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Thursday, August 13, 2015

Are 'death panels' coming back?

Obama and I have our differences, but when it comes to end of life care we seem to see eye to eye. I think.

It is simply a fact that doctors need to (er, should) have that talk with their patients regarding end of life care. Doctors must (should) explain end of life care, and must have patients fill out advanced directives.

The difference Obama and I have regarding this matter is how such a directive should be enforced. I tend to agree with men like Thomas Jefferson, James Madison, James Monroe, and Grover Cleveland, that such matters should be dealt with by the states and not the federal government.

I bring this up because of an LA Times article titled "Obama Administration Revives Plan Once Criticized as Death Panels."  If the government gets to decide who lives and who dies, then I'm out.  If the government gets to decide that a 90 year old grandma cannot get the pacemaker she needs and wants, then I'm out.  If the government decides who lives or dies, I'm out.  This is unacceptable in my book. This is the end of the slippery slope I think conservatives are worried about, and how terms such as "death panels" came about.

If the government is just doing this to save money, then I'm definitely out.  When it comes to saving lives, money shouldn't matter. Human life is more precious than anything else on earth, even the earth itself.

However, if the goal is noble, then I'm all in.  If the goal is to get people to make smart decisions about end of life care, then I'm in.  I see too many people who want chest compressions and intubation who have no idea what that means.  Too many people get it all when they shouldn't.  I mean, I certainly don't want to be pounding on grandma's chest.  If that's what grandma wanted, I'm fine with that. But a responsible doctor would have at least had that talk with her at some more (hopefully by choice and not by mandate).

So, it should be grandma's decision and not Uncle Sams.  The government should have no say in who lives or who doesn't.  And I certainly don't think the government should even get involved in this.  They should not even offer negative incentives, such as they do with reimbursement criteria (if you don't do this we're paying you less.  Negative reimbursement is basically a nice way of saying you have to do it or else. There really isn't much of a choice there.

Still, I think it's a noble cause if it's done right.  It's a noble cause if there's an educational campaign that goes on, and not an Uncle-Sam-is-going-to-force-you-to-do-this-and-everyone-over-the-age-of 70-will-now-be-a-DNR-campaign.  I think doctors should be encouraged to talk to their patients about end of life care. It would be a noble public relations campaign to get into -- but it should not be a law, nor a regulation, nor a mandate.

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