Death, politics and denial

Somewhere near the middle of the 1,018-page health care reform bill is a provision that would entitle seniors to Medicare coverage for an end-of-life consultation every five years – or more often if their health condition changes.

This relatively obscure and minor portion of the bill has ignited a firestorm of debate about government intrusion and the slippery slope toward euthanasia. In the past couple of weeks the public discussion has practically exploded over this one issue.

Here’s Catholic Online:

Will this National “Health Care” Plan encourage our elderly to take their own lives rather than somehow become a “drain” on the rest of us? Will it withhold medical care from them based upon a bureaucrat’s decision regarding so called “quality of life” issues? Will it encourage the rationing of medical services? Will it counsel the withdrawal of nutrition and hydration in order to expedite their death? In short, is Euthanasia included in this National “Health Care” Reform? The more I have looked at the proposals, the more it seems not only possible but probable.

Chain e-mails are making the rounds, warning that seniors will be browbeaten into suicide for the sake of saving Medicare dollars. Watchblog calls it a mandate that “would make George Washington throw up in his grave.”

But here’s the thing: None of it is true. did the research and concluded that “the claim that the House health care bill pushes suicide is nonsense.”, one of the leading debunkers of urban myths, came to the same conclusion. AARP leaders were so concerned about the disinformation that’s being spread that they felt compelled to issue a news release, calling for an end to the scare tactics.

What’s apparently going on is a whole lot of political maneuvering. I’ll leave it to others to explain in more detail and move on to the real issue here: Since when have we as a society become so averse to death that we can’t even discuss it without having it turn into a moral showdown?

Most of us, if we really thought about it, would like to have at least some control over how we die. Most of us don’t want a death that’s prolonged or agonizing. We’d like to be able to die at home, if possible, surrounded by family and loved ones.

But there seems to be a huge barrier to actually talking about it. Although laws recognizing the validity of health care directives have been on the books for almost 20 years, the majority of Americans don’t have a health care directive. According to this source, fewer than 30 percent of us have completed a health care directive or living will. Conversations about when to bring in the hospice team are still difficult to have, and all too often these conversations don’t take place soon enough.

Dr. Drew Rosielle, who co-blogs at the Pallimed hospice and palliative care blog, ponders what the current political tempest is telling us about our collective beliefs about death and dying:

… these people make these claims in part because they believe they will have traction with some of the public and should give us pause as a community to acknowledge that this speaks to some portion of the public, and thus our patients. And as better end-of-life care and palliative care are being put out there as potential solutions (in part) to the U.S. health care crisis, this is likely to escalate. Anytime it’s pointed out that “palliative care” (or discussing end-of-life options) saves money, that is going to be sufficient for some to conclude that this is a government conspiracy to euthanize people with disabilities and deny Grandma dialysis because she’s 80.

We need to talk about it anyway, Rosielle says, urging hospice and palliative care providers to “Be Out, Be Proud, Superb End-of-Life Care for All, No Apologies!” He writes:

What we do helps people, tremendously, and it’s what most want (when it’s time), and the fact that it probably saves Medicare a few bucks should be seen as good news by everyone.

Good news too if the political debate causes a few more Americans to stop and examine why we are often so intent on denying the death that inevitably comes to all of us.

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