Health

End Of Life Advocates Work To Overcome 'Death Panel' Claim

OPB | Oct. 14, 2009 1:48 a.m. | Updated: July 17, 2012 1:09 a.m. | Portland, OR

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By Colin Fogarty

The fervor over "death panels" has receded in the national debate over health care. But end-of-life experts are still smarting over accusations that one plan in Congress would lead to "government-encouraged euthanasia."

The provision would reimburse doctors for discussing advanced medical planning with their patients. It was dropped because of the political distraction it created.

These conversations are already common in the Northwest.

Colin Fogarty explains end of life experts from the region are convinced provision that should be resuscitated.


Gina Cushow is at her introductory check up to Medicare.

She just turned 65 and feels spry. But Doctor Elizabeth Eckstrom takes this chance for a discussion about what happens when Cushow turns frail or faces a serious illness.

Elizabeth Eckstrom: "And I think it works best to do that in a time in life when you're healthy, happy and fully capable of making your own decisions and we don't have to guess about what your wishes and values might be."

Gina Cushow: "You know, I'm really happy that we're doing this, because it's really important for my family…."

With that, Eckstrom gently explores a series of questions: Who do you want to make medical decisions for you if you can't do so yourself? Say an accident leaves you brain dead. What kind of extraordinary medical care do you want? Cushow listens carefully and raises questions of her own.

Gina Cushow: "As I get older and I might have more problems I might want to change it. So the procedure that for that would be…?"

Elizabeth Eckstrom: "We just fill out the forms with the new values, the new choices you would make."

That future conversation is one Eckstrom says she would have regardless of whether it's covered by insurance. But a tiny section of the mammoth House health care bill would allow Medicare to pay doctors to have that conversation every five years. It would not create any "death panels."

Jon Keyserling: "I've only got 30 something years of legislative experience. And I've never see a more blatant misrepresentation of legislative language."

Jon Keyserling is with the National Hospice and Palliative Care Organization, which lobbies on end of life policies in Washington, D.C..

He acknowledges the amendment in question would have some impact on the health care economy. If more Americans forego some aggressive medical interventions at the end of life, it could save the system money. But Keyserling of Hospice says that's not the point.

Jon Keyserling: "The patient autonomy really drives this side of the equation."

And that's why support remains high in Congress to expand Medicare coverage of end of life conversations between doctors and patients. That's according to Portland Democrat Earl Blumenauer, who's a co-sponsor the amendment

Earl Blumenauer: "Other than the death panel lie, there is no substantive argument against it."

Nonetheless, one survey by the Pew Research Center for the People and the Press showed that 86 per cent of Americans had heard about "death panels." Blumenauer thinks in the end it there could be a silver lining.

Earl Blumenauer: "Ironically, even if it doesn't get in the final bill, and I'm working to keep it in there, it's a made a big difference in people taking advantage of living wills, advanced directives, getting down and making sure that they're not leaving it to chance."

Beyond advanced directives, doctors in Oregon, Washington and Idaho use a standardized form to make sure patients who don't want extraordinary medical interventions don't get that. It's a bright pink form known as the POLST, or Physicians Orders for Life Sustaining Treatment.

Susan Tolle: "It works extreme well. The problem is its not always there."

Doctor Susan Tolle with the OHSU Center for Ethics says surveys of EMT's have shown that about a quarter of the time, patients can't find their form in an emergency.

Susan Tolle: "People really don't want it on their refrigerator at home where the EMTs will find it because every time they get the milk or a neighbor gets a beer, they're looking at their POLST form."

So Tolle is organizing an effort to make Oregon the first state in the nation to digitize end of life medical orders. It would allow EMT's to contact a call center to find out within minutes what to do.


On the web:

http://www.ohsu.edu/polst/

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