Critics of Health Reform Concerned Over Government’s Role in End of Life Issues

Of all the criticisms concerning health care reform, I find this one the most disingenuous. Readers know that I am a strong advocate of palliative care. Treating patients should not just focus on extending life or trying to cure someone (while decreasing their quality of life). Rather, we should individualize care by working with patients to determine their desires.

As I sat in my house yesterday, racked by an interferon storm, I watched incredulous that a provision in the house bill had become a rallying cry. As I read the provision, physicians could charge for having these important conversations. Hopefully this provision will encourage physicians to address goals of treatment in patients facing the end of life.

Opponents have perverted this concept into claiming that the government will bully patients into forgoing “life saving” treatments. These opponents do not understand medicine or end of life care.

Recently I cared for a patient with bacteremia from a dog bite. He had pancytopenia secondary to acute leukemia (which resulted after chronic leukemia). He did not respond to chemotherapy. Hematology opined that further treatment would be futile.

So we had a very nice man with few white cells, who was recovering from his septicemia. What should we do next? We were enforcing reverse isolation because of his leukopenia.

I had a long discussion with him about his goals. He wanted symptomatic treatment and he wanted to spend time at home.

We consulted our outstanding palliative care service, and arranged discharge the next day. We treated the patient well. We ignored the disease because we really could not address the disease.

While this story does not sound remarkable, I suggest that too often such patients remain in reverse isolation to prevent an infection. He decided that an infection would come eventually, so he wanted some quality time at home with his wife.

He left the hospital satisfied, and received ongoing home care.

We should provide such consultation for the main reason that it is good for patients. Such consultations often decrease unnecessary health care costs, but that alone would not matter if it were not also good for patients.

So I say to the critics of this provision – shame on you. Any bill has much to criticize, but this provision stands beyond reproach.