End of Life Planning - A Rare Obama Idea I Can Live With

[jbg]

The article excerpted below highlights one area on which I am in strong agreement with the Obama administration. Politicians have been afraid to face the consequences of ever-expanding life spans on medical care, medical insurance, social security and private pension plans.

The simple fact is that society's financial expectations take into account the first 22 years or so of a person's life as being non-income producing, and avout seven years at the end of what was then a 72 year life span. Thus, people worked for more than half their life span. Now, with people routinely surviving into their nineties, people often work for about 43 years out of a 90 year life.

The numbers don't work.

Also, end of life heroics result in a poor quality of life. A person in their 40's recovering from, say, an appendectomy will resume a full, productive life. Not so with someone who is 88.

Obama Returns to End-of-Life Plan That Caused Stir

(link to full article)

By ROBERT PEAR

Published: December 25, 2010

WASHINGTON When a proposal to encourage end-of-life planning touched off a political storm over death panels, Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1.

Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.

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Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.

Congressional supporters of the new policy, though pleased, have kept quiet. They fear provoking another furor like the one in 2009 when Republicans seized on the idea of end-of-life counseling to argue that the Democrats bill would allow the government to cut off care for the critically ill.

The final version of the health care legislation, signed into law by President Obama in March, authorized Medicare coverage of yearly physical examinations, or wellness visits. The new rule says Medicare will cover voluntary advance care planning, to discuss end-of-life treatment, as part of the annual visit.

Under the rule, doctors can provide information to patients on how to prepare an advance directive, stating how aggressively they wish to be treated if they are so sick that they cannot make health care decisions for themselves.

Edited December 27, 2010 by jbg

[Bonam]

Certainly it is something that should be discussed with one's doctors, planned, and formalized. It is good to give people options as to what kind of procedures and health care they may want done as they reach an advanced age. Of course, for those that do want aggressive/extreme measures taken to sustain their life even in advanced age, that option still needs to remain open.

[jbg]

Of course, for those that do want aggressive/extreme measures taken to sustain their life even in advanced age, that option still needs to remain open.

I agree. But perhaps not on the public's dime.

[Shady]

That's some pretty disgusting stuff. So the government's going to pay doctors to advocate patients decline treatment and die early.

[BubberMiley]

Your reading comprehension is getting terrible. Perhaps too much rum and eggnog.

[jbg]

Your reading comprehension is getting terrible. Perhaps too much rum and eggnog.

For once you and I seem to agree.

[bush_cheney2004]

That's some pretty disgusting stuff. So the government's going to pay doctors to advocate patients decline treatment and die early.

Definitely....families are already subject to DNR/DNAR/DNI paperwork upon admission of an incapacitated patient to the hospital. Hospice care, pain management, and "permitting a natural death" are the latest medical fashion statement.

Personally, I want the Edward G. Robinson Soylent Green treatment with IMax videos and classical music playing in the background.

[Shady]

Your reading comprehension is getting terrible. Perhaps too much rum and eggnog.

It's all right there in black and whilte.

the government will pay doctors who advise patients on options for end-of-life care

What type of end-of-life care do you think doctors are going to be advising? It ain't gonna be more and better treatment!

The government shouldn't be involved. This should be left up to the doctor, and between the doctor and the patient. There should be no government advocacy.

[BubberMiley]

What type of end-of-life care do you think doctors are going to be advising? It ain't gonna be more and better treatment!

You don't know what the word "options" means, do you?

[Shady]

You don't know what the word "options" means, do you?

You don't know what end-of-life means, do you?

[punked]

You don't know what end-of-life means, do you?

You don't know what freedom for patients to make their own choices means do you? Shady just hates freedom that is all I get from this.

[BubberMiley]

You don't know what end-of-life means, do you?

Of course I do. But your post implied that the doctors were doing more than what the quoted piece said---providing options. I assumed you either don't know what the word "options" means, or you are trying to misrepresent the issue for pathetic political purposes.

I figure it's most likely the former.

[scribblet]

It's a slippery slope, how long before the option to end life becomes, a must end life - to save the State et al money

[TimG]

The government shouldn't be involved. This should be left up to the doctor, and between the doctor and the patient. There should be no government advocacy.

The US government IS involved and has been involved since it agreed to fund Medicare. This means the government needs to make it clear that people do have choices other that wasting money on treatments that are likely to be futile. I cannot understand why any conservative whould oppose proper cost-benefit analysis being applied before the government spends money.

[TimG]

It's a slippery slope, how long before the option to end life becomes, a must end life - to save the State et al money

The state does not have an infinite pool of resources. If you choose to make futile medical care at the end of life a mandatory expense then something else will have to be sacrificed. Will be it be pensions? Education? What?

[BubberMiley]

It's a slippery slope, how long before the option to end life becomes, a must end life - to save the State et al money

If you mean there's always more money to spend and some bureaucrat is deciding whether to spend it, that line is already being drawn every day.

But judging from the birther movement, I guess reality is something that is largely irrelevant to rabid anti-obama right-wingers.

[jbg]

I cannot understand why any conservative whould oppose proper cost-benefit analysis being applied before the government spends money.

The state does not have an infinite pool of resources. If you choose to make futile medical care at the end of life a mandatory expense then something else will have to be sacrificed. Will be it be pensions? Education? What?

I just don't, for the life of me, see the utility in expensive cancer therapy for 87 year olds. Who is paying for this hyperactivity? Not the patient or their families.

