Wednesday, November 4, 2009

A Tale of Two Deaths

Proposed health-care reform legislation includes a provision that allows Medicare to pay for "end-of-life" counseling for seniors and their families who request it. The provision -- which Sarah Palin erroneously described as "death panels" for seniors -- nearly derailed President Obama's health-care initiative. Some Republicans still argue that the provision would ration health care for the elderly.

Does end-of-life care prolong life or does it prolong suffering? Should it be a part of health-care reform?



Two women with the exact same diagnosis are brought to the hospital to seek treatment. Both seek the best possible outcome for their illnesses: comfort from the pain. Both women are in their 80s, and both have lead wonderfully full and rich lives. The people around these women understand that this illness will most likely claim their lives.

One woman is counseled by doctor upon doctor about the medical options before her, yet no one seems to be talking about what they all know is coming, the big elephant in the room, death. So, she takes their lead and undergoes painful tests and surgeries that cost thousands and thousands of dollars, only to die a few months later, in a hospital bed, bruised and battered, without ever fully acknowledging her death.

The other woman comes to the hospital and is met with a team of care specialists who discuss the situation in a holistic way, showing her the realities of her illness and the opportunities for growth in these final days. The woman is able to return home and be surrounded by her comforts and her family. She dies having come to terms with her death, comfortably and safely.

Unfortunately, only one of the previous scenarios is the norm in this country, the first one. And even more unfortunate, our Medicare system only pays for the first one unless there is proof that the person is dying, and that proof involves those uncomfortable conversations that most people avoid, those conversations that should be guided by a trained professional in the field of counseling.

We as a society are so terrified of death and dying that we avoid any and all conversations that bring our mortality into the forefront. Case in point, most seniors or terminally ill patients have not explicitly decided their end of life wishes so the responsibility falls on those who love them the most, those who feel they must do everything they can to keep their loved ones alive.

It is common knowledge that the majority of medical costs in a person’s life are accrued during the final months of their life which shows that people are entering into this precious moment without any guidance or support. If we as a country are willing to provide counseling for those who are mentally ill, why are we denying those who are terminally ill from the necessary benefits of counseling?

During an internship at a congregation, I had the opportunity to make the rounds in the hospital as a pastoral chaplain, and the common concern I heard from the people who were ill was “I don’t know what’s happening to me.” This concern is one that involves the spiritual, emotional, and physical well-being of the patient. We must begin to treat people who are nearing their final moments with the dignity they deserve. End of life counseling is a right every person should have so that they can choose how they would like their final days. At this point, we are denying them that choice, and that’s downright terminal.

1 comments:

Jason said...

Thank you, Rachel.

Issues like this always bring up the most personal of our histories, it seems, and that's how it should be. Unfortunately, some people (myself included) will forever know this team of holistic care specialists as "death panels," thanks to the seemingly never-ending relevance of the incomparable Sarah Palin.

But they were most certainly a panel of life when it came to my mom. She was offered counseling as her Alzheimer's-ridden mind began to waste away - and when she stopped comprehending entirely, the team went to my dad to continue the conversation.

My mom died a gut-wrenchingly drawn-out death, but we were given the opportunity to understand that she was, in fact, dying. And the "life panel," along with the entire hospice team where she lived for her last two years, were some of the most caring people I have ever met.

All of this is to say: I agree, my friend. We have no concept of what it means to die with dignity in this society. And yet those who die have a dignity that is deep and exquisite, and should never take a backseat to profit and "medical options."

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