Sunday, August 16, 2009

A sad thing

The matter is basically resolved, so it's silly to post here, but I wanted to say something about the "government death panels" that have been around the news.

First, just how stupid do they think we are? A couple G7's in suits weighing granny's value to society and cutting off or reducing her medical care on that basis. Yeah, right.

What the provision would have done was allow Medicare to pay for end-of-life counseling, including things like the development of advance directives, which help your chosen representatives make choices in accordance to your wishes when you are too sick to make them yourself.

I have been thinking about palliative care a lot -- in part because I have signed up for the home-nursing service's palliative care unit even as I continue chemotherapy -- and advance directives are a key part of that process. I actually did mine quite some time ago, as did L.; in my case it may be time to revise some of my answers, but something is most definitely better than nothing.

It would be great, of course, if everyone were cognizant of the necessity of planning for not being immortal, but since most folks are highly resistant to the simple fact that they too will die one day, a few bucks spent helping folks to make their choices and preferences legally enforceable (hopefully) seems worthwhile. Note that there really isn't anything in the bill for the doctor or social worker here; removing the cost, as I see it, almost exclusively helps the patient, who may feel reluctant to pay to enter a difficult conversation. (The time we spent with a social worker going over the forms was covered without discussion by our cancer center; we paid for legal documents like powers of attorney when we had our lawyer draft our will.)

As I said, though, this is moot: No advance directives in the bill. But I still find myself dispirited by the crude, fear-mongering language used by opponents of the provision, as well as my sense that it was picked as a target purely as a matter of opportunity, not on any rational policy grounds. Even worse, this is an expensive target; expensive (as documented by studies) in terms of end-of-life spending, but, even worse, expensive in terms of human suffering.

It's been a quite while since I did my advance directive, so I may not have much to say about that, but over the next couple weeks, I am going to document MY experiences with opting to use some palliative care services long before they are strictly necessary. Summarizing my responses with some writerly tough love, my feelings are good, bad, intrusive and emotionally charged. Of course, I wouldn't feel right if I didn't expand upon that quite a bit.

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