Friday, August 13, 2010

Death panels that work

Here's a subject that is guaranteed to cause discomfort:  what (if anything) to do about the fact that well over 3/4 of total medical expenses for the average person are spent during the last year of life?  what to do (if anything) about the overpowering human instinct to survive in the face of overwhelming medical evidence that time is running out.  Can we afford as a society to spend great sums to extend life spans for a few months?

Several of the great ethics philosophers have explored the bigger question---in what circumstances are moral  choices we make for ourselves and family members result in morally questionable outcomes if our choices are replicated on a society-wide level?

Fortunately, have faced only one life-and-death medical decision in my family history in which I had a role to play.  And even though I revisit that decision and its consequences from time to time, my take-away is that this is a deeply personal matter in which the State has a limited useful role.  Yet, I am reminded of how this plays out under different circumstances on a wider scale, through an article by my fave medical writer, Atul Gawande, whose recent piece in The New Yorker is a must-must-read for you and your family.

Although grim reading, my take-away from the Gawande piece was a hopeful one:  we can achieve an improvement in medical care, human dignity, and comfort and serenity through communicating more clearly among ourselves and our loved ones about the real options we face and the true goals of a patient facing perilous circumstances.  And that is where the State DOES have a role to play----the death panel issue, if you recall, was the demagogued question of whether social insurance should pay for the critical counseling that patients and their families need at these times of maximum stress and fear and minimum clarity. As it turns out, Medicare won't pay for a doc's time and efforts in this regard, but will pay for more rounds of chemo, surgeries, drugs, and weeks or months in the ICU.  No, no, no, in Red State America we don't talk about such matters nor should the Big Bad Government support end-of-life decision-making.  Better to leave it in the hands of the Almighty, right?

Here's where to find the article, well worth your time.  And please pass it along:
http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande

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