Saturday, October 10, 2009

I Was a Teenage Death Panelist and The Case for Killing Granny

I Was a Teenage Death Panelist
Published Sep 12, 2009
From the Newsweek issue dated Sep 21, 2009

Though I did not realize it on either occasion, I have twice served on death panels. The first was more than two decades ago, when my grandmother was ill and there was little hope of recovery. My grandfather asked me (in passing, to be sure; I was 16) whether we ought to prolong her life by artificial means or let her die what I clearly remember his calling "a noble death." Then, last year at this time, my father was diagnosed with a fatal case of lung cancer (three packs of cigarettes a day for 40 years will do that to you) and quickly ended up on a respirator for several days, with, the doctors advised, no hope of ever waking up. His wife and I consulted over a painful weekend and made what was to us a clear decision. A priest was summoned, prayers said, and the machines turned off. He died within moments.

Such situations are not what the right-wing opponents of President Obama's health-care reform were thinking of when they coined the term "death panels," a lie crafted to foment opposition to the president's push for reform. In fact, the origins of what became the dreaded death panels show the idea to be sensible and humane: the proposal was to encourage families to consult with their doctors about end-of-life care. The phrase is at once politically brilliant and horribly misleading.

The original bill was heading in the right direction: Americans do spend an inordinate amount of money (30 percent of Medicare, for instance) on care in the last six months of life...

The Case for Killing Granny

Rethinking end-of-life care
By Evan Thomas
Published Sep 12, 2009
Newsweek issue dated Sep 21, 2009

My mother wanted to die, but the doctors wouldn't let her. At least that's the way it seemed to me as I stood by her bed in an intensive-care unit at a hospital in Hilton Head, S.C., five years ago. My mother was 79, a longtime smoker who was dying of emphysema. She knew that her quality of life was increasingly tethered to an oxygen tank, that she was losing her ability to get about, and that she was slowly drowning. The doctors at her bedside were recommending various tests and procedures to keep her alive, but my mother, with a certain firmness I recognized, said no. She seemed puzzled and a bit frustrated that she had to be so insistent on her own demise.

The hospital at my mother's assisted-living facility was sustained by Medicare, which pays by the procedure. I don't think the doctors were trying to be greedy by pushing more treatments on my mother. That's just the way the system works. The doctors were responding to the expectations of almost all patients. As a doctor friend of mine puts it, "Americans want the best, they want the latest, and they want it now." We expect doctors to make heroic efforts—especially to save our lives and the lives of our loved ones.

The idea that we might ration health care to seniors (or anyone else) is political anathema. Politicians do not dare breathe the R word, lest they be accused—however wrongly—of trying to pull the plug on Grandma. But the need to spend less money on the elderly at the end of life is the elephant in the room in the health-reform debate. Everyone sees it but no one wants to talk about it. At a more basic level, Americans are afraid not just of dying, but of talking and thinking about death. Until Americans learn to contemplate death as more than a scientific challenge to be overcome, our health-care system will remain unfixable.

Compared with other Western countries, the United States has more health care—but, generally speaking, not better health care. There is no way we can get control of costs, which have grown by nearly 50 percent in the past decade, without finding a way to stop overtreating patients...

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