Do We Want Government Reimbursing our Doctors for End-Of-Life Conversations?

The New York Times printed an article last week that addressed end-of–life talks between doctors and patients.  The Times article introduces the concept of doctors being reimbursed by Medicare for services of “advanced care planning” conversations with their patients.  Doctors would converse with their patients on how they would want to spend their final days.  The American Medical Association proposed to The Centers for Medicare and Medicaid Services reimbursement for end-of-life conversations with a newly created billing code for the services.  If the proposal is adopted, then, according to the article, this will set the standard for private insurers.  In fact, there are already a few private insurance companies that cover end-of-life conversations between patients and health care workers.

If our medical professionals are paid by Medicare to discuss end-of-life issues, this could be problematic for Americans.  Ben Cosman wrote an article in The Wire that states the introduction of the expression “death panels” to the American public would be Sarah Palin’s biggest legacy.  The reason is because the discussion will continue to live on when Government decides the fate of health care distribution.  If our federal monies are paying for discussions between doctor and patient on end-of-life issues, who do you think will dictate the guidelines for such discussions?

The decision whether or not to adopt the recommended reimbursement to doctors by the Centers for Medicare and Medicaid Services could come as early as next year.  If that is the timeline, then right now is the time to put some thought behind the AMA’s proposal for end-of-life discussion reimbursement by The Centers for Medicare and Medicaid Services.  We can begin by talking about the phrase end-of-life. That implies that whatever decisions we make for ourselves will result in “ending” our lives, which, of course, is exactly what the euthanasia movement is about. 

It is imperative to differentiate between euthanasia and making choices for final stage of living planning (advanced directives).  Euthanasia is defined as the act or practice of killing or permitting the death of hopelessly sick or injured individuals (as persons or domestic animals) in a relatively painless way for reasons of mercy.  Choosing the exact time and method of “permitting” death is indeed the practice of killing, whether it is painless or subjectively merciful.  As in my book,  A Question of Dignity, and also in in-depth studies, there are reasons for concern over the practice of euthanasia. 

It is important to understand the practice of euthanasia is not the same as making plans for final stage of living, or advanced directives.  Advanced life planning is taking responsibility for your final stage of living and making informed choices about what medical treatment you do and do not wish to have in that final stage.  Advanced directives neither decide the exact time of death, or the method. When planning advanced directives, people are weighing finances, physical status, support system, and spiritual readiness with regard to health care wishes.  You are making choices about your health care wishes, communicating them to your loved ones, and putting it in writing with the expectation your choices will be met. 

There were a few thought-provoking concepts brought out in the Times article. One concept mentioned by Dr. Rodgers, co-chairman of public policy for the American Academy of Hospice and Palliative Medicine, was the fear people hold about being denied lifesaving care. Dr. Rodgers is correct in that the fear of denying lifesaving care is a tough political issue.  Our politicians should not have the authority to play God.  For that matter neither should our insurance companies.  Taking responsibility of planning our own lifesaving wishes in our final stage of living would be a giant step in preventing Government and Insurance companies from evolving into “death panels.” So why don’t we?  According to some statistics 60% of adults say they want control over their health care wishes in final stages, but only 25-30% have advanced directive.

The most logical answer to the avoidance of planning advanced directives is that letting go of this life on earth is too hard to contemplate.  Ask yourself how the thought of having a conversation about planning your final stage of living makes you feel?  However, another concept in the Times article that rings true to me is that conversations make a difference and can leave family and patients with a sense of peace.  With regard to healthcare, the truth is someone is going to plan the final stage of living for everyone. Everyone is going to face this time in life.  Therefore, people should have a say in planning advanced directives.  There is no question that individuals should take responsibility for planning and completing advanced directives.

The question is: can a conversation about final stage of living planning be done by a health care professional without interjecting concepts of euthanasia? On the other hand, can health care professionals converse with patients about the choice to refuse feeding tubes or other life sustaining measures without prejudice?

If part of reimbursement by our government to doctors for “end-of-life” discussions with patients includes euthanasia, we need to know that now.  Or more specifically our legislators need to know now. 

