Finally we seem to be coming to our senses. Finally we are paying for what has been characterized as encouraging terminally ill patients to die.
As of Jan 1 2016, Medicare Administration says they will pay doctors specifically for counseling patients about end-of-life care.
This was suggested as a feature of the Affordable Care Act (“Obamacare”) but was shot down by blowhard opponents. And characterized, not as a very necessary part of caring patient management, but as “Death Squads.”
The Institute of Medicine notes in their landmark report, Dying in America, “the reality too often is unwanted invasive care and not enough comfort, in part because too few people make their wishes known to their doctor and loved ones.”
As I have noted in other posts, if you don’t stay “stop” the default position is to get on the incredibly expensive and so very often futile, “do everything” hurdy-gurdy.
This is a delicate business and can be a time consuming for your doctor. It is a bit outside the normal scope of a days work, but incredibly important, so it doesn’t seem unreasonable to provide special funding (Medicare payments for consultation services are pretty meager as it is, and avoiding people receiving intensive care in their last few days/weeks of life will probably actually save Medicare money – though that’s an inflammatory thing to suggest).
In the chapter “How to Get the Right Death,” of my book Managing Your Doctor, I encourage people to take this upon themselves, as making your wishes known, and enacting some kind of advanced directive, is the best way to avoid what the bioethics research organization, The Hastings Center, calls “dying badly.”
Even before January 2016, or if your doctor doesn’t initiate an end-of-life-care conversation, take it upon yourself to make your wishes known – it’s never too soon.
