By Dr. Kate Scannell, Syndicated columnist
First Published in Print: 01/09/2011
LAST WEEK, the Obama administration removed a provision from the new health care law that would have encouraged opportunities for patients to consult with doctors about life and death concerns. Under the provision, Medicare would have reimbursed physicians for time spent with patients who wanted to discuss end-of-life treatment and voluntary advance care planning during their annual wellness visits.
Thank goodness -- and Sarah Palin -- that the Obama administration had the timidity to withdraw such a ridiculous provision. Really, why would any mortal being ever want to talk about ... being mortal? Why would anyone ever want to document their own preferences to guide their future medical care when they became unable to speak for themselves?
Besides, whoever heard of a dead person complaining about the insurers and medical personnel who took charge of their health care during their final hours or months within an ICU?
Clearly, it is better to allow our dying process to arrive as one big surprise party for all concerned. Better to plan it in the moment of its making, with the doctors and friends and family members who just happen to be present at the time. When we become too ill to decide about our own care, we should be able to lie back and relax within the warm caring hands of modern medicine that always act in accordance with our highly personalized best interests. Let family and friends advise the doctors about the care we should receive -- they are always in cheery agreement about that.
Besides, why bother a harried doctor now with niggling concerns about a future "problem?" Our doctors are already overwhelmed with managing our blood pressure, cholesterol, diabetes, AIDS, heart disease -- all the stuff that must be controlled in the moment if we hope to forestall our . . . . Oops! -- almost mentioned the "D" word.
And yet, some of us will insist on instructing doctors about how to respond to our -- uh, "un-living" process -- within guidelines of our own choosing. Some of us will want to make sure that doctors know which family and friends should be authorized -- or eliminated -- as candidate spokespersons for us when critical medical decisions must be made during times of our incapacity.
For those insistent people, it's advisable to keep "advance care planning counseling" on the problem list they bring to the doctor at each annual visit. Because you never know -- one year, you and your doctor may have addressed every other important health issue on that list and have nothing else to discuss within your 15-minute visit. Voila! Seize that moment!
Still, no matter what balance of time remains, you will need to talk fast and efficiently with the doctor. To be prepared for that opportune moment -- should it ever come -- it would be wise to study beforehand, to get a sense of what realistically happens when someone begins to un-live. That will allow you to hone some decisions or questions about your future un-living. The best advice? Watch as many prime-time cop shows, Hallmark specials and medical dramas as you can.
Additionally, this will offer a more entertaining educational venue about un-living than any real doctor could ever provide. While watching characters un-live, note which scripts -- and, perhaps, background music -- most appeal to your deepest sensibilities.
I realize that for many people, the term "unliving" now more readily associates with thoughts about zombies. The current flood of zombie-themed movies, TV shows and books reflects our burgeoning cultural fascination with these unliving (and also undead) beings. And considering our culture's hallmark inability to speak frankly about mortality, this trendy zombie allure makes wholly resonant sense.
As the adage goes, once again, art imitates life -- or, at least, something life-like about us.
In the end, who can really blame the Democratic administration for running scared -- perhaps, of zombies -- and withdrawing support for a patient's right and opportunity to discuss with doctors something as trivial and untrendy as "dying?" Who can criticize the Republicans for their refusal to aim a fire hose at conflagrations of political speech fueled by self-serving delusions of death-panels? Addressing the painful reality of human mortality can be a major distraction for any politician.
I don't know. ... Maybe we'll witness robust bipartisan cooperation with the new Congress, and both parties will vote to ban death so that Americans need never speak of it again. We could become a nation of zombies.
But for now, we are left with a dehumanizing politicization of dying that robs us of a simple but crucial means of obtaining some comfort and solace in our very real and inevitable encounter with death.
––––––––––––––––––––––––-
Kate Scannell is a Bay Area physician. Her new book is "Flood Stage."
© Copyright 2011, Kate Scannell
First Published in Print: 01/09/2011
LAST WEEK, the Obama administration removed a provision from the new health care law that would have encouraged opportunities for patients to consult with doctors about life and death concerns. Under the provision, Medicare would have reimbursed physicians for time spent with patients who wanted to discuss end-of-life treatment and voluntary advance care planning during their annual wellness visits.
Thank goodness -- and Sarah Palin -- that the Obama administration had the timidity to withdraw such a ridiculous provision. Really, why would any mortal being ever want to talk about ... being mortal? Why would anyone ever want to document their own preferences to guide their future medical care when they became unable to speak for themselves?
Besides, whoever heard of a dead person complaining about the insurers and medical personnel who took charge of their health care during their final hours or months within an ICU?
Clearly, it is better to allow our dying process to arrive as one big surprise party for all concerned. Better to plan it in the moment of its making, with the doctors and friends and family members who just happen to be present at the time. When we become too ill to decide about our own care, we should be able to lie back and relax within the warm caring hands of modern medicine that always act in accordance with our highly personalized best interests. Let family and friends advise the doctors about the care we should receive -- they are always in cheery agreement about that.
Besides, why bother a harried doctor now with niggling concerns about a future "problem?" Our doctors are already overwhelmed with managing our blood pressure, cholesterol, diabetes, AIDS, heart disease -- all the stuff that must be controlled in the moment if we hope to forestall our . . . . Oops! -- almost mentioned the "D" word.
And yet, some of us will insist on instructing doctors about how to respond to our -- uh, "un-living" process -- within guidelines of our own choosing. Some of us will want to make sure that doctors know which family and friends should be authorized -- or eliminated -- as candidate spokespersons for us when critical medical decisions must be made during times of our incapacity.
For those insistent people, it's advisable to keep "advance care planning counseling" on the problem list they bring to the doctor at each annual visit. Because you never know -- one year, you and your doctor may have addressed every other important health issue on that list and have nothing else to discuss within your 15-minute visit. Voila! Seize that moment!
Still, no matter what balance of time remains, you will need to talk fast and efficiently with the doctor. To be prepared for that opportune moment -- should it ever come -- it would be wise to study beforehand, to get a sense of what realistically happens when someone begins to un-live. That will allow you to hone some decisions or questions about your future un-living. The best advice? Watch as many prime-time cop shows, Hallmark specials and medical dramas as you can.
Additionally, this will offer a more entertaining educational venue about un-living than any real doctor could ever provide. While watching characters un-live, note which scripts -- and, perhaps, background music -- most appeal to your deepest sensibilities.
I realize that for many people, the term "unliving" now more readily associates with thoughts about zombies. The current flood of zombie-themed movies, TV shows and books reflects our burgeoning cultural fascination with these unliving (and also undead) beings. And considering our culture's hallmark inability to speak frankly about mortality, this trendy zombie allure makes wholly resonant sense.
As the adage goes, once again, art imitates life -- or, at least, something life-like about us.
In the end, who can really blame the Democratic administration for running scared -- perhaps, of zombies -- and withdrawing support for a patient's right and opportunity to discuss with doctors something as trivial and untrendy as "dying?" Who can criticize the Republicans for their refusal to aim a fire hose at conflagrations of political speech fueled by self-serving delusions of death-panels? Addressing the painful reality of human mortality can be a major distraction for any politician.
I don't know. ... Maybe we'll witness robust bipartisan cooperation with the new Congress, and both parties will vote to ban death so that Americans need never speak of it again. We could become a nation of zombies.
But for now, we are left with a dehumanizing politicization of dying that robs us of a simple but crucial means of obtaining some comfort and solace in our very real and inevitable encounter with death.
––––––––––––––––––––––––-
Kate Scannell is a Bay Area physician. Her new book is "Flood Stage."
© Copyright 2011, Kate Scannell