End of life care discussion.

Commenter and friend Derek pointed me to this story making the rounds today.

One look at Eileen Mulligan lying soberly on the exam table and Dr. John Marshall knew the time for the Big Talk had arrived.

He began gently. The chemotherapy is not helping. The cancer is advanced. There are no good options left to try. It would be good to look into hospice care.

"At first I was really shocked. But after, I thought it was a really good way of handling a situation like that," said Mulligan...

Many people do not get such straight talk from doctors, who often think they are doing patients a favor by keeping hope alive.

New research shows they are wrong.

Only one-third of terminally ill cancer patients in a new, federally funded study said their doctors had discussed end-of-life care.

Surprisingly, patients who had these talks were no more likely to become depressed than those who did not, the study found. They were less likely to spend their final days in hospitals, tethered to machines. They avoided costly, futile care. And their loved ones were more at peace after they died.

The word "surprisingly" in that last paragraph amuses me in a bitter sort of way -- it doesn't surprise me at all that patients don't get depressed when their doctors are honest.  (Nor does it surprise me that only a third of patients hear about end-of-life care from their doctors.) This is a really, really important finding, and I hope people pay attention to it.  A patient's right-to-know bill is in the works in California.  I haven't seen the details of the bill, but whether it's well-crafted or not, let's hope it raises public awareness.

People need time to prepare, and doctors owe it to them to give them the information they need up front.

Comments

[Kelly]

The Catholic Register says that the CA bill is being pushed by the assisted suicide people. It informs people, among other points, that they can refuse food and water, and be medicated so that they don't notice the lack of food and water.

[bearing]

Politically speaking, a law that purports to ensure that patients are informed about all their options reasonably includes all legal options, whether morally licit or not.

It strikes me that this isn't a reason to oppose the bill -- it does point out the need for clear teaching and preaching on the licitness of the various options for end-of-life care. I consider myself pretty well-informed about Catholic teaching and even I get muddled about what is and isn't licit in this area -- I can usually back it out but it generally takes more than a little careful thought!

[Derek]

Personally, I'm skeptical. It isnt black or white (you're dying vs. you can live). In a case like in the article, it makes sense - the chemo has failed, the tumor is progressing... go take a cruise. But what about the patient recently diagnosed with a tumor with high mortality? Or a generally low mortality, but some patients do badly? It just doesn't make sense - how do you incorporate medical judgement that best reflects the specific details of each case into a broad mandate? There are so many ways people die, time courses, disease processes,underying diseases, etc. A bill of this sort is loaded with potential problems. How will compliance be verified (and physicians protect themselves from almost inevitable lawsuits)? Can people sue b/c they were told at 3 months and not at 6 months? (my doctor cost me 3 of the most important months of my life). Doctors will develop ways to protect themselves - perhaps a handout with a dizzying array of options for patients, or maybe the patient has to sign a form saying that his/her doctor has discussed end-of-life issues with them?

I'm not saying I have a better way, and raising awareness is certainly a good thing. Too many physicians do a poor job at discussing these matters. But this bill strikes me as a bad idea. Reminds me of the pamphlet Homer is holding in a Simpsons episode - "So You're Going to Die"...

[FrB]

This California bill is poison--figuratively and literally! Not only does it say that doctors should discuss end-of-life care with patients (which is fine), but it also broadens the options beyond the beneficial hospice care to include the pernicious "voluntary stopping of eating and drinking" (VSED--for those who like acronym disguises) and palliative sedation. The latter would be moral if someone were imminantely dying and in great pain. If not, then it is little different than putting Grandma "to sleep" (which is NOT fine).

This bill envisions doctors making these options available when a patient has "less than one year to live." How many doctors feel comfortable guessing that prognosis? And if the doctor feels uncomfortable with VSED or "palliative" sedation, then he must transfer the patient to a doctor (or veterinarian?) who is willing to offer these options.

It would provide an easy out for insurers and hospitals to reduce costs of caring for the underinsured and people with disabilities. It is toxic to the doctor/patient relationship. That's why such a broad coalition of organizations here is vehemently opposed.

More details are currently at the website for the Californians Against Assisted Suicide http://www.ca-aas.com/

There is also a great analysis by Bobby Schindler and Wesley Smith here: http://www.wesleyjsmith.com/blog/2008/05/more-on-ab2747.html

Pray our CA Senate rejects this bill!

To paraphrase Flannery O'Connor: Tenderness without Christ leads to the gas chambers!

[bearing]

Hold on, are you saying that the bill actually broadens the "options" that dying patients can legally choose? It changes the legal status of so-called "voluntary stopping of eating and drinking?"

That it's not currently legal but the bill would make it legal?

In a way this sounds a bit like the debate we had here in Minnesota about a "Women's Right to Know" law that required health care providers to provide information about fetal development, among other things, to women seeking an abortion. The lengthy part of the fight wasn't so much about whether to have the law or not (IIRC) as it was over the specific language that physicians would be required to provide. I recall physicians arguing that it was wrong for the government to interfere in the physician-patient communication by requiring them to provide a patient information about how her baby was developing.

So this kind of discussion (what is and isn't appropriate to require physicians to say to their patients) can cut both ways.