Though I disagree with Presisdent Obama on right-to-life issues, I am pleased that he is creating a national dialogue about how we make decisions at the end of life. I find myself agreeing more with someone I didn’t vote for and usually disagree with: we live in a great country.
His proposal that we pay physicians to have end-of-life discussions with patients and families is a good idea. We doctors need to slow down enough to listen to our patients’ feelings, particularly when age and disease progress, and cure options regress. Knowing what our patients feel and know, we physicians can offer better counsel.
People trust their doctors. They will listen to sound advice even if it goes against our cultural grain that demands “everything be done.” Sometimes, what is best for the patient is to avoid aggressive treatment.
Recently I counseled one of my practice patients, who was suffering from end-stage lung disease, to go on hospice (not Texas Hospice, for I don’t refer my own patients to myself). He agreed. He had been in and out of the hospital for months. His hospitalizations, which included ventilator treatment and intravenous feeds, were de-humanizing and uncomfortable.
Unfortunately, his spouse, who was doing what she thought was best, revoked hospice, just as he was near passing comfortably. He recovered somewhat with aggressive treatment, again a ventilator and steroids, and has spent the past 8 weeks in and out of long-term care hospitals.
That particular case is not unusual. A national dialogue could cultivate a nationwide approach to end-of-life care that is more wise than the current Americana dogma. And maybe, we will make decisions that are different and better.
What must be said in response to Obama is something like, “I understand your desire to create a more thoughtful end-of-life dialogue, but let us be very wary of going too far toward withdrawing curative treatment.” There is a tenuous balance here which we must continually seek. Going too far in either direction will hurt human beings.
Unfortunately, conservative politicians have thrown in audacious names, such as “death panels.” Frankly, I am embarrassed when we act that way.
“Let your conversation be always full of grace, seasoned with salt, so that you may know how to answer everyone.” Colossians 4
Yes! Despite what our culture tells us, less is often more — in healthcare and in many arenas. And thank you for reminding us to be unafraid of honest inquiry and dialogue.