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End-of-Life Politics: The View From A Hospice

For people who have spent years wrestling with the emotional complexities of caring for the dying in Maryland, the recent spasm of angry, hyper-charged debate over end-of-life issues and health-care reform has been cause for some major head shaking.

Ann Mitchell is president of Montgomery Hospice, which has cared for thousands of terminal patients. Hospice staff are contacted for almost a third of all deaths in Montgomery County, Mitchell said, and spend their time making patients comfortable and counseling survivors.

False accusations about "death panels" have baffled Mitchell. A provision in a House reform proposal would allow Medicare to pay for end-of-life counseling.

"It's not a question of denying care. It's a question of what kind of care do you want if you can't speak for yourself, which in life is kind of frequent," Mitchell said. "What is the leap to bureaucrats making decisions at the end of life? It has nothing to do with that. It was always in the law that people had a right to make an advance directive."

That could include a signed statement outlining who you would want to make medical decisions for you if you can't, or a list of which treatments you do or don't want if you lack the capacity to answer questions.

Maybe a third of Americans have the directives filled out. Advocates emphasized that they don't need to be done by a lawyer. A napkin and two witnesses will do. Or the Attorney General's office in Maryland has this model form:

MarylandAdvanceDirective

Getting Medicare to pay is a good way to get more people to have such a

conversation with their doctor, Mitchell said. (There is thoughtful dissent on the question of the House proposal, the fate of which is uncertain.)

Mitchell's own experience working in South Carolina in the 1990s pointed to the harried realities of modern medicine. The facility where she worked asked doctors whether they had complete conversations with their patients on matters such as powers of attorney or living wills. "We never got a yes," she said.

"It's very hard when you have a busy practice to talk about such an important issue without spending a lot of time. You need to tell people what this means for them, these are the implications for you as a person with this kind of disease. ...You just don't want to be quick about it," Mitchell said.

"It should be compensated for. ... If you're not paying for it, it's likely not going to happen," she added. "It's not the fault of the medical practitioner. There are just so many things you can do."

By Michael Laris  |  August 19, 2009; 5:52 PM ET
Categories:  Health Care , Michael Laris , Montgomery County  
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