Health care bill's end-of-life counseling has moral value

Q: Does end-of-life care prolong life or does it prolong suffering? Should it be a part of health-care reform?

No political deception this year has been more shameful than that of Sarah Palin, the Christian Right and many Republicans who have tried to sabotage health care reform with the canard of "death panels." Even after many myth-debunking articles and reports, the anti-health care reform crowd still crows about death panels.

Only a few weeks ago, the Southern Baptist Convention's chief lobbyist told students at New Orleans Baptist Theological Seminary that a Senate bill would reinstate "death panels."

The myth-that-will-not-die distorts the provision for voluntary counseling by doctors with patients once every five years related to the care patients want at the end of life--paid for by Medicare.

Rather than affirm the cherished value of the doctor-patient relationship, the right sees a conspiracy of the federal government pulling the plug on grandma.

Part of the right's fear is rooted in its anti-government DNA. Part of it is embedded in the belief that our culture hates life and is slipping down the pro-death slope toward active euthanasia for the aged and terminally ill.

For years, "right to life" groups have opposed living wills. They see such legal documents as a stalking horse for the "right to die" movement accused of advocating mercy killings and assisted suicide. They distrust the courts and legislatures, charging them with having a presumption against life, of favoring a "quality of life" ethic. They urge their supporters to sign "wills to live," documents that request treatment to include food and fluids when the patient cannot speak for themselves, as opposed to being allegedly starved to death. They often warn that without a will to live what happened to Terri Schiavo might happen to them and their family members.

From my perspective, I don't see our culture on a slippery pro-death slope. The amount of money that our country spends to prolong life at the end of life suggests a commitment to avoiding death at all costs.

Nor do I see death as something to abhor. But then, for me, it's a faith thing.

Diagnosed several years ago with acute leukemia, I readily signed my living will. I gladly initialed the clauses related to the withholding of nourishment and fluids and providing organ donation. I was relieved to have this long overdue document activated.

Of course, I had no intention of dying. If I was really that sick, I planned to rage against the illness, bending but not breaking in the contest between life and death. If I lost that struggle for life, I had no desire to drag my family into a prolonged death. I had neither fatalism nor escapism about death--death was part of life, which is not to say that I embraced the often-heard Christian prattle that rationalizes death as good based on the belief that the next life will be better than this one. That supposed pastoral word was empty comfort for me. I rather preferred living as long as I could, if living had quality, purpose and without punitive reprisals on relatives.

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.

If Medicare payments will facilitate such good decision making, then the health care reform bill ought to include end-of-life counseling.

By Robert Parham  |  November 3, 2009; 5:29 PM ET
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