The devcelopment of Medicare in the U.S. took away teh element of fiscal sanity inmake medical decisions. If the default choice is always unlimited treatment how can teh result be anything other than bankrupting?

The ideological conservatives need a reality shake here.

But judging from the birther movement, I guess reality is something that is largely irrelevant to rabid anti-obama right-wingers.

I go issue by issue on Obama. Edited December 27, 2010 by jbg

[Jack Weber]

Of course I do. But your post implied that the doctors were doing more than what the quoted piece said---providing options. I assumed you either don't know what the word "options" means, or you are trying to misrepresent the issue for pathetic political purposes.

I figure it's most likely the former.

I think The Professor is trying to get in the woebegotten "Death Panel" angle...

What a buffoon...

I'll bet he does'nt realize that there are such things as "Do Not Ressusitate(sp)" and "No Heroic Measures" orders that are given by family members to Doctors when dealing with very old family members very near the end of their lives...

Usually through Power of Attorney stuff...

Edited December 27, 2010 by Jack Weber

[Shady]

I'll bet he does'nt realize that there are such things as "Do Not Ressusitate(sp)" and "No Heroic Measures" orders that are given by family members to Doctors when dealing with very old family members very near the end of their lives...

Yep. Which don't involve the government. Thanks for making my point Einstein.

[BubberMiley]

Yep. Which don't involve the government. Thanks for making my point Einstein.

By that logic, medicare shouldn't exist at all. Try selling that one to the electorate.

[Jack Weber]

By that logic, medicare shouldn't exist at all. Try selling that one to the electorate.

Really..

Dr. Professor Kitzel to the rescue again....

Edited December 28, 2010 by Jack Weber

[scribblet]

The state does not have an infinite pool of resources. If you choose to make futile medical care at the end of life a mandatory expense then something else will have to be sacrificed. Will be it be pensions? Education? What?

This is the thing isn't it, who is to decide if it's futile or what quality of life someone should be allowed to survive with? I agree that for instance keeping a baby alive who was born with anencephaly is futile, no question there, but where do we draw the line, and what would we have in place to ensure that ending someone's life at a particular point becomes mandatory? I agree that expensive cancer therapy for 87 year olds would probably be futile and maybe most wouldn't want it anyway, but what if the 87 year old is other wise robust, active with all his faculties. We should really take each case on an individual basis.

If money is the main force behind the decision, then at what point do we say no to keeping premature babies alive, especially if it's likely they will have a low quality of life... it can get pretty sticky can't it. I just worry about when end of life planning or even euthanasia could become mandatory...

I don't think we are talking about rabid anti birthers here either - BTW, what exactly is an 'anti birther'

[jbg]

This is the thing isn't it, who is to decide if it's futile or what quality of life someone should be allowed to survive with? I agree that for instance keeping a baby alive who was born with anencephaly is futile, no question there, but where do we draw the line, and what would we have in place to ensure that ending someone's life at a particular point becomes mandatory? I agree that expensive cancer therapy for 87 year olds would probably be futile and maybe most wouldn't want it anyway, but what if the 87 year old is other wise robust, active with all his faculties. We should really take each case on an individual basis.

If money is the main force behind the decision, then at what point do we say no to keeping premature babies alive, especially if it's likely they will have a low quality of life... it can get pretty sticky can't it. I just worry about when end of life planning or even euthanasia could become mandatory...

My point when I gave the example of the 87 year old cancer patient is not far-fetched. Let me explain.

My mother and stepfather married in 1974, and they are now, respectively, 91 and 78. Both are alert, ambulatory and driving. My stepfather has been under treatment for a blood cancer for about 10 years, maybe more. My mother had a uterine cancer removed during 2008 and since then has had chemo and radiation, and seems quite healthy. In both cases I am happy that they are alive and still at family gatherings. The fact that they are alive is purely thanks to the very generous New York and U.S. taxpayers.

I know if I were making the decisions the treatments would have proceded since I love them. I wonder, from a societal point of view, if either was wise.

[TimG]

where do we draw the line, and what would we have in place to ensure that ending someone's life at a particular point becomes mandatory?

What we talking about is foregoing treatments and letting a disease take its course. We are not talking about euthanasia - that discussion should be kept seperate.

what if the 87 year old is other wise robust, active with all his faculties. We should really take each case on an individual basis.

These factors would always be taken into account when deciding whether a treatment is futile. A treatment that is futile for one 87 year old may not be futile for another.

If money is the main force behind the decision, then at what point do we say no to keeping premature babies alive

Money is always behind the decision whether you like it or not. Even with government assistance caring for a special needs child costs a lot of money. Do you really think that does not factor into the decisions made by parents of premature babies? Why do you insist that money should be kept out of the discussion?

I just worry about when end of life planning or even euthanasia could become mandatory.

Again. Nobody who has the money will ever be required to resort to such things. We are talking about putting limits on what government funded medical care will pay for and no one has any right to expect unlimited government funding for their medical care. Edited December 28, 2010 by TimG

[BubberMiley]

I agree that for instance keeping a baby alive who was born with anencephaly is futile, no question there, but where do we draw the line, and what would we have in place to ensure that ending someone's life at a particular point becomes mandatory?

Well, for example, we could draw the line at babies born with anencephaly. You feel you have the mental resources to make that judgement call with "no question." Given that, why would there be a problem with medical professionals who actually know what they are doing making similar judgement calls with lots of question?