Julie Sneider

Have you visited your death panel today?

By - Mar 1st, 2010 04:00 am

PalinPainOne of the unfortunate moments in last summer’s town hall hearings on health care came when former VP candidate Sarah Palin used the words “death panel” to describe an important part of end-of-life planning.

Palin applied the phrase to describe a measure in the U.S. House health reform bill that addressed “advance directives,” or the legal paperwork that outlines patients’ wishes for medical treatment should they lose the ability to make such decisions.

In Wisconsin, advance directives involve two legal documents that protect your rights to refuse or request life-sustaining medical treatments. One document is a “declaration to physicians” or a living will; the other document establishes your “power of attorney for health care.” The latter allows you to appoint someone to make medical decisions for you when you no longer can.

The reform idea Palin was talking about would have allowed Medicare, the federal health plan for people 65 years and older, to reimburse doctors for time spent talking with patients about advance directives. Right now, Medicare doesn’t cover that, and a Republican congressman thought it would be a good idea if it did. The political firestorm that followed Palin’s “death panel” remark prompted the congressman to drop the idea.

photo by Borya, via flickr.com

Photo by Borya, via Flickr.com

Whether Medicare should pay for a doctor’s time to talk with patients about advance directives is debatable. The real problem with the “death panel” rhetoric is that it preys on some people’s fears that advance directives are part of a sinister plot to ration medical care for the elderly and other vulnerable populations. The words conjure up images of nameless, faceless bureaucrats hanging around hospital ICUs saying, “Let’s cut costs by pulling the plug on Grandma before she’s ready to go.”

Unfortunately, the political ruckus over Palin’s words overshadowed the need for people to think and talk about why advance directives are important. Most people haven’t put their medical wishes in writing, and Kathleen Schneider and Cheryl Anderson see the consequences of that nearly every day.

Schneider, a medical social worker at Froedtert Hospital, and Anderson, a clinical ethicist for Wheaton Franciscan Healthcare, help patients understand what they need to consider when writing up their advance directives. They also try to help many grief-stricken families of dying patients who have never completed a living will or appointed a health care power of attorney.

photo by Trinity, via flickr.com

Photo by Trinity, via Flickr.com

“When patients are very ill and can’t make decisions for themselves, everyone around them is under a lot of stress and families have a difficult time trying to decide what should be done,” Anderson says. “If the patient has chosen an agent — that person can be a spouse, a friend, a pastor or someone else who can let the health care team know what they (the patient) would want — it eases the burden on the family.”

Some people worry that even thinking about this topic tempts fate. Others fear that by signing advance directives, they’re giving up their right to make choices for themselves or change their mind. On the contrary, Anderson explains, advance directives support the patient’s right to make decisions by putting it in writing.

“I’ve had more than one patient say, ‘If something happened to me, my family will know what to do.’ Well, guess what. They may know, but they can’t do it if they don’t have your direction,” Anderson says. “You might have one family member say, ‘Do this,’ and then your sister says, ‘No, no, she wouldn’t want that.’ You really need to have a legal decision-maker.”

So do yourself and your family a favor. Let your loved ones know in writing what you want before you get too sick to tell them. You don’t even need to hire a lawyer to make it official; the state of Wisconsin provides the forms for free. Just download them, fill them out and give them to your doctor (and be sure to save a copy for yourself and share a copy with someone you trust).

If you have a comment on this column or a suggestion for a future one, I’d love to hear from you.

Categories: The View From Here

0 thoughts on “Have you visited your death panel today?”

  1. Anonymous says:

    Great article Julie!

  2. Anonymous says:

    Regarding “death panels”, it’s my opinion the what Palin was referring to with government run healthcare the decision making for the elderly is taken out of their hands. In other words, if I at the age of 72 needed a by-pass operation, based on my age, government run health care “panels” might decide I’m past my prime and therefore let’s not waste any money on this patient. My wishes would be moot point.

  3. Anonymous says:

    Thanks for weighing in, Jackie. Your comment is the essence of why we at TCD felt it so important to begin this column. Navigating health care – whether understanding proposed reform plans or just your own insurance – is dizzyingly complex, and sometimes misleading. I hope Julie’s article today cleared up a misconception. Palin’s reference was inaccurate – this piece of the proposed reform was never about about panel-directed health choices, but about self-directed, advance planning and whether Medicare should pay doctors to counsel patients and their families about the need to cover contingencies.

    I hope you’ll continue to read “View From the Waiting Room” each week.

  4. Anonymous says:

    Regarding panel directed health choices, I guess that depends on which bill you have read, Congress’s bill or the Senate bill. At this point I don’t think any one knows what is in these bills. Our government is getting too big and I’m not comfortable with our government dictating what my health care choices are. True, there is a need for health care out there, but there is no one in this country who will go without treatment if they don’t have healthcare, that’s why we have Medicade. If the government feels they have to pass “some kind of legislation”, let them provide it for those who don’t have it and get them off of the Medicade rolls.

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