Determining “quality of life”
August 13, 2009, 10:22 am
Posted by David Gibson
“We have to make decisions that are deliberative about our health care at every moment. What I have said is that if I cannot say another prayer, if I cannot give or get another hug, and if I cannot have another martini — then let me go.”
–Monsignor Charles Fahey, 76, chairman of the board of the National Council on Aging, a nonprofit service and advocacy group. He was responding to the Associated Press about Sarah Palin’s “death panel” accusations and was Religion News Service’s Quote of the Day.
I’m trying to think of a medical condition that would prevent me from getting a hug.
Kathy, posting at dotCommonweal can certainly accomplish that goal.
I mean, there’s the boy in the bubble. But he could wear a space suit, if I remember correctly.
I hope that recovering alcoholics don’t take this PRIEST too seriously when he says a life without a martini is no life at all.
At least thank goodness he didn’t mention golf.
David, X
Nancy, back at you!
Kathy: I can understand the martini. (Though he could have made it a Gibson.) Golf I cannot understand. And both my brother and many here may consider that my greatest heresy ever. Ever.
I mean, what is this monsignor saying? If he gets a prickly skin disease, he will commit suicide? Go off life support? (Is he drinking martinis on life support?) What kind of “deliberative decisions” does he go around making “every moment?”
Focusing on the martini part of the quote indicates the distance from where the senior perspective is.
In recent years, the shift has moved away from emphasizing prolonging life at all cost to living life fully, responsibly and lovingly as one ages.
Of course, the problem is the “death panel” semantic and the broader unfortunate disinformation fight going on in the health care debate.
I don’t understand golf either. But the question of getting hugs is serious.
Is there a person who is beyond loving? Conceivably.
Is there a person who is beyond being loved? No. That is what Catholic Democrats should be standing up for, within their party.
Instead of the usual avuncular mugging for the AP.
In regard to the AP “fact check” article linked in David Gibson’s post:
See:
Sarah Palin: Concerning the “Death Panels” , 8/11/09
http://www.facebook.com/note.php?note_id=116471698434
———————-
ObamaCare and the Right to Life: Elderly Patients May Face Pressure to Die
http://www.ncregister.com/daily/health_care_duty_to_die/
By ROBIN ROHR
National Catholic Register, 8/9/09
———————–
Health care reform: What is costly overuse, what is humane?
By Katherine Dowling Schlaerth (Practicing physician and associate professor emeritus of the University of Southern California School of Medicine).
SF Chronicle, July 29, 2009, p. A-11
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/07/29/EDV218VMTQ.DTL&type=printable
“HR3200 has created tiers of administrators, who do not necessarily have medical experience. They will attempt to facilitate your end-of-life care, probably with the assistance of the electronic medical records each medical facility will shortly be required to use.
These and other provisions of the health choices act frankly scare me. As a physician, I took an oath long ago to put my patient’s interests above all else, but provisions in the bill have a quality of coerciveness that make me wonder if I can fulfill my oath. Certainly they bear deeper inspection than possible during the brief month long look-see President Obama wants lawmakers to give this 1,000-page bill before passage.”
Kathy, you sound like you had an unusually large helping of Postum at breakfast this ayem. I think the monsignor was making a larger point in what was likely a much more extensive conversation. I wouldn’t analyze his physics of the hug quite so literally, nor his affection for martinis. What he was getting at is I think the Catholic view of end-of-life care, which was perhaps summed up more appropriately by an elderly priest who was dying but declined further care:
“Let me go to the House of the Father.”
–Pope John Paul II’s final words, April 2005.
And yes, Michael J. Kelly, Sarah Palin was absolutely right! By the way, don’t you have to get in line for a town hall meeting…?
I am cheering Kathy on, every post of the way.
We can cut the good Monsignor some slack, I’m sure he was speaking off the cuff (I hope!), but a few seconds of further reflection would, (I hope!) lead him to retract the “martini” part of it.
JPII was literally at the end of his life when he spoke those words. A senior who is bidding farewell to martinis at the 19th hole clubhouse in order to prepare for his move into assisted living may be facing many more years of life in an institutionalized setting.
Pope John Paul suffered in public for 12 years from a progressive, embarassing disease. How many people continue speaking in public after they can no longer swallow?
http://www.youtube.com/watch?v=agGaIpXMzD4
Who needs Postum when there is real–not cheezball–leadership, here in this world? Also, what is Postum?
Well, I think a sense of charity, not to mention humor, is a virtue. Not here, of course. As has often and amply been demonstrated, alas.
I can safely argue, I think, that monsignor was not talking about walking out of the clubhouse and into a hospice, or in front of a “death panel.” He was referring to the same end-of-life decisions that John Paul and others made up until the last. One could, and I think should, argue that indeed John Paul’s end-of-life care and his decision were not necessarily the best, by any stretch. He made no provisions for incapacitation and that posed a great challenge for those close to him and for the church, given his position. Health care for popes has historically been notorious, and the efforts to keep up John Paul’s image of strength and suffering, as well as strength-in-suffering, led the pontiff and his aides to make questionable decisions on his care.
But after his death the Vatican renovated the papal apartments completely and added a state-of-the-art medical unit, so present and future popes can be treated in house and beyond the media gaze. That in itself can create other problems, of course.
In any case, as John Paul’s longtime aides said, when it became clear in his final weeks that he could no longer speak he accepted that he could no longer carry out his temporal role, and he began a more intensive preparation for dying.I think that is a very human and Catholic thing, and not to be dismissed so casually.
PS: Kathy, I did not find John Paul embarrassing.
Unlike David Gibson, I am going to analyze the monsignor’s affection for the martini, one of my favorite topics in the world. Though still well-known and consumed, the martini is nowhere close to the level of popularity it once had. It was considered one of six classic cocktails in America. (Sorry, David, the Gibson wasn’t among the six.) It remains a classic symbol for postwar prosperity and leisure.
There was for example the “three-martini lunch,” once a province of businessmen. Yes, I mean men, since there were few businesswomen at the time. This lunch was also tax-deductible. But of course it was not confined to men. Middle-class women, of course, consumed martinis in quantity, not only at parties but also plenty at home. Think John Cheever and early Philip Roth: the martini is often in the background of their fiction as a symbol of the good life for WASPs and Jews, respectively. On Catholics, I haven’t read JF Powers so don’t know if martinis figure in his fictional landscape. But anecdotal evidence indicates that there was plenty of alcoholic consumption among the laity and clergy also in the Fifties and Sixties, and martinis were likely among their favorite items.
In a delightful essay about table manners by Guy Davenport, the late English professor at University of Kentucky, he recalls having dinner in a Lexington hotel restaurant with several men. One was a visitor who came straight to the restaurant from a car accident, still bloodied. Another was Thomas Merton donning farmer’s clothes. The visitor kept asking waitresses for napkins to wipe off his blood and wounds while Merton kept ordering half a dozen martinis. Davenport was most impressed by the waitresses who served the table without as much as a blink of the eye.
Not sure if Merton was anywhere close to an alcoholic, but obviously the martini was considered a great indulgence. Sensibility about drinking (and of course smoking and eating) has changed a lot since. But the monsignor’s remark should be thought in this context. He is in his mid-70s and the martini possibly serves as a continuity to his past, when it was much more than just one drink among others.
David G.: BTW I think the Gibson wasn’t included among the classic six because it is just like the martini except for the garnish.
Historyman, many thanks for those stories and context. It salves my ego. Almost.
Catholics and notably immigrants have a storied history with alcohol, and being accused of using it too much, and getting upbