Fear of Death Leads to Serious Consequences
by Stephen J. Busalacchi

The U.S. Senate Finance Committee’s decision to drop end-of-life provisions from health reform legislation is plain dumb. It’s really unfortunate that the part which would give people the option of getting Medicare-covered counseling regarding pain management, power of attorney for healthcare and hospice care would get nixed from a health reform bill. It’s dumb because end-of-life counseling leads to decision-making that honors each person’s wishes, provides more compassionate care and may well do so at much less expense than simply doing everything medically possible, whether the patient would want that or not.

End-of-life care is not the scary prospect portrayed in some political circles. In fact, hospice, pain control and consultations with a palliative care specialist make one's life better! What a shame that the Democrats' health reform proposal that would have paid doctors to make such consultations fell victim to fear mongering.The irony is that end-of-life care is all about options. It is not about telling people they have to die a certain way. The whole point is that the patient's wishes are carried out, after he or she is aware of the medical options. Unfortunately, a great many people find the whole topic too taboo and never discuss it, leaving their families in the lurch when some catastrophic illness strikes and mom or dad isn't able to make decisions anymore. To me, that's the scariest position to be in.

So, what tends to happen, according to many physicians I know, is that all medical care is given, whether the person has a reasonable hope for recovery or not. Think about that one for a moment. Medical technology can keep people alive for a very long time, even if they have no cognition and little prospect for regaining it. Look at the case of Martha "Sunny" von Bulow. She lived for almost three decades in an unconscious state, before dying last December. Imagine the medical expense associated with such choices!

The good news is that anybody wanting to make smart decisions regarding his or her health can do so right now by filling out the Power of Attorney for Healthcare form. In addition, speak to loved ones about your wishes, should you become unable to make your own healthcare decisions. Our population is aging to the point where those 65 and over will triple by mid century. Equally daunting, there will be fewer workers to support these retirees.

The fact is it will be impossible to do everything for everybody, and we might as well address that reality right now, as President Obama so wisely has. It's my belief that most people who are informed, will choose a pain-free, quicker death when there is really no hope for recovery, rather than live on indefinitely connected to tubes with no recognition of who they or anybody else is. How could the latter be a moral choice when so many lack basic health needs, especially children who may not even have access to immunizations?

Anybody who wants to die with dignity, pain-free and according to his or her own wishes, can do so right now! We don't need the permission of those who would rather bury their heads in the sand. The doctors in End-of-Life Matters clearly explain better than I can why this makes sense and why it will be less expensive, to boot.

        Stephen J. Busalacchi is a medical journalist and author of White Coat Wisdom: Extraordinary doctors talk about what they do, how they got there, and why medicine is so much more than a job. © 2008 See www.whitecoatwisdom