Skip to main content

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.

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.
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.
Anonymous said…
work as a correctional nurse
hospice and nursing home nurse
and private care,
very frustrated on so many vitamins
and medication put to the elderly,
and medically compromise patients
lmp lpn

Popular posts from this blog

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Dying without Dialysis

There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis.  This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis is increasing, we know little about the alternatives to hemodialysis.  Specifically, we know nothing about symptoms affecting quality of life among patients who elect not to start dialysis (so called "conservative management" - is this the best label?).  This article provides a terrific counterpoint to the article in last years NEJM showing that nursing home residents who initiated hemodialysis tended to die and decline in function (see GeriPal write up here). 

The study authors followed patients with the most advanced form of chronic kidney disease (the new name for renal failu…

Survival from severe sepsis: The infection is cured but all is not well

Severe sepsis is a syndrome marked by a severe infection that results in the failure of at least one major organ system: For example, pneumonia complicated by kidney failure. It is the most common non-cardiac cause of critical illness and is associated with a high mortality rate.

But what happens to those who survive their hospitalization for severe sepsis? An important study published in JAMA from Iwashyna and colleagues provides answers and tells us all is not well. When the patient leaves the hospital, the infection may be cured, but the patient and family will need to contend with a host of major new functional and cognitive deficits.

Iwashyna examined disability and cognitive outcomes among 516 survivors of severe sepsis. These subjects were Medicare enrollees who were participants in the Health and Retirement Study. The average age of patients was 77 years.

When interviewed after discharge, most survivors were left with major new deficits in their ability to live independently. …