Ano is a Justmeans staff writer for health, and an instructional designer for the newly created Master of Health Care Delivery program (mhcds.dartmouth.edu) at Dartmouth College. Ano brings over a decade of evidenced-based health research and writing, and a Masters of Public Health from Dartmouth Medical School to the Justmeans Editorial section. Special interests include health policy, conflict ...
Why True Conservatives Should Support 'Death Panels'
There was a time when being politically conservative in the US meant that you endorsed the primacy of individual preferences and values (within the logical confines of the law.) Alas, those days seem to be over, at least in health care. Why else would political conservatives rally against rules that would incentivize doctors to inform patients about the choices they faced at the end-of-life?
Specifically we are talking about treatment choices for situations when there is no clearly superior option, specifically the time when the patient's own preferences and values should be the determining factor in what course of treatment is taken, or not taken. This process of empowering patients to exercise their self-determination over the manner in which they face their final days is what morphed into 'Death Panels' once uninformed politicos entered the debate.
It is truly beyond comprehension to anyone who understands the complexity of health care decision-making, the need for supporting more informed patient decision making, or anyone who has ever faced a difficult health decision where there was no clearly beneficial choice. These choices don't just exist at the end of life, though since we will all face that eventuality it is perhaps the most ubiquitous. In breast cancer there is the choice between lumpectomy and radiation versus mastectomy: Neither choice is clearly superior at lengthening your life, so the decision is best left to the patient. In fact, only an informed patient can make the "right" treatment decision, based on her values and preferences. There is the question about whether to treat benign prostatic enlargement: A man must balance the current urinary discomfort he faces against the risk of future sexual side effects. There is no clearly good choice, it is up to the informed patient to make the 'right' choice based on his own values and preferences. And there are a host of other decisions, sometimes called 'preference sensitive' care decisions.
At the end-of-life we often do many things that cause great discomfort, and erode the dignity of the patient, but do nothing to improve their survival or quality of life. In such cases, when heroic efforts may only prolong life for a short time, or may require sacrifices to quality of life, it is up to the patient to decide the best course. Naturally these are difficult decisions, that must be approached ahead of time, and with patience. They take time. Lots of time. They take time for the patient and the doctor. And hence the idea that doctors should be reimbursed for taking the time necessary to clearly explain to patients and their loved ones what choices loomed ahead. A necessary step to inform patients about the choices they have, and to help them make end-of-life decisions that best fit the patient's, not the practitioner's, personal values and preferences. It was that educational experience meant to overcome avoidable ignorance and restore some dignity and choice to the process of dying that was labeled 'Death Panels.'
And that's why anyone who believe they are a true conservative should support death panels: They seek to empower the individual to make health care decisions that best reflect their own values and preferences.
Ironically the political left has also chosen to give into avoidable ignorance and give up on fighting for dignified, rational, reasonable, compassionate care to those who need it most. A rule passed by current Medicare head Don Berwick that would have paid doc's to inform their patients about end-of-life choices was overturned by the Obama administration after only a few weeks.
Isn't the idea of informed patient choice supporting individual preferences and values when no clearly beneficial choices exist clearly a conservative value?
Isn't it also a value worthy of support from the political left?
Completely off the mark? Let me know!