To offset the shrill cries of those opposing the health-care-reform bill's end-of-life counseling provisions, I would like to insert a calmer word: End-of-life counseling is not aimed at euthanizing grandma or, in my case, grandpa.
Counseling sessions for older individuals are not death sentences covertly signed by government agents to weed out the unfit and elderly. Rather, they provide the elderly with opportunities to discuss some other serious issues that aren't really related to end-of-life at all.
Such counseling sessions emerged in the health-care setting because older people often have chronic illnesses or disabilities and they want to know what to expect in the future and what the possible alternatives are to managing these sometimes complex and challenging medical issues.
The hard fact is that medical care for the health problems of the elderly is very costly for individuals, for health insurers, and for the medical-care system in general. These skyrocketing costs cause at least 3 harmful problems:
- Many people cannot afford health insurance.
- Elderly people often must worry a lot about the financial burden they are imposing on their families.
- Many seriously ill people cannot afford the very medications or lifestyle measures that could keep them healthy enough to avoid costly hospitalizations.
Isn't it obvious, then, that a really functional health care system--rather than euthanizing such individuals--would instead provide the assistance and advice that would help them get well, or would at least keep them well enough to stay out of hospitals, and would substantially reduce health care costs to boot?
As we grow older, we all must face the likelihood of diminishing mental capacity and the inevitability of dying. Why wouldn't we welcome an opportunity to discuss real end-of-life issues and express our own preferences while we're "still of sound mind"? The only alternative to such end-of-life counseling would be to wait until we're unable to speak for ourselves, and then leave such earth-shattering decisions to doctors and family members--those who would only be able to guess at what we wanted.
Since 1991, the Patient Self-Determination Act has been providing us with some of these very protections by requiring hospitals, nursing homes, and hospices to advise their patients, at the time of admission, of their rights to accept or refuse medical care and to execute advance directives. Advance directives are simply a set of written instructions that describe the care and treatment you want (or don't want) to receive if you should lose the ability to speak for yourself.
End-of-life counseling for the elderly, then, is not a perilous threat or hazard; in fact, it is a meaningful bonus of any health-care reform package.
In fact, these current debates about end-of-life issues might even encourage people to learn about and then prepare their own advance directives. I will discuss the content and importance of such directives in a future blog.
