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What's So Terrible about Death Panels?

To hear the likes of former Alaska governor Sarah Palin, at least in her first inflammatory salvo, health care reform would have the disabled (among them her son Trig who was born with Down's syndrome) as well as everybody's grandma and grandpa dragged in front of a nefarious "death panel" of government bureaucrats who would put them down like sickly pets if and when their medical bills become too high.

Death panels, of course, are a myth. The health reform bills in the House and Senate) allocate no funds for such panels. Instead they require Medicare to cover voluntary end-of-life counseling sessions between patients and their doctors. The hoped-for result, according to Georgia Senator Johnny Isaakson (R, Ga.), a proponent, would be an advance directive, a legal document in which patients declare how much care they want when the end appears certain.

Such counseling, however, will be completely ineffective unless doctors, caretakers, the government and maybe even private citizens come to some conclusions about how effectiveness various treatments are for certain patients and whether the life saved will be worth living. If we don't raise such issues and try to come to some determination, doctors won't be able to provide much guidance. Excessive end-of-life spending will continue, and, more important, the suffering of terminal patients will never end.

Take the case of my mother-in-law. An art teacher with a master's degree and a taste for travel and fun, Doris developed Alzheimer's disease in her late 70s and had to be confined to a nursing home. One afternoon, something happened--nobody knew what -- but she collapsed at the facility. By the time an ambulance came, she had died of heart failure. Emergency medical technicians, however, who are bound by law to revive their patients, saved her life on the way to the hospital. But it wasn't much of a life. Tests showed that she had no brain activity; she would never be a functional person again.

Nonetheless, the hospital system cranked on. For five long days she lay in a bed with tubes coming out of every orifice. Nurses, technicians and doctors regularly visited to take her blood and perform other invasive tests, mostly to see if the machines she was attached to were working. By her moaning and thrashing about, it was clear, however, that she was suffering. When my husband asked a doctor to give her a tranquilizer, the doctor responded that it might end her life. My husband commanded: "Do it." She died peacefully about an hour later, and we all breathed a sigh of relief that her struggle had ended.

An advance directive wouldn't have helped unless it had been pasted to her forehead. The EMTs wouldn't have known it existed, nor would the hospital. Even if her private physician knew, by the time he arrived, the assembly line of care would have had her hooked up to IVs and everything else.

Medicare paid $7,000 for her care (although the hospital would have billed someone without insurance $17,000). This was about a dozen years ago; the bill today would probably be double that. According to The Archives of Internal Medicine, the 5 percent of Medicare patients who die each year account for almost 30% of Medicare expenditures. Most of it goes toward heroic efforts to keep very elderly people alive a few extra days or even hours. Often, like Doris, they are hooked up to IVs and machines and miserable in the extreme or completely unconscious.

I don't begrudge Doris her final five days. I just wish she could have enjoyed them. Instead she suffered and died without much dignity. How much easier her struggle would have been had there been a protocol to require the hospital and her caretakers -- recognizing that she would never be able to make a comeback --to stop treatment and let her go. I would want the same done for me and other members of my family. And if you want to call the people who develop such protocols "death panels," I say okay, maybe we need them.

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