Informed choice

Tying discussions about end-of-life to a plot to form “death panels” is a disservice to both patients and physicians.

January 2, 2011


We have no choice in how we come into this world, but many of us will have an opportunity to exercise some control over how we leave it.

We can and should give our families and caregivers some instructions about what kind of life-sustaining medical treatment we find acceptable. That should be our choice — an informed choice based on whatever counseling and input we seek from family, faith advisers and medical professionals.

Somehow, end-of-life care has become a political football in the United States. During contentious discussions about the federal health care overhaul, the mere act of offering people information about end-of-life choices has been demonized into a plot to implement “death panels” that make decisions about how and when people should die. The issue arose again last week when the Obama administration approved a new policy, which went into effect Saturday, allowing Medicare to pay doctors for informing patients about options for end-of-life care.

Again, doctors are offering “information.” They are not making decisions. Doctors are giving people the information they need to make decisions about their own care rather than having those decisions made by someone else when they are no longer capable of making their wishes known.

This is not a “death panel” or the first step toward legalized euthanasia. It is an opportunity for individuals to guide the care they receive at the end of their lives. It is an opportunity for a patient to tell doctors and family members that he or she doesn’t want to be resuscitated and kept alive on a ventilator after all hope of recovery is past. If they don’t want to leave specific directions about what treatment they do and don’t want to receive, they can simply delegate those decisions to trusted friends or family members, with whom they have shared their wishes. There is no death panel, no doctor or government entity turning thumbs up or thumbs down on a patient.

People facing a terminal illness are allowed to make choices about their care or lack of care. Although it may be hard for family members to accept, patients are allowed to weigh the effects of aggressive medical treatment against the potential benefits of that treatment. Advanced medical directives simply extend a patient’s right to make those decisions to a time when they will be unable physically to express them.

To equate end-of-life counseling with death panels is a huge disservice to patients and their families. Being able to discuss and express end-of-life treatment choices actually puts control for those decisions firmly back with individuals who leave clear instructions for family members and medical professionals. It makes sure people receive the treatment they wanted, not the treatment someone else chooses.

Medicare recipients should be encouraged to talk about end-of-life care decisions with their families and their physicians, and it’s not unreasonable to reimburse doctors for the time they spend providing information to their patients concerning those choices. Discussions about end-of-life care are just as important as discussions about any other care decisions that patients must make. We shouldn’t be afraid to have that conversation.


cato_the_elder 7 years, 3 months ago

This editorial completely misses the point. What's wrong with this is that the Obama administration is trying to do by regulation what it could never have done legislatively, and not just on this issue. The courts are going to be quite busy for the next two years with challenges to Obama's attempts to circumvent the legislative process through administrative fiat.

just_another_bozo_on_this_bus 7 years, 3 months ago

"This editorial completely misses the point."

Correct. The whole "death panel" thing has nothing to do with healthcare policy. It has to do with whipping up hysteria to keep the sheep in line.

Looks like you might be due for a shearing there, cato.

cato_the_elder 7 years, 3 months ago

Bozo, of all of the intellectually challenged sicko leftists on this forum, your ovine tendencies are second to none. In fact, your knee routinely jerks so high that your chin must be one permanent left-wing bruise.

I stand by what I said. The Obama administration is trying to do by regulation what it could never have done legislatively, and will face major litigation as the result of its actions.

just_another_bozo_on_this_bus 7 years, 3 months ago

"The Obama administration is trying to do by regulation what it could never have done legislatively,"

Wow, that would make them just like every administration in the past 50 years or more, wouldn't it? And no one was more guilty of it than Reagan/BushCo.

cato_the_elder 7 years, 3 months ago

"Reagan/BushCo?" Really? OK, Bozo, provide a specific example, please, of the promulgation of a regulation that mirrored a failed provision in a proposed piece of legislation that had to be removed in order for the legislation to pass.

just_another_bozo_on_this_bus 7 years, 3 months ago

And the whole "death panel" BS remains precisely that-- BS.

cato_the_elder 7 years, 3 months ago

No, Bozo, the BS is the conduct of Barack Obama, "Mr. Transparency" himself, in burying within a complex set of regulations a specific provision for which he couldn't even get a sufficient number of Democrats to vote a year ago and which, as a result, instead of actually becoming law has been unilaterally imposed by Obamanian fiat. Hopefully, the court system will strike it down.

Jimo 7 years, 3 months ago

How will "the courts be quite busy" when Republicans have delayed confirmation for federal judges so comprehensively that the Chief Justice has to write begging for action?

I believe the brainy types call thing being hosted on one's own petard.

notajayhawk 7 years, 3 months ago

Maybe math wasn't your best subject, but wouldn't having fewer available judges indeed make the remaining judges busier?

cato_the_elder 7 years, 3 months ago

Notajayhawk, you can try pointing out the obvious to him but he still won't get it.

Ralph Reed 7 years, 3 months ago

Yes, Tom, don't be a hypocrite. Doctors have been offering information for years. But then, I assume you're never going to be ill or suffer a debilitating disease, instead you're just going to keel over dead not needing information.

Advance directives (living wills) are one part of the information you despise so much. I suggest that if you have one, then you are in fact a hypocrite - saying one thing and doing another.

Personally, I want a doctor to tell me what my options are. That's not a death panel (unless it's one convened against me by the right-wingnuts because I'm not right wing). If I have a fatal disease (other than old age - you suffer from that one also Tom), then I want to know what my options are for treatment and extending my life should I so choose. Tom, that is information; having all the facts so I can make the most informed choice possible.

