End-of-Life Discussion—Age with Dignity and Make Your Wishes Known

Mention the term end-of-life discussion to a group of seniors, and you’re going to get some strong reactions. No wonder, with all the connotations this term has taken on in recent years.

An end-of-life discussion in past decades may have centered primarily on getting one’s financial and family affairs in order before waiting for the inevitable.

end of life discussionOver time the discussion took in living wills, power of attorney, extraordinary measures options, and more. But in the current age of legalized physician-assisted suicide in three states and possibly counting, to some people, talk about end-of-life discussions conjures up images of so-called death panels and overreaching or unscrupulous doctors stepping in to decide when it may be time to pull a plug or administer a lethal injection.

As clinical psychologist and author Janis Abrahms Spring points out in her June 24, 2012 letter to the editor in The New York Times, the Affordable Care Act originally contained a proposal for Medicare to cover end-of-life discussions between doctors and patients. As reported in the Times on Jan. 4, 2011, that proposal was pulled by the Obama administration due to concerns, including those expressed by former Republican Vice Presidential candidate Sarah Palin and current Speaker of the House John Boehner, that end-of-life planning with physicians was likely to encourage “death panels” and lead the nation “down a treacherous path toward government-encouraged euthanasia.”

Also in January of 2011, Forbes, in a piece titled The Logic of End-of-Life Counseling, suggested that opposition to Medicare-covered end-of-life discussions “comes from folks who fret about a dystopian future where cost-conscious doctors or insurance companies or bureaucrats render judgment about which old people live and which ones die.”  Although I agree with much else in the article, that statement seems a gross oversimplification. There are many people who legitimately are concerned about the possibility of public funds being funneled to consultations between patients and doctors involving talk of assisted suicide options. Many people are concerned about the American medical profession possibly taking steps contrary to the expectations and oath it has been called to uphold for generations, and in my view the Forbes characterization is unfair to them.

With that said, I support end-of-life discussions between patients and doctors whenever possible and appropriate. However, I do not believe those discussions should ever involve a doctor going over suicide options with a patient—and for that reason I will say nothing in this piece to suggest end-of-life discussions should include discussion of physician-assisted suicide options of the sort considered allowable under Oregon, Washington State, and Montana law.

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