Proposed health-care reform legislation includes a provision that allows Medicare to pay for "end-of-life" counseling for seniors and their families who request it. The provision -- which Sarah Palin erroneously described as "death panels" for seniors -- nearly derailed President Obama's health-care initiative. Some Republicans still argue that the provision would ration health care for the elderly.
Does end-of-life care prolong life or does it prolong suffering? Should it be a part of health-care reform?
Cover photo: Terminally ill patient Jackie Beattie, 83, releases a dove on October 7, 2009 while at the Hospice of Saint John in Denver, Colorado. (John Moore/Getty Images)
Sally Quinn and Jon Meacham on November 3, 2009 8:51 AM
If end of life care means treating people like people, and investing into them, then it should be part of health reform. The point is, human connection and interaction should never be secondary. It gives hope for the soul, and proves the invisible love of God is real.
Posted by Matt Maher, on November 12, 2009 8:51 AM
In some moments, it's the right time to die. In others, it's the right time to extend life. There are no easy answers. What I know for sure is that if ever there is a time when individuals and families need wise counsel, it is times like these. Everyone deserves end-of-life counseling. It is time for our nation to provide it.
Posted by Katharine Henderson, on November 6, 2009 8:39 AM
Would counseling have helped those of us who loved him cope with the horrible choices my grandfather had to make? Absolutely. We were reeling with shock and loss, devastated by the rapid deterioration of a beloved relative, and the sure knowledge that we had a very short time to be with him. While we honored and respected his choice, that did not make it easy to live with. (Again, much the same could be said if he had chosen to prolong his life).
Posted by Pamela K. Taylor, on November 5, 2009 10:49 PM
We have built a narrative where not giving up, holding up hope is heroic, and capitulating to death is cowardly. And indeed, we must face disease courageously, trust our physicians, maintain a positive attitude and pray. But there is a time for battle, an age for battle, time for prayer and then an acceptance when the outcome is certain.
Posted by Aseem Shukla, on November 5, 2009 5:16 PM
End of life counseling may take two different forms, in almost opposing directions. One kind of counseling assists elderly people (or people with terminal illnesses of any age) to prepare themselves for death. This may include psychological support, palliative care and legal preparations. In theory, no one can be against such help.
Posted by Adin Steinsaltz, on November 5, 2009 3:05 PM
1.... .End-of-life physical-health care can prolong both life AND suffering, depending on the kind of care given. Over one-third of the residents in our retirement home are 90 or older, and none of these (including myself, nearing 92) is without at least one major health issue involving some degree of suffering. When the facility opened eight years ago, few were that old. The wave of the truly old has hit, and it's a tsunami of Medicare-Medicaid costs. Not far out to sea is an even greater wave, the baby boomers beginning to qualify for Medicare.
Posted by Willis E. Elliott, on November 4, 2009 9:20 PM
Whoever called it "end-of-life" counseling made a terrible mistake, not only from a marketing perspective, but from an ethical/spiritual one. By ceding values-laden language to their opposition, and failing to approach this issue from a values-driven perspective, they opened themselves, and all those who support this much-needed aspect of health care reform, to the death panel crowd and their charge that such counseling is about nothing more than cost-cutting. Nothing could be further from the truth
Posted by Brad Hirschfield, on November 4, 2009 8:03 PM
My father died in a hospice. I loved the quiet room where he lay unconscious, freed from feeding bags and transfusions and from the noises of a busy hospital. I could sit and sing to him, talk to him, say goodbye in utter certainty that he was at peace and so was I.
Posted by Margaret O'Brien Steinfels, on November 4, 2009 12:49 PM
Making decisions about the end of life makes more sense when the living can discern their choices in consultation with their family doctor. That's a better course than making decisions in the midst of an emotional crisis at the end of life.
Posted by Robert Parham, on November 3, 2009 5:29 PM
In the Judeo-Christian tradition death has become a kind of risky lottery where the soul discovers, to its delight or horror, that it's headed for heaven or hell. But many wisdom traditions around the world make a different argument, that the afterlife is an extension, in non-physical terms, of present life.
Posted by Deepak Chopra, on November 3, 2009 2:03 PM
Today's 'end-of-life care' controversy didn't exist 1000 years ago, when most believed that the terminally ill were in "God's hands." With scientific breakthroughs, the terminally ill are often in technology's hands, and it's up to humans to decide the extent to which that technology should be used.
Posted by Herb Silverman, on November 3, 2009 12:18 PM
More than 20 years ago, my mother and my mother-in-law both requested that we not to prolong their lives, if they ever had to go into hospital. Both had strokes, both could have "lived" a vegetative life on life support, but I honored their wishes and refused to put them on life support. This is my wish too.
Posted by Arun Gandhi, on November 3, 2009 11:08 AM
End-of-life counseling is a way for seniors to keep some of their dignity, because it can help them and their families make some purposeful choices about this important time of life--a time of life that comes to all of us.
Posted by Susan Brooks Thistlethwaite, on November 3, 2009 10:04 AM
The reason why this issue has become another attack point for the religious right is not, as conservatives contend, fear of government control. It is, rather, the belief that only God has the power of life and death. That's one reason why the right regards assisted suicide with horror.
Posted by Susan Jacoby, on November 3, 2009 9:18 AM