Sheila Holt, RN, MSN, writes from North Charleston, SC. She welcomes your correspondence at sheilaholt2@gmail.com. You can follow her at http://www.swaddlerest.com

The New York Times printed an article last week that addressed end-of–life talks between doctors and patients.  The Times article introduces the concept of doctors being reimbursed by Medicare for services of “advanced care planning” conversations with their patients.  Doctors would converse with their patients on how they would want to spend their final days.  The American Medical Association proposed to The Centers for Medicare and Medicaid Services reimbursement for end-of-life conversations with a newly created billing code for the services.  If the proposal is adopted, then, according to the article, this will set the standard for private insurers.  In fact, there are already a few private insurance companies that cover end-of-life conversations between patients and health care workers.

If our medical professionals are paid by Medicare to discuss end-of-life issues, this could be problematic for Americans.  Ben Cosman wrote an article in The Wire that states the introduction of the expression “death panels” to the American public would be Sarah Palin’s biggest legacy.  The reason is because the discussion will continue to live on when Government decides the fate of health care distribution.  If our federal monies are paying for discussions between doctor and patient on end-of-life issues, who do you think will dictate the guidelines for such discussions?

The decision whether or not to adopt the recommended reimbursement to doctors by the Centers for Medicare and Medicaid Services could come as early as next year.  If that is the timeline, then right now is the time to put some thought behind the AMA’s proposal for end-of-life discussion reimbursement by The Centers for Medicare and Medicaid Services.  We can begin by talking about the phrase end-of-life. That implies that whatever decisions we make for ourselves will result in “ending” our lives, which, of course, is exactly what the euthanasia movement is about. 

It is imperative to differentiate between euthanasia and making choices for final stage of living planning (advanced directives).  Euthanasia is defined as the act or practice of killing or permitting the death of hopelessly sick or injured individuals (as persons or domestic animals) in a relatively painless way for reasons of mercy.  Choosing the exact time and method of “permitting” death is indeed the practice of killing, whether it is painless or subjectively merciful.  As in my book,  A Question of Dignity, and also in in-depth studies, there are reasons for concern over the practice of euthanasia. 

It is important to understand the practice of euthanasia is not the same as making plans for final stage of living, or advanced directives.  Advanced life planning is taking responsibility for your final stage of living and making informed choices about what medical treatment you do and do not wish to have in that final stage.  Advanced directives neither decide the exact time of death, or the method. When planning advanced directives, people are weighing finances, physical status, support system, and spiritual readiness with regard to health care wishes.  You are making choices about your health care wishes, communicating them to your loved ones, and putting it in writing with the expectation your choices will be met. 

There were a few thought-provoking concepts brought out in the Times article. One concept mentioned by Dr. Rodgers, co-chairman of public policy for the American Academy of Hospice and Palliative Medicine, was the fear people hold about being denied lifesaving care. Dr. Rodgers is correct in that the fear of denying lifesaving care is a tough political issue.  Our politicians should not have the authority to play God.  For that matter neither should our insurance companies.  Taking responsibility of planning our own lifesaving wishes in our final stage of living would be a giant step in preventing Government and Insurance companies from evolving into “death panels.” So why don’t we?  According to some statistics 60% of adults say they want control over their health care wishes in final stages, but only 25-30% have advanced directive.

The most logical answer to the avoidance of planning advanced directives is that letting go of this life on earth is too hard to contemplate.  Ask yourself how the thought of having a conversation about planning your final stage of living makes you feel?  However, another concept in the Times article that rings true to me is that conversations make a difference and can leave family and patients with a sense of peace.  With regard to healthcare, the truth is someone is going to plan the final stage of living for everyone. Everyone is going to face this time in life.  Therefore, people should have a say in planning advanced directives.  There is no question that individuals should take responsibility for planning and completing advanced directives.

The question is: can a conversation about final stage of living planning be done by a health care professional without interjecting concepts of euthanasia? On the other hand, can health care professionals converse with patients about the choice to refuse feeding tubes or other life sustaining measures without prejudice?

If part of reimbursement by our government to doctors for “end-of-life” discussions with patients includes euthanasia, we need to know that now.  Or more specifically our legislators need to know now. 

Sheila Holt, RN, MSN, writes from North Charleston, SC. She welcomes your correspondence at sheilaholt2@gmail.com. You can follow her at http://www.swaddlerest.com

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