The Obama administration said Wednesday that it plans to have Medicare pay doctors for talking to their patients about dying. It is the right call, one that could go a long way toward alleviating suffering, confusion and conflict around the end of life.
Everybody dies, and everybody knows it. Far too few of us plan for it, however, or make our wishes known about possible contingencies. The hope is that if Medicare reimburses doctors for talking to patients facing death about their wishes for the end, more of those conversations will occur.
The U.S. population is aging, and people are living longer with serious conditions. Americans are also increasingly intent on making important life decisions for themselves.
There is a lot to consider. Perhaps the most critical is whether and how individuals want to be kept alive if they become incapacitated and cannot speak for themselves. Should everything possible be tried, even if there is little chance of success? If not, what would be acceptable? A ventilator? Feeding tube? For how long? Under what circumstances should life support be discontinued?
This is not about assisted suicide. It is most emphatically not about Sarah Palin’s imaginary “death panels.” In fact, it is not about ceding control to anyone – in or out of government.
On the contrary, having an informed conversation with a doctor about end-of-life issues is all about understanding the possibilities, establishing the patient’s wishes and following them.
Without those wishes being clearly expressed, family members may be asked to decide. But they may not know what those wishes are, they may not agree with them or they simply may not be able to accept that their loved one is dying and insist on extraordinary measures no matter what.
Such choices are difficult in the best of circumstances. But if there is no spouse or clear next of kin, there can be confusion not only as to what to do but about who should decide. And if family members disagree about what should be done, things can get ugly.
Encouraging health-care providers to have conversations about those issues should mean more people have advanced directives or other documents outlining what they want done at the end. It may also help control costs by eliminating some unnecessary or fruitless care spurred on by distraught relatives or doctors worried about the family’s reaction.
Lowering costs, however, is not the point. Rather, it is all about human dignity and honoring the final wishes of the dying. Those are worthy objectives.
They are not easily achieved, though. A similar idea was part of the original thinking in the Affordable Care Act. That was shot down amid the hysteria surrounding the false contention that this was somehow a mechanism to allow the government to decide who got what care. A similar idea was undone a year later under political pressure.
This time, Medicare should follow through with it. A final decision on the proposal is expected by Nov. 1, with the rule scheduled to take effect in January. There will be a 60-day public-comment period.
Not everyone gets to plan for their death. Those of us who can, however, should be offered that chance. And a talk with a doctor is a good place to start.
