Lois Shepherd Discusses Idea of Doctor/Patient End-of-Life Counseling and the Ongoing Health Care Debate

Below is commentary by Lois Shepherd, J.D., in which she discusses the idea of doctor- patient conversations about death and the current status of such counseling in the universal health care debate. Shepherd is the author of If That Ever Happens to Me: Making Life and Death Decisions After Terri Schiavo.  She holds a joint appointment as associate professor of biomedical ethics and as professor of law at the University of Virginia.

Why Are We Afraid of Caring Conversations about Death? — by Lois Shepherd

We seem to be losing our way when it comes to reasonable, compassionate care.

If Congress does pass a universal health care plan this year, it may not get all the details right. But one of the details that is right in the current House bill is the provision that would pay doctors for the time they spend talking with terminally ill patients about their goals for medical care.

Last week, former Alaska Gov. Sarah Palin characterized the provision as creating “death panels” that would determine when it was someone’s time to die. Other radical conservatives, in the media and in Congress, joined in the fray.

“There is some fear because in the House bill, there is counseling for end-of-life,” said Sen. Charles Grassley, R-Iowa. “And from that standpoint, you have every right to fear. You shouldn’t have counseling at the end of life. You ought to have counseling 20 years before you’re going to die.”

Under the current House resolution (H.R. 3200, Section 1233, “Advance Care Planning Consultation”), Medicare would reimburse doctors for advance care planning consultations every five years or when patients’ conditions changed substantially. Our complaint should have been not that the idea was included, but that it did not go far enough — conversations with families and surrogates should be reimbursed as well.

While reasonable voices pointed out that there were no “death panels” in the bill, and that critics were misrepresenting the meaning of the provision, the damage had been done.

Grassley, the ranking Republican on the Senate Finance Committee, said that his committee’s discussions of health care reform legislation have not included end-of-life provisions. So, the prospects for that provision in the Senate look grim.

But if this provision is left out of health care reform to qualm unjustified fears, we will lose not only an important innovation in end-of-life care but also a new approach to providing care in all phases of life — one that values communication, coordination, and collaboration among patients, families and health care providers.

-Lois Shepherd

For more information on the Terri Shiavo case, or Shepherd’s book, If That Ever Happens to Me, visit UNC Press online.