Saturday, July 24, 2010

The beauty of death panels

First let me say that I don't know what entity could accurately be called a "death panel" (the Supreme Court when it sends someone to death row?), but I do know what Sarah Palin meant when she said it and I'd rather use her definition anyway.

If you've been listening to NPR this week, you'll have noticed that they've talked quite a bit about palliative care. Many of you, like me, may not know what that is. Palliative care is the holistic approach to health care that takes into account a patient's psychological, emotional, and spiritual, as well as physical needs. Often this care emphasizes helping a patient feel better (holistically) rather than curing the patient (it's usually used in cases where a cure is doubtful). 

So, instead of shipping grandma off to the hospital and pumping her full of drugs until she's drooling and wetting the bed just to keep her alive for an extra six months, palliative care might send her to a hospice instead (hospice care is a type of palliative care) where she is made comfortable and allowed to settle into the idea of death without the frantic attempts of extending her life.

The idea here is dignity and dying a good death rather than drawing out the process into an ugly experience that leaves families gasping emotionally.

But, there's another huge benefit to palliative care: it saves loads of money.

For those of you who followed the health care debate (or tried to avoid it, but were ambushed every time you turned on the TV or opened the newspaper), you know that the cost of health care was one of the things that both drove the need for reform and set the parameters of the debate.

Simply, we're spending too much on health care. And much of that expenditure comes in the very last part of life (unusually in the form of heroic treatments that have very predictable and negative outcomes). In fact, according to this article from the Journal of the Royal Society of Medicine, 10-12% of all our health care dollars and 27% of Medicare dollars are spent on a patient's last year of life.

Palliative care enthusiasts (a group I now find myself in) insist that all this money is going to care that isn't helping the situation anyway.

There's quite a lot of debate out there about how to cut down on this. The article that got the most attention was a piece in Newsweek entitled "The Case for Killing Granny."

The health care reform bill originally contained a measure that would provide funds for voluntary end-of-life counseling that would discuss options like palliative care. It was these counseling sessions that Sarah Palin called "death panels." However, it was also these counseling sessions that John McCain and Sarah Palin supported during the 2008 presidential campaign. So, similar to her position on Alaska's "bridge to nowhere," Palin was "for it before she was against it."

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