Monday, October 12, 2009

Death Panel Redux: Palliative Care Strikes Back

The hysteria around “death panels” has largely died down (no pun intended). This largely coincided with the removal of the provision to reimburse doctors for discussing end of life planning from the health care reform bill. So it was a shock to see PBS use the title “Life Panel? Death Panel?” in its most recent PBS Now series (for a quick review of the episode check out pallimed's review). I can’t recite the exact adjective-laden prose I yelled at the TV but it went something like this: “For heaven’s sake, let the death panel rumor die a natural news cycle death.  It was on its way out - why are we keeping it alive? Pull the plug on it already!!!”

Since watching the episode I have been wondering why the only time I hear the term "death panel" nowadays is in the context of blogs, advocacy groups, and news sites promoting end-of-life decision making. It turns out that the term death panel has become somewhat of a rallying call in the field of hospice and palliative care. The myth of death panels stimulated discussion about what end-of-life care should be about and what palliative care really does.  Case in point - the google news search interest in the keyword "palliative" has skyrocketed since late July, coinciding with the introduction of the term "death panels" in the general press (thanks to Sarah Palin's facebook post).  Best of all, the interest level has stayed high despite the drop in usage of "death panels".

Looks like Diane Meier was right in her panel discussion with the Health Affairs Journal:
despite the current controversy over the advance care planning consultation provision, the ongoing debate “will turn out to be positive, as the Terry Schiavo debacle turned out to be positive. … We’ve begun to turn the tide on the lies about death panels. That’s all they are – lies – and we need to keep saying that.”  

Yes, we may have lost the battle in regards to the Advance Care Planning Consultation proposal, but the war is far from over.

5 comments:

Dan Matlock said...

Interesting. I love the positive outlook. Perhaps those initially outraged are now deep in the throes of an introspective journey into the human condition. Perhaps "death panel" was really a backdoor way of confronting the societal death taboo. Certainly a nice thought...

ken covinsky said...

Really interesting post Eric. Hopefully this will be one of those cases where time is the arbiter of truth.

Drew Rosielle MD said...

I think it's also important to take the long view about all of this. We (the palliative care world, and our allies) have history on our side: patients, families facing chronic and life-threatening illnesses, are desperate for the approach to medical care that we try to exemplify (we don't own this approach but I think we're the only professional community who centralize it as a matter of course): patient and family care which is relentlessly focused on quality of life, maximizing benefits to burdens, speaking the truth, and humanizing the whole experience.

So, f**k the 'death panelistas' - most patients and families who have gone through the experience of chronic/life-limiting illness/death in this system know what we're talking about and we who do this see it all the time: tremendously grateful family/patients who ask us where were we 2 years ago after they were first diagnosed?

I think the trouble is, on the ground, grounding this approach in our death denying culture: no one wants to die; we all want to kick against the pricks and stick it to death, but when you're dying, you want to have someone in your camp who takes our approach.

The relentless idealist in me wants to think that In America, this 'conversation' can occur, without it degenerating into a 'death panel' shouting match...but reflect on your most 'death denying' patient you've had in the last few years: they were (most likely) terrified, feeling alone, feeling out of control, wanting desperately to be able to control what happens to them. Well, we (at our best) have the power to help with that, not in the Cure Death way, but in every way else.

This should be a 'debate' we can 'win.'

On the other hand when I reflect that a good quarter of our population doubting that our president was born in the US...it makes the misanthrope rise up.

Eric Widera said...

Well said Drew. I think you just gave me a new idea for a bumper sticker with your 'death panelistas' quote. I also would not worry about any misanthropic tendencies. Most Americans in a National Geographic survey couldn't find Mississippi or Iraq on a map - I'm guessing that locating Hawaii was not much better.

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