You can add in lawyers and financial planners also. I'm sure your wife has a will to distribute her money when she passes. That was designed using information.

Richard Heckler 7 years, 3 months ago

Planning for end of life before end of life is here makes sense,

Why keep a dying person on life support systems? That is not pro life that is painful life and expensive life. Why increase the cost of health care and health insurance to keep a person alive in pain who is dying no matter what?

What if the person does not want to endure such pain any longer and knows they are dying?

domino 7 years, 3 months ago

I have watched 3 people I loved deeply die of cancer. They knew they were dying and chose to make as informed decisions as they possibly could about their care. I'm here to tell you, there is not enough pain medicine that can be given to them to keep them pain free. We won't even go into the pain and suffering it causes family and friends who are there to support them. Perhaps you have been in the situation of watching someone you love go thru that and hold their hand while they take their last breath, if you have not, I pray that you never have to.

texburgh 7 years, 3 months ago

An LJW editorial that is rational! What a concept! Where was the LJW when this was being used to block any and all health care reform?

Corey Williams 7 years, 3 months ago

All it does is pay the doctor for the time spent discussing this with their patients. Are you against doctors being paid for what they can do with all those years in school? Are you against people being made aware of their choices?

Yes, it is all a plan to kill off seniors. That way we don't have to pay for their social security. Keep thinking that. Used to be that I would know you by your turned ankles, now I know you by the stupidity of your opinion.

woodscolt 7 years, 3 months ago

Hey tom, try reading the article. Your post has nothing to do with the content of the article. whats up with that?

woodscolt 7 years, 3 months ago

If that is the case, maybe if you pointed out just how finally being able to have professional advice on how to manage your last run on earth is government intervention. It is the person who is making the decision. You comprehend this as the government making the decision. You always come up with your boiler plate response to everything. You and sarah just don't get it. Go ahead and insult everyone else because you just don't get it. Bless you as well tom and may you have wonderful new year.

Scott Drummond 7 years, 3 months ago

Except that you don't appear to be making any cogent point.

gudpoynt 7 years, 3 months ago

So Tom, it's hypocritical to accept some forms of government intervention (read "laws") and to reject others?

The disdain you hold for critical thinking does not reflect well on your sensibilities.

tomatogrower 7 years, 3 months ago

woodscolt, Tom just plays the far right scheme of changing the subject. They all do this on this forum. Then while they are ranting and preaching, they accuse the those who oppose them of being hysterical and emotional. In psychology I think they call that mirroring. It's when the person who has a drug problem puts down and hates people who have drug problems. Kind of like one of their favorite pundits. I'm not sure if they receive training for this technique, or if it just comes naturally.

Corey Williams 7 years, 3 months ago

Yes nancyboy, it's all about the government telling you what to do. Not about doctors finally getting paid to have a conversation. So anti-choice no matter what, huh? Just keep repeating what they tell you. No need to have an independent thought in your head. Why would we expect any less?

tomatogrower 7 years, 3 months ago

Tom is going to live for years comatose on life support, because that's what his pundits tell him he must do. He'll only die when there is an electrical failure that shuts off his life support, which of course will be considered an act of God.
By the way, Tom. For such a good White, Christian Male, shouldn't you be at church? Are you posting this during the sermon?

Ralph Reed 7 years, 3 months ago

Corky, Tom has already self-identified as being "a good White, Christian Male" among other things. I see no labeling other than what Tome applied to himself.

Ralph Reed 7 years, 3 months ago

Excuse me, "...what Tom applied to himself."

parrothead8 7 years, 3 months ago

How is the government interfering? All they're doing is telling doctors that they'll get paid for giving people information...even poor people.

booyalab 7 years, 3 months ago

So, if the DMV started using bureaucratic loopholes to make it harder for people driving red cars to get a driving license, after a proposition on the subject was voted down, ljw and many readers would be ok with that? Doesn't sound like a bad precedent?

Scott Drummond 7 years, 3 months ago

The proposition was not voted down. It was removed from a health care proposal to protect the overall passage because the right wingers and their willing allies in the corporate press were engaged in a campaign of disinformation on the matter.

booyalab 7 years, 3 months ago

So it wasn't "voted down", just the majority of our elected representatives didn't want it in there. Gotcha.

jafs 7 years, 3 months ago

Not having a filibuster proof majority isn't the same thing as not having a majority.

Ralph Reed 7 years, 3 months ago

Not germane to the editorial or discussion.

Whitney, can we request removal if a post is not germane to an article?

Ralph Reed 7 years, 3 months ago

Tom, I read your posts. No need to re-read them as they never change.

Take your official Glen Beck tin foil cap off for a while. All it calls for is that Doctors will now be paid for the time they spend discussing advance directives. It doesn't stipulate how they should be worded or administered.

I do find it interesting that you choose the respond here when I was facetiously speaking about booyalab's 1143. I wasn't even writing about you at all - this time.

booyalab 7 years, 3 months ago

I really don't try to put people on edge, but somehow it's so amusing when it happens.

usnsnp 7 years, 3 months ago

Got to this late. Two things. 1. You are not forced to take any advice, the doctor will ask you if you want to talk about end of life decisions, then it is up to you to say yes or no. 2. How many of the people complaining have Medical Decision paperwork stating what type of medical care that they want in specific circumstances. One other thing, if this was done by a Republican then it would be all right, many of the people that are against this policy were for it before it was the idea of the Democrats.

jafs 7 years, 3 months ago

That's an interesting point.

Why/how is it that doctors wouldn't be compensated for their time with a patient while talking about a variety of things, including end of life counseling?

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