End of Life Issues

July 25, 2015

Theresa Brown wrote Choosing How We Die for the New York Times on July 24, 2015. It’s an excellent overview of the challenges we face as a nation with an aging population and not very adequate mechanisms for providing options about end-of-life issues.

On July 8, 2015—yes, only as recently as slightly more than two weeks ago—the Centers for Medicare and Medicaid Services issued a proposed rule which addresses, in part, advance care planning. As the CMS fact sheet reflects, advance care planning—as a service for which Medicare will pay a doctor—has only been available as a part of “Welcome to Medicare” at age 65. For healthy, active, never gonna die Boomers, advance care planning discussions are not going to happen at 65. (In 2011, a 65-year-old man had a life expectancy of almost 18 years, while his same-age spouse could expect to live another 20 years. Boomer slam aside, why would you plan for something almost two decades away?)

With the proposed regulations Betsy “Death Panels” McCaughey is back. Ms. McCaughey, who was the Lieutenant Governor of New York from 1995-98, made her bones as a critic of both the 1990s health care proposals, and of the Affordable Care Act. In 2009-10, she focused heavily on claims that the law would let the government decide who lives and dies, in part because of the provision for advance care planning.

On July 12 Ms. McCaughey wrote ‘End of Life Counseling:’ Death Panels are Back for the New York Post. Michael Mechanic wrote You’re About to Hear a Lot More “Death Panels” Talk. Here’s Why It’s Nonsense for Mother Jones on July 9. He does a fine job explaining the issue, and effectively preempts what Ms. McCaughey is still trying to sell. And, pleasantly, there’s been almost no media discussion about the issue. Trump Effect? Who knows, but it’s nice not hearing much about the issue.

NPR broadcast Knowing How Doctors Die Can Change End-Of-Life Discussions on July 6. It’s a fine story by Stephanie O’Neill about how most doctors choose to die: At home, without much of the end-of-life care so many of them, and the system, provide to so many of us.

In a “more is better, judge everything by how many dollars we throw at it” society, the notion that we might let someone die as peacefully as possible tests many people. (By the way, that peaceful death at home may not be very peaceful, for our bodies don’t always do what we want them to.) And with the Betsy McCaugheys and Sarah Palins of the world screaming for attention, in a We v. They political world, the challenge is even greater.

I suspect the CMS rule will get adopted without controversy. The comment period ends on September 8, which means smart people have taken advantage of the summer to get something that matters done. Of course, paying doctors to talk about advance care planning does not solve a problem, all by itself. But it’s a start, and maybe the lack of noise from anyone other than Ms. McCaughey means one part of the battle to reach a better place when it comes to end-of-life issues—the political overlay—will get left behind.

P.S. For those who are following Oliver Sacks as he shares the end of his life with the world, read Oliver Sacks: My Periodic Table, in the New York Times Sunday Edition. It’s a lovely piece!

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