Recently there’s been alot of debate about what will be included in the Health Care Reform Act that’s due to be passed sometime this year. In some Catholic circles the debate has centered around the inclusion of taxpayer-funded abortion and euthanasia. Yes, you read me right, some would have you believe that buried in the massive bill currently before Congress, H.R. 3200, is a sinister plot to euthanize our elderly (anyone on Medicare).
Where did this get started? Well, as part of this massive bill, there would be a requirement for anyone on Medicare to meet, in 5-year intervals, with a qualified person (physician, nurse practitioner, or physician’s assistant “who has the authority under State law to sign orders for life sustaining treatments” [p. 428]) and discuss advanced directives. “Do not resuscitate orders” as some would call them. But, this is not a mandate telling Medicare patients they must sign anything saying that they want doctors to just stand around and let them die. Far from it. The bill simply mandates a CONSULTATION about end of life issues and directives. No decisions will be made except by the Medicare recipient him/herself.
“The level of treatment indicated … may range from an indication for full treatment to an indication to limit some or all or specified interventions…” [p. 430]
Clearly, as stated in this bill, the Medicare recipient can choose full treatment, including ventilators, tube feeding, etc. or he/she can choose “do not resuscitate” or anything in between.
Hardly government-mandated euthanasia.
Whether this is needed is what should be debated. I think it’s a good idea to inform people about all the options in end-of-life care ahead of time, when a person is of sound mind and body. This is the best time for a person to make the decision about what would happen if they ever got to a point where their wishes could not be communicated. This, at the very least, gives the family peace of mind knowing what Mom’s or Dad’s (or Grandma’s or Grandpa’s) decision would be in that situation. And, because the consultation is every five years, the patient can review their decisions periodically and make any changes necessary. (The consultation can also take place more often than 5 years depending on when the patient feels a review is necessary.)
Advanced directives I believe are a good thing. And, would’ve been helpful when my father was in a nursing home.
A personal story: When my father was in a nursing home back in the early 1990s, he developed an infection in his lower leg. Eventually the doctors said that the leg would have to be amputated. My father for years increasingly had trouble walking and feared the loss of his legs. He repeatedly said that he would rather die than have his legs amputated. My father was dying at this stage. He had been having mini strokes for three years prior, and a larger stroke that paralyzed him a couple of months before. He was bedridden 24/7. His pulse was so weak in one of his arms, the paramedics that took him to the hospital could not even get a pulse. Considering all this, and especially my father’s wishes not to have his leg amputated I decided against the amputation and for keeping him comfortable until he quietly passed naturally. The doctor threatened to take me to court to force my father to have the surgery. My cousin convinced me to let the surgery happen, saying that there would be no medicines that would lessen the pain of the infection and dying from the infection would be worse. My father’s leg was amputated. Surprisingly, my father survived the surgery. A week later, I got a call from a doctor’s office saying I had to take my father to his office so he could fit my father with a prosthetic leg. I couldn’t believe it. They wanted to fit a dying man, a man that’s been bedridden for months with a prosthetic leg! I refused. The doctor let that slide. A couple of weeks later the wound from the surgery got infected. Shortly after that my father died of a massive stroke and septicemia.
Another personal story: my father had to deal with end-of-life issues for a loved one too. In 1974, at the age of 38, my mother lay dying in a hospital room, on a respirator. My father begged the doctors to take her off the machines, but they refused. She lingered like that, breathing just once every minute or so, for weeks (or maybe it just seemed like weeks to her loved ones) before her heart stopped.
No one should have to fight with doctors to deny unnecessary procedures to dying family members. Granted, end-of-life care has gotten more humane since these incidents, as evidenced by my aunt’s last days in hospice in 2002. However, it’s unnecessary, costly medical procedures like the ones mentioned in my personal stories that President Obama and whoever drafted the provision for the consultations wants to avoid, or at least minimize.