Perhaps it’s because I recently lost two friends to ovarian cancer. Both received palliative care at home through a hospice before finally dying. Perhaps it’s also because I recently went through complex major surgery to remove a tumor, followed by innumerable complications that made me question whether I was going to survive all of it.
In any case, I was so pleased to read recently that as of January, Medicare will be authorized to pay doctors for consultations with patients on how they want to be cared for as they are dying. This is a step that was initially proposed in 2009 but was politicized at the time and labeled “death panels.” In July this year, when the proposal was raised again, no one flinched.
Most people who have reached middle age know that they need to write wills and express any other wishes in writing. Especially if they have been ill and hospitalized at some point, they know to sign medical directives, declaring their wishes to be kept alive with all means possible, or not. But not everyone has thought out what it would be like if they die slowly. We all imagine that we’ll be lucky enough to die peacefully in our sleep. But as we live longer and more of us are diagnosed with diseases such as cancer that take our lives slowly, we need to broaden our thinking.
I am well aware that most people will do everything to avoid imagining their slow demise. But an increasing number of us have no choice. So we are deciding whether we want to die at home or in a hospital or hospice. We are choosing not to prolong our lives with treatment that may be painful and not even successful.
But do we really know what all of our choices are? The American Medical Association and the American Hospital Association both support these newly authorized “end-of-life” consultations with doctors. The patients choose whether or when to have these consultations. They can choose to know their options even before becoming ill, or after they receive a serious diagnosis. Then they can decide whether and how they would like to be kept alive if they become too ill to speak their wishes later.
According to the new directives, Medicare will pay $86 for the first 30 minutes of “advance care planning” in a doctor’s office. For an additional 30 minutes, doctors would be paid $75.
Like my friends, I already have a pretty good, though general, idea of what I want as disease no longer renders treatment worthwhile. However, I still believe I would learn something from having the discussion with my doctor.
My only question at this point is whether doctors have been trained sufficiently to know all the options available, and whether – after fighting to keep their patients alive – they would be comfortable having these “end-of-life” conversations.
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