Avoiding a “Death Panel” Redux

Abstract

a physician walked into my (N.P.'s) mother's hospital room and introduced himself as a palliative care specialist. I was terrified. A little more than two years before, my mother, at the age of fifty, had been diagnosed with advanced ovarian cancer. After countless rounds of aggressive chemotherapy treatments, she had enjoyed a few short months of remission before an MRI revealed the cancer had returned and metastasized to her brain. Although we were told this meant the cancer was no longer "curable," none of the physicians said anything about my mother eventually dying or even used the word "death" in any context. And I never wanted them to. As ridiculous as it sounds, I had made it my ultimate goal to protect my mom from the fact that she was dying. In an attempt to prevent the physicians from giving us any kind of prognosis, I made sure to attend all doctor visits with my mom; I knew if I were in the exam room, she would not ask how long she had to live because, ironically, she was protecting me from the same reality. Neither of us wanted to hear the gravity of our situation, and consequently, we never did. When it came to prognoses, the doctors were always silent.Despite the fact that my mother and I avoided the topic, I did not believe we were in denial about her death. I truly believed that if her death was imminent, I would have heard something about it from her doctors. So, one could imagine my surprise-and terrorupon meeting the palliative care physician that day. I cordially shook his hand, although I wanted to push him out the door and into the hallway so I could explain to him that he was not allowed to tell my mom the truth. Instead, I stood there quietly as he explained The "Advance Care Planning Consultation" would have fostered discussions about end-of-life issues with Medicare patients, but it would also have imposed a structure on them, and in the context of the costcontainment goals of the overall health care reform effort, that structure helped doom it.

Advance Directives for Older Adults in the Emergency Department: A Systematic Review

“…During that time there was an effort to include in the Affordable Care Act payment of primary care physicians for counseling on AD. 17 That portion of the law was dropped due to misinterpretation and politicization of the issue. 17 The act of counseling on end-of-life planning remains uncompensated at the time of this publication.…”

“…17 That portion of the law was dropped due to misinterpretation and politicization of the issue. 17 The act of counseling on end-of-life planning remains uncompensated at the time of this publication. A metaanalysis was not conducted due to the limited available data as well as the heterogeneity among the populations studied.…”

Does facilitated Advance Care Planning reduce the costs of care near the end of life? Systematic review and ethical considerations

“… 14 A proliferating suspicion of biased ACP conversations will erode patient trust in the process and prompt fears of undertreatment which could eventually undermine the efforts to introduce ACP into regular health care. 32 , 49 , 50 …”

“…In Australia, for example, ACP in residential homes for the elderly was funded in order to reduce hospital days for acute care. 33 Policy makers should therefore openly acknowledge the potential interference with patient autonomy and introduce safeguards to ensure the openness of the ACP process: 32 , 49 , 50 (1) make programme objectives and potential conflicts of interest transparent, (2) ensure adequate training and supervision of facilitators, (3) establish clearly defined standards for the facilitation process to guarantee its high quality and (4) educate facilitators to identify and manage conflicts of interest.…”