Some opponents of the House bill have
expended great energy and resources in recent weeks to convince seniors
that this provision will somehow result in government-sponsored
euthanasia.
We have seen the volatile response to these allegations at town hall meetings across the country.
This argument is completely false. This provision simply provides for
Medicare to pay for voluntary conversations between patients and their
health care practitioners on the difficult but important subject of
planning for care at the end of life.
The provision is purely
optional, and patients would be able to choose whether to discuss the
issue with their practitioners. For those who decide to do so, there
would be clear benefits.
These discussions can include where a
person wants to receive care and how physical needs, including pain,
are to be managed. The merits of broader health care reform legislation
aside, there should be no controversy about the benefits of end-of-life
care planning discussions. According to a 2008 study in the Journal of
the American Medical Association, these discussions have been proven to
improve patient care and quality of life.
Confronting the prospect of death
isn't easy for anyone. So perhaps it's no surprise that few people talk
with their doctors, nurses or loved ones about their wishes for
end-of-life care. Surveys show that only 13 percent of Americans have
established a living will laying out their desires for treatment near
death, and shared it with their medical teams.
We discuss
end-of-life care with patients to fulfill our commitment to them
throughout the course of their care. When a disease cannot be cured, we
can assure our patients that we can make them comfortable in their last
days. When these conversations are done in advance and done well,
everyone benefits -- patients, families and all members of our care
teams.
As practitioners, we know from experience that
discussions with patients in the end stages of their cancers and with
their family members may be long and emotional, but ultimately lead to
end-of-life care centered on the patient's wishes. We have seen many
patients who were well-cared-for by their families, with professional
help, and were comfortable in their surroundings.
We know,
through research and through our own experience, that patients who have
discussed end-of-life care make better-informed treatment decisions,
experience less pain and depression, and fare better overall.
At some point, we all will need to make decisions about care at the end
of life. Whether ill or not, every American should think ahead about
the kind of treatment they want, discuss their desires with their loved
ones and their doctors and nurses, and develop living wills to document
their wishes.
A new Medicare
benefit that acknowledges the value of end-of-life conversations
between health care practitioners and patients is long overdue and
should be included in any health care reform bill. It is good medicine
and improves the lives of patients -- exactly what policymakers say
they are looking for in health care reform. More importantly, it would
help all Americans live their final days with dignity and in accord
with their own wishes.
The opinions expressed in this commentary are solely those of Douglas W. Blayney and Brenda Nevidjon.
Editor's note: Douglas W. Blayney, MD, is president of the American
Society of Clinical Oncology and professor of internal medicine at the
University of Michigan. He specializes in the treatment of breast
cancer and lymphoma and was in private practice for 17 years in
California. Brenda Nevidjon, RN, is president of the Oncology Nursing
Society and clinical professor of nursing at Duke University School of
Nursing. She was the first nurse and first woman to be chief operating
officer of Duke University Hospital.