Since we at Yo San are all members of the health care team, it is important to get a correct perspective on the end of life discussion that occurs between the patient and their doctor. The true content of ‘the end of life discussion” has unfortunately been referred to by many politicians as “the death panel” discussion.
It was not too long ago that the public discussion of sex and death was taboo. Just as the Kinsey Report (1950’s) and Masters and Johnson’s (1960) work on the “Human Sexual Response” elevated the study of human sexuality to a legitimate topic, Elisabeth Kubler-Ross’s “On Death and Dying” (1969) set a precedent for an honest discussion of death with terminally ill patients. Prior to this, the physician was often given complete control on whether to tell a patient if he or she was dying. Many physicians were prompted by the family not to tell the patient or opted not to tell a patient in order to keep the patient from worrying. The results of this type of treatment can be read in Tolstoy’s famous novella on “The Death of Ivan Illyich”, where Ivan’s many physicians and family conspired to reassure him that he was ok in spite of the fact that he was feeling worse and was, in actuality, dying.
The practice of modern medicine protects us from this type of mistreatment and misinformation. It is now unethical for a physician to withhold information from his or her patient unless that patient wishes otherwise. This means that patients must be included in the decision making at this critical point in their lives. This requirement, to make the patient the center of this process, has prompted the end of life discussion to be done at an earlier time, when a patient is getting older but may not be terminally ill.
The end of life discussion is in fact a duty of the personal physician. The irony of this duty is that rather than being a “death panel”, it actually insures that when the final hours come, the wishes of the patient will be respected and carried out. This important responsibility often requires several visits and a significant amount of time in order to help the patient decide what he or she really wants in the event of different possible scenarios.
The discussion of these circumstances would include questions such as: If you are terminally ill, do you want everything done, including extended life support? If you cannot make decisions for medical care, whom do you want to designate to make them for you? Whom do you want to handle your financial affairs if you are incapacitated? The result of these all significant questions are recorded in the medical chart, which is a legal document that gives the power to the patient.
Physicians do this now as a matter of duty. The reason for the “death panel” deception was that there was a proposal to specifically reimburse physicians for this time as part of the new health care law. The truth is that physicians will do this anyway, whether they are reimbursed or not, because it is the right thing to do.