Toxic debates offer no cure

By Terry Plumb

An unexpected benefit from a recent trip to Africa was respite from the hateful hoo-hahing that's undermining discussion of the U.S. health care system.

Indeed, not much about American politics seems meaningful on a continent plagued by poverty, war, AIDS and other life-threatening issues most Americans never deal with. If I thought anyone would act on the suggestion, I would propose shipping congressmen, Cabinet officers and cable bigmouths to a truly deprived country. They might develop a sense of gratitude for what this nation offers and empathy for those whose views differ from theirs.

Unfortunately, the current political climate in America is so toxic that reflective discussion of core health care issues is impossible.

End-of-life questions, for example, have become a third rail. Any politician who dares suggest that physicians be required to have such talks with patients — or rewarded for doing so — immediately is accused of wanting to install gas ovens like the Nazis built at Auschwitz.

A physician I ran into at an auto repair shop recently told me he thought that health care reform wouldn't happen until this country comes to grips with dying.

As a nation we spend a disproportionate amount of health care dollars sustaining patients destined to die soon. What's worse is that the hours, days or even months that are purchased at high cost often deprive the patient of the dignity and serenity that might be possible if he weren't hooked up to machines that merely postpone the inevitable.

Washington Post columnist Charles Krauthammer has taken heat for a column in which he criticized a House bill that would reimburse doctors for end-of-life counseling. He opposes that plan, not because it would create “death panels,” as Sarah Palin would have us believe, but because he doubts the effectiveness of living wills to ensure the patient's wishes are followed.

The columnist writes: “You are told constantly how very important it is to write your living will years in advance. But the relevant question is what you desire at the end — when facing death — not what you felt sometime in the past when you were hale and hearty and sitting in your lawyer's office barely able to contemplate a life of pain and diminishment.

“Well, as pain and diminishment enter your life as you age, your calculations change and your tolerance for suffering increases. In the ICU, you might have a new way of looking at things.”

Krauthammer knows whereof he speaks. He and his family dealt with his father's dying. He says they understood his dad's wishes and weren't concerned about a piece of paper he may have signed during better days.

Were it that simple.

My sister and I were faced with a similar decision 15 years ago as our mother lay in the intensive care unit at Tampa (Fla.) General Hospital — ironically a unit where she herself had served as head nurse many years earlier.

Not only was she capable of reading and understanding her own chart, but also her internist, a longtime friend, had built his practice treating elderly cardiac patients. He told us, “Your mother and I have an understanding.” She would not want to be kept alive if it meant a life of misery, he said.

Nevertheless, when the hospital's cardiac specialist told us with confidence that he “could get her out of ICU” if he were allowed to operate, we concurred with his recommendation.

From the surgeon's viewpoint, the operation was successful. My mother left the hospital, returned home and lived for another six weeks. During that time, however, she couldn't muster the strength to read or enjoy her favorite TV shows or even call her Meals-On-Wheels clients. Because she was on Medicare, cost of those six weeks to the American taxpayer was approximately $50,000. The cost to her was infinitely greater.

It's a mistake, I think, to pooh-pooh end-of-life counseling At a minimum, a living will can give families a sense of what the patient would want.

Nevertheless, the least-rewarded aspect of our health care is the time a doctor spends with a patient.

That's not an easy problem to fix, but the current political climate isn't making it easier.