NEW YORK TIMES: Five years after it exploded into a political conflagration over “death panels,” the issue of paying doctors to talk to patients about end-of-life care is making a comeback, and such sessions may be covered for the 50 million Americans on Medicare as early as next year.
Bypassing the political process, private insurers have begun reimbursing doctors for these “advance care planning” conversations as interest in them rises along with the number of aging Americans. People are living longer with illnesses, and many want more input into how they will spend their final days, including whether they want to die at home or in the hospital, and whether they want full-fledged life-sustaining treatment, just pain relief or something in between. Some states, including Colorado and Oregon, recently began covering the sessions for Medicaid patients…
“We think it’s really important to incentivize this kind of care,” said Dr. Barbara Levy, chairwoman of the A.M.A. committee that submits reimbursement recommendations to Medicare. “The idea is to make sure patients and their families understand the consequences, the pros and cons and options so they can make the best decision for them.”… (more)
EDITOR: Often young people, children and grandchildren, have a much greater aversion to death than do the elderly who accept the inevitable and, because of ongoing illness and loss of control of their own lives, are ready to move on.
Patients and their families need to understand what lies ahead and have an opportunity to evaluate and discuss. The elderly may make their desires very clear, to avoid possible acrimony among their progeny.
And lastly, terminally ill individuals may prefer to opt out of significant treatment. Many will choose not to spend their remaining times visiting doctors and suffering painful treatment if it only means a few month or a couple of years of extended life…perhaps in a dependent, enfeebled role.
There should also be a dignified path to euthanasia, with consent of the authorities and understanding of loved ones.
The byproduct of all of this will be less medical expense in dealing with the final years of life and more funds for the pressing needs of other members of society. We are not advocating ‘rationing’ (although circumstances may someday warrant that.) We are talking about allowing people to make informed choices.
No one lives forever. Let’s get use to it.
