do you want to be on a ventilator in ICU?

If you have been in an accident and are brain dead, do you want to be kept on machines for an indefinite period of time?

If you have a terminal illness and can no longer eat, do you want tube feedings?

I worked for eight years as hospital chaplain and dealt with many situations where these questions had to be answered during times of extreme emotional distress. Family members were looking at their loved ones and feeling a desperate need to keep them alive. Because their emotions were so raw, they couldn’t see past that to the pain and misery their husband, wife, mother, father, sister or brother might have been going through.

Being in ICU on a ventilator is not a pleasant experience.

And it is an extremely expensive proposition.

In our medical ethics sessions we would often discuss the sad fact that thousands of dollars were spent daily to keep a body alive when a person should have died days or weeks earlier without the pain and desperation that is so often the case in an ICU.

Which doesn’t mean that every case in ICU or Oncology is hopeless. But many an ICU nurse would share their frustration with me over the fact that they had to keep sedating some poor old lady who kept trying to pull all the tubes out and that poor old lady died a week later anyway. She just had seven days of misery. And took seven days of time and attention that needed to go to a patient who had a chance for a positive outcome.

As part of my job, I had to start talking to patients about Advance Directives. It was easier to talk to them and to families when they were not in a crisis situation. It was also easier on them to have someone trained to deal with death and dying issues and with what the documents provide. Which is the point, I think, of this provision in the health care plan.

I know. I wish I had someone to help me talk to my mother about this.

So, if you want to protest the health care plan, protest because it is going to cost too much. Or protest because it is going to be administered by the government, who are so efficient with administrative matters. But don’t protest the end-of-life provision.

We all need to think about how we are going to go “into that goodnight.”

12 thoughts on “Read My Lips”

  1. Maryann, I’m so thankful that my father made advanced directives. He had Alzheimer’s but died from complications to hip surgery. I was with him when he stopped breathing, unexpectedly. My first reaction was to ask them to resuscitate. Then the nurse reminded me of his wishes.

    I’m thankful that you, a professional, has spoken up on this healthcare issue, and the crazy claims that are made to stir people into a false frenzy.

    Straight From Hel

  2. Thanks for the support, Helen. When the whole “death squad” issue first got raised, I thought surely reasonable people will see through the hyperbole. Apparently not.

    I’m glad you had that nurse to help you honor your father’s wishes. I know that children often feel like they are killing their parent if they don’t “do everything” but sometimes doing everything is futile. I can’t tell you how many patients told me they wanted to die in peace, not in ICU.

  3. I have not read the whole proposed health care bill yet, so I can’t speak with authority about all of its provisions. However, most of the protests I’ve heard against the bill’s end-of-life counseling are protests against government intrusion in our personal lives. I find it hard to argue with that one.

  4. The death squad issue is definately not the primary problem with the health care reform issue. Yes it is inflammatory hyperbole designed to create an emotional response. Both sides are guilty of using this tactic on most issues. The best argument against government run health care is to witness it in action, or speak to individuals that have had to experience it first hand. Medicare and medicaid are prime examples, and they are barely qualifiers. For ten years I had the dubious honor of working with these entities on a daily basis. Describing it as frustrating is woefully inadequate, in some cases borderline criminal is not to harsh. The tentacles of government have already slipped in to far and the current trend is less than comforting.

  5. David, I agree that the protests should be focused on putting one more program into the hands of government to run with their customary efficiency.

    And, Pat, I do agree that government should stay out of our personal business. All this provision is doing is paying to train people to help others deal with the end-of-life issues. It’s so hard to make those decisions when you are on the inside. Like I said in my blog, I wish there was someone to help me tackle this tough subject with my mother.

  6. Patricia, those who protest the end-of-life counseling part of the bill never read it carefully. I HAVE, and I can tell you that all it says is that under this provision, doctors could bill Medicare for the time they spend discussing end-of-life decisions with their patients. They could bill for that services every five years or if their patient’s medical condition changed and warranted it. Now doctors can’t bill Medicare for that service, which is why 90% won’t spend the time talking with Medicare-eligible patients about end-of-life decisions. This is NOT about government intrusion in our personal lives. This is about rewarding doctors for giving their patients information so the patient can decide for himself if and how he wants to die with dignity. Like it or not, we’re all going to die some day. We should all have some say in how long we want doctors to prolong our suffering. Without an Advance Directive, what happens to you in your last days is simply a crap shoot.

  7. David, you may not like Medicare or Medicaid, but like you, I worked with it for almost two decades when I worked as a nurse in the ER. Most of our patients had one or the other, and let me tell you, those people were damned thankful they had it. You show me an average senior citizen who could afford $100,000 cardiac bypass surgery without Medicare, even if they had private insurance. Look at what private insurance costs for senior citizens, what it covers, what its lifetime limits are, and how quickly a private company will drop you after a major illness or catastrophic event. Working with Medicare/Medicaid may be frustrating, but you show me a better program for the aged, the mentally challenged, or the poor in this country. My son was recently injured in Canada. He works full time for a mid-sized company that does not offer health insurance. He’s an Army vet, so he uses the VA hospital. The Canadian hospital made absolutely no fuss over the fact that he had no insurance. He received excellent care from both the ER staff and the hospital neurosurgeon and got all the care he would have received in an American hospital. So don’t give me that line about government sponsored healthcare being so awful. It may have its faults, but so does private insurance based healthcare. I have private health insurance because I’m under the age of 65, but I thank God for Medicare and how it’s helped millions of people obtain the care they’ve needed. The way I see it, those who don’t believe in government-sponsored Medicare don’t have to sign up for it.

  8. Maryann, thanks for writing about this issue. I blogged about it on Cicero’s Children back in September when Palin and others made such a public stink about so-called “Death Squads”. Like you, I’ve counseled many families on a patient’s rights under Advanced Directives. Doctors are hopelessly poor at giving accurate end-of-life information to their patients, and that’s because very few of them are ever around when their patients die. They run into a patient’s room and stay for maybe (if you’re lucky) five minutes, then get the hell out because they don’t want to have to face the patient or the family with the bad news that the patient is dying. As one doctor told me, “I leave that up to the nurses.” I actually had one doctor ask me to come into a patient’s room with him because he thought the patient might be dead. I went into the room with him and yes, for once in his life, that doctor was right. Doctors are woefully undertrained in caring for the dying patient. People have to educate themselves and demand realistic and honest answers from doctors re their medical conditions.

    And to Morgan:
    The time to think about Advanced Directives is now while you’re still healthy. Respect your loved one’s decisions re end-of-life care. Don’t countermand what someone has written down as to what they want done at the end of their life.

    And to anyone who doesn’t like everything I’ve said here, I can only say that you’ve never walked in my shoes, never seen the misery I’ve seen when people are dying and their families insist that hospital staff members continue to prolong the patient’s agony with unneccesary interventions. That’s criminal to my way of thinking. Criminal and cruel and ugly.

  9. Mary, I wish you would just say what you think. 🙂

    Seriously, thank you for filling in with a lot more information for the people who read this. Your perspective is a good one having worked in ER so long.

    I did have one doctor in oncology who was very attuned to the patients and their emotional and spiritual needs. He would not come into a room and interrupt if I was with a patient, and he called me frequently to come and work with him as he delivered painful news. I had the greatest respect for him as a healer, and was so touched that he came to my going away party. The only doctor who showed up. Not surprising.

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