You Better Know What "Palliative Care" Means! - Belle Ringer - http://www.salvationandsurvival.com/2014/09/you-better-know-what-palliative-care.html
Get ready for the new buzz word in the world of Medicine and Health Insurance/Provider jargon ... "Palliative Care". Do you know what it means? I didn't, but figured it must be pretty important to be at the center of a new report on End-of-Life Care by a 21-member "non-partisan committee" appointed by the Institute of Medicine, which is the research arm of the National Academy of Sciences.
I don't know about you, but I get a little nervous when any "committee" gets together to decide how I should be treated in the latter stages of my life --- especially a group that is supposed to be "nonpartisan" and is appointed to provide guidance and advice to policy-makers. When the make-up of that committee overwhelmingly consists of professors from university medical schools ... well, let's just say I'm a little suspicious of recommendations coming from academia. A little real-world experience with actual patients might give me a little more confidence in their opinions.
Nevertheless, this distinguished group of professionals determined that "The country's system for handling end-of-life care is largely broken and should be overhauled at almost every level." That's a pretty bold statement with serious implications! Among their key findings and recommendations are the following points:
* One out of every 4 Americans over the age of 65 dies in the emergency room or hospital, which results in a burden on hospital facilities and family budgets.
* The elderly are living longer, often with lengthy illnesses that task family resources and demand excessive time delegated to caring for the patient.
Most people nearing the end of life are not physically, mentally, or cognitively able to make their own decisions about care. The majority of these patients will receive acute hospital care from physicians who do not know them. Therefore, advance care planning is essential to ensure that patients receive care reflecting their values, goals, and preferences.
* Although professional guidelines and expert advice increasingly encourage oncologists, cardiologists, and other disease-oriented specialists to counsel patients about palliative care, wide-spread adoption of timely referral to palliative care appears slow.
* Palliative care services, including hospice, improve patient outcomes and may reduce health care costs by lessening use of acute care services. Changes are needed throughout the health care system to incentivize provision of comprehensive palliative care.
* Medical schools and groups that accredit and regulate health providers should greatly increase training in palliative care and set standards so that more clinicians know how to compassionately and effectively treat patients who want to be made comfortable but avoid extensive medical procedures.
* Finally, there is a need for public education and conversations about death and dying. Americans need to know what their choices are, and the value of Palliative Care.
That's just a quick and incomplete summary of "the panel's" findings. But, I'm sure you noticed that term "Palliative Care" sprinkled throughout their recommendations. So, what is it? The dictionary defines it as: Specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness-whatever the diagnosis. The goal is to improve quality of life for both the patient and the family. A little more research into the exact meaning of "palliative", and you will find the sense of soothing or calming for the terminally ill. A little bit deeper, and you will find these terms associated with Palliative Care: painkiller, sedatives, tranquilizers, opiates. It's one thing, to consider Hospice Care, when that is the decision of the patient and the family. It's quite another to consider that Palliative Care is also recognized as a method of reducing the costs of health care.
So, while I agree that too often, the elderly and terminally ill may be subjected to painful, long-term, and expensive care that does not yield a positive result; and that there are times they would actually choose to forego such treatment, it makes me just a little bit nervous that we now have a panel of "health experts" who are recommending that Palliative Care of the elderly be incorporated (and dare I say, mandated) into our health care system.
Even the panel, itself, issued a veiled warning with this recommendation: "Quality standards and measures are needed to ensure that changes in payment systems, particularly those occurring under the Patient Protection and Affordable Care Act, do not adversely affect quality of care for patients at the end of life." Sounds like they might be just a tad concerned that Palliative Care could get out of hand and be misused in ObamaCare.
There is a fine line that needs to be walked here. Would I rather die at home in my bed, surrounded by friends and family, instead of in a cold, hospital environment attached to tubes? That's an easy answer. Any policy that allows me to make that decision at the time it needs to be made is one that I could accept. But to make the blanket statement, "Most people nearing the end of life are not physically, mentally, or cognitively able to make their own decisions about care", lends itself to suspicions that those decisions will be taken away from us and made by the oft-denied "death panel."
And if I have this "Advanced Planning" discussion with my doctor, what are my options for changing or amending those decisions? Or does that private conversation with my physician become part of my permanent medical records, which are shared with insurance providers and hospital staff, so that anytime I am admitted to the hospital, it becomes potential grounds for determining my medical care (or in this case, lack of life-saving care)?
At what age does Palliative Care become mandatory? If you read between the lines of these recommendations, you might become concerned about your twilight years. We all know that our economy is suffering in many sectors, and with our aging population, the exorbitant costs of health care are coming under extreme scrutiny. And it's not hard to get a little worried, when you read what The Blaze recently reported: "Dr. Ezekiel J. Emanuel, a former Obama administration health policy adviser and the brother of Chicago Mayor Rahm Emanuel, said in a recent op-ed that 75 is the ideal age to die, claiming that "living too long" can often lead to a "deprived" state - one that sometimes causes people to be remembered as "feeble, ineffectual, even pathetic."
The last thing I want is "policy advisors" like him to start determining when I might become a burden on society. So, maybe I'm becoming a little too paranoid, but the way I see it is that how I live the end of my life should be a determination made by myself, my family, and my doctor. When panels and policy wonks and insurance providers start laying out guidelines, how long before my voice is no longer heard?
Leviticus 19:32 "You shall stand up before the gray head and honor the face of an old man, and you shall fear your God: I am the Lord."
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