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You Say ‘Death Panel’ I Say ‘End of Life Planning’

You Say ‘Death Panel’ I Say ‘End of Life Planning’

Some call it a death panel. Some call it end-of-life counseling. Let’s just call it humane.

Oncologists Call for End-of-Life Counseling
Despite hysteria over so-called death panels, The American Society of Clinical Oncology (ASCO) is calling on physicians, medical schools, insurers, and others to help patients understand and make decisions about end-of-life care.

The ASCO encourages physicians to initiate candid discussions about the full range of palliative care and treatment options soon after patients’ diagnosis with advanced cancer (defined as incurable disease).

“While improving survival is the oncologist’s primary goal, helping individuals live their final days in comfort and dignity is one of the most important responsibilities of our profession,” said ASCO President George W. Sledge, Jr., MD. “Patients have a right to make informed choices about their care. Oncologists must lead the way in discussing the full range of curative and palliative therapies to ensure that patients’ choices are honored.”

The ASCO released a guide to help patients initiate conversations about their prognosis, treatment, and palliative care options with their physicians, and later this year will issue clinical guidance to help oncologists incorporate palliative therapy into oncology practice.

Palliative Care Improves Quality-of-Life for Patients and Caregivers
“Studies show that palliative therapies not only improve patient quality of life, but can even extend life,” said Dr. Sledge. “Yet for many with advanced cancer, conversations about palliative and hospice options do not occur until the patients’ final weeks or days of life, if they happen at all. This not only hurts patients, but their caregivers as well. ASCO’s new patient booklet and upcoming clinical guidance will help patients and physicians broach these topics early in the course of care.”

A randomized trial sponsored by The ASCO Cancer Foundation found that patients with advanced lung cancer who received both chemotherapy and palliative care immediately after their diagnosis lived almost three months longer than those who received chemotherapy alone. Another study published in the Journal of Clinical Oncology showed that caregivers of terminally ill patients who receive palliative therapy suffer less emotional stress. ICU and hospital deaths were associated with more psychiatric illness among bereaved caregivers compared with home hospice deaths.

It’s Not a Death Panel: What You Don’t Know Can Hurt You
Most public or private insurance plans provide little or no compensation for palliative care options, but ASCO points to the demonstrated value of physician/patient discussions regarding end-of-life care.

Is there a need for honest talk between doctors and their patients regarding terminal illness? Of course. Who would argue otherwise? When faced with terminal illness, would you choose a hospital, hospice, or home? How would you want pain treated? Would you want information on clinical trials? Who will speak for you if you can no longer communicate your wishes?

These are important decisions that should not be left to chance. The “death panel” label that succeeded in getting incentives for end-of-life planning cut from the Affordable Care Act did us all a great disservice.

It doesn’t have to be cancer. When you get to end-of-life issues, what you don’t know… and what you don’t plan for… can hurt you. Kudos to the ASCO for telling it like it is and putting patients’ rights first.

Source: American Society of Clinical Oncology

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Photo Author: Rhoda Baer, Source: National Cancer Institute (NCI)

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68 comments

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7:36AM PST on Feb 26, 2011

Here in my state of Oregon we've passed 'right to die' legislation that's been very significant in opening up the dialog between family, doctors, clergy and others. Citizens passed that law with a grassroots effort and other States could do it too.
I work in the natural funeral business and I can tell you first hand that the most expensive thing about a funeral is NOT planning. I can also say - after plenty of contact from people with a terminal illness who want a natural funeral - that usually it's concern about family members that keeps someone from saying what they want.
It only makes sense that any government sponsored medical system - that understands the options available that it will support - should required to educate people about all of the options. Otherwise, the education only comes in advertising and that limits choices to the companies that have money to advertise.
This lack of complete disclosure then results in the family (and society) spending a LOT more money on hospital care pre-death and funeral goods and services post-death.
Since the result of not-planning means more expense to the family and government, it's not surprising that elements of industry oppose it.
After all, when you leave expensive things up to professionals to decide for you, it's hard for them to resist the temptation to charge you as much as they think you can afford for their services - or to pressure your family to spend as much as possible.
Thanks again for this article!

8:12PM PST on Feb 25, 2011

My mother just died on Jan. 15, and she had her papers signed and was under Hospice care, the best thing she ever did for herself, and we, for her. She died peacefully of Alzheimers with her brain slowly shutting down her heart and lungs, with small doses of a narcotic to ease her respirations. We were with her, and it was the death we wanted for her, that most people hope for. Alzheimers is as terminal a disease as virulent cancer.

America is very unprepared for death. We used to accept it as a natural part of life, in the old days, but we've gotten so concerned with saving a person's life, no matter how bad off he is, that we've lost sight of the quality of living. Birth > life > death is the natural course for all living things, whether animal or plant. We need good education about palliative care, when hope for quality living is over. So much better a way to go, than in a hospital, hooked up to tubes and wires, among strangers. Just because it is possible to transplant an organ, doesn't mean that all people, suffering with multi-system failures, should want to continue.

You've been in charge of your life -- you should be in charge of your death. Talk to your doctor, and let doctors be recompensed for their advice and time. It is so unfair that certain people in certain parties have brought FEAR into the equation, with the LIE of death panels. Shame on them for depriving the public of the right to determine their own deaths.

12:08PM PST on Feb 25, 2011

Thanks for the info.

2:40PM PST on Feb 12, 2011

I don't understand what the argument is about in the first place! This is a sensible, rational solution to a painful and difficult problem.

The article points out that quality of life is improved in many cases, even extended, and it's got to be better than last-ditch, useless "extreme measures" which only waste money, resources, and even that same quality of life for something that is ultimately destined to fail.

9:17AM PST on Feb 12, 2011

Thank God. Finally, a voice of reason. Thank you for an intelligent and well-researched article.

9:35PM PST on Feb 10, 2011

Let's face it. The term "Death Panel" is just another way the Repubs use to scare their sheep to death and keep them cowering in fear of anything they don't understand. A stupid voter is a committed voter!

9:51AM PST on Feb 10, 2011

I can think of a few people whom need to be under review of these panels,..Starting with the person that coined this phrase...Sar..ohh wait I can't even say her name without Gaging.

7:15AM PST on Feb 10, 2011

"Death Panel" That term should be applied to abortion. I want information to end my own life on MY terms. Unfortunately babies who had NO say so in their conception don"t have that choice!! Seems I don't either cause everyone seems to think I am part of a DEATH PANEL!!

5:04AM PST on Feb 10, 2011

Thanks for the info.

3:48AM PST on Feb 10, 2011

It's more accurate to call what we have now "death panels." That would be the bureaucrats and bean-counters who decide to refuse coverage to some people and to deny needed treatments to others.

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