The New York Times has a story on “end of life” medicine today that features a macabre section with the subhead “An Escort for the Dying:”
“They are tour guides on the road to death, the equivalent of the ferryman in Greek myth who accompanied people across the river Styx to the underworld. They argue that a frank acknowledgment of the inevitability of death allows patients to concentrate on improving the quality of their lives, rather than lengthening them, to put their affairs in order and to say goodbye before it is too late.”
These “tour guides” are the doctors who specialize in breaking the bad news and setting up palliative care for the moribund patient. This is a subject we’re all interested in these days—as, of course, we should be. But I can’t help wondering if this story isn’t designed to promote the idea that people need to get on the ferryboat quickly, before they take up too much of our resources. Let’s ease into this end-of-life business.
Indeed, some of the story comes across as special pleading for the end-of-life panels put forward in versions of healthcare reform:
“Palliative care has become a recognized subspecialty, with fellowships, hospital departments and medical school courses aimed at managing patients’ last months. It has also become a focus of attacks on plans to overhaul the nation’s medical system, with false but persistent rumors that the government will set up ‘death panels’ to decide who deserves treatment. Many physicians dismiss these complaints as an absurd caricature of what palliative medicine is all about.
“Still, as an aging population wrangles with how to gracefully face the certainty of death, the moral and economic questions presented by palliative care are unavoidable: How much do we want, and need, to know about the inevitable? Is the withholding of heroic treatment a blessing, a rationing of medical care or a step toward euthanasia?
“A third of Medicare spending goes to patients with chronic illness in their last two years of life; the elderly, who receive much of this care, are a huge political constituency. Does calling on one more team of specialists at the end of a long and final hospital stay reduce this spending, or add another cost to already bloated medical bills?”
Here’s the deal: I don’t want someone from the government involved in this decision. I realize that ultimately there often comes a time when palliative care is the appropriate path. But these are personal decisions for the dying, their families, their doctors, and perhaps their clergy. I don’t want my ferryman on the river Styx to be a federal bureaucrat. Do you?