We need to talk more about… dying.
No, that’s not much of a conversation starter, but Americans have long existed in a state of denial about the inevitable.
A national nonpartisan panel of medical, legal and religious leaders concluded in a report released last September that “The experience of dying in the United States is often characterized by fragmented care, inadequate treatment of distressing symptoms, frequent transitions among care settings and enormous care responsibilities for families.”
In short, dying in America is often more painful than it has to be.
However, starting later this year Medicare will begin reimbursing doctors, nurse practitioners and physicians assistants for conversations with patients about their end-of-life care so they can make their wishes known.
Dr. Alvin Moss, a kidney specialist and director of WVU’s Center for Health Ethics and Law, supports Medicare’s decision. “I think this is a good thing,” Moss told me on Talkline Monday. “These conversations are not happening now… there is a conspiracy of silence.”
That leads to confusion, pain and suffering for many at the end of life, especially when patients are too sick to speak for themselves and family members are uncertain or conflicted about their loved one’s desires to, for example, be kept alive through a feeding tube or on a ventilator. What kind of palliative care is available?
Moss believes paying doctors to consult patients on end-of-life care means more will do it, but “the bad news is that most surveys show they don’t know how to have the conversation. It has not been part of standard medical school training.” (Moss says, however, that WVU’s medical school has included end-of-life training for students for a decade.)
End-of-life planning was originally included in the Affordable Care Act, but pulled out because of fears the federal government was creating “death panels” that would decide when patients were too sick—or too expensive—to treat. And the National Right to Life organization opposes the proposed Medicare changes, fearing patients could be pressured to refuse potentially life-saving treatment.
But what we are talking about is training and encouraging health care providers to have honest conversations with their patients who are then more empowered to make decisions about how they want to be treated as death approaches.
The passing of a loved one causes heartache for those left behind. Nothing can change that. However, better end-of-life planning means individuals can have greater control over their care decisions, and family and friends can be comforted knowing their loved one’s final wishes were honored.