Debate Misses Point of End-of-Life Counseling

As a doctor specializing in palliative care and hospice, I'm disheartened to see how end-of-life counseling was twisted into something sinister and untrue, then ultimately dropped because it was deemed too divisive.
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Aside from the outrageous talk about death panels and killing grandma - talk that reasonable people recognize as a distraction with no basis in fact - the debate about Medicare coverage for end-of-life counseling has completely missed the point about this important provision. The goal is to encourage individuals, their families and their doctors to think and talk objectively about end-of-life options and wishes while they're healthy, clear headed and not in the midst of a medical crisis.

The whole discussion so far has been framed in the context of people with a poor prognosis suddenly having to make life-and-death choices about their medical treatment. This is exactly what end-of-life counseling seeks to avoid.

As a doctor specializing in palliative care and hospice, I found it exciting to see the provision because it would make it more likely that people would start having these conversations in a neutral and non-threatening setting - long before they needed them. And, I'm disheartened to see the way this concept was twisted into something sinister and untrue, then ultimately dropped because it was deemed too divisive.

In my professional life I routinely see patients in crisis who have never talked with their doctors or family members, or even thought about how they want to manage a life-threatening illness.

And then, in my personal life, I suddenly became an example of how easy it is to put off those conversations until a crisis hits.

Last summer, I sat in the preoperative holding area in one of those silly gowns they give you in hospitals, waiting for surgery for my newly diagnosed ovarian cancer. In my lap was a copy of the "5 Wishes" advance directive and I was hurriedly going through the scenarios with my husband. Like the shoemaker's children who went without shoes, I had never actually completed an advance directive. I had lectured and I had educated others, but I had never put pen to paper for myself. Luckily, I wasn't in a car accident on I-95 that left me in a coma, but instead had 48 hours between my diagnosis and my surgery - enough time to grab the form from my home office and take it with me to the hospital.

In addition to seeing patients, I'm the president of a professional organization of palliative and hospice doctors. Until recently, we took care of our patients without much attention from politicians or the public. The health care debate has brought us out of the shadows, which is good, but it has also advanced inaccurate information that can frighten away people who could most benefit from our care. We have a Web site: It contains no buzz words, hyperbole or political debate. It just clearly and simply presents the facts and can help you frame the questions you'd like to discuss with your doctor. Visit the site. Then make an appointment today to discuss your health care goals with your doctor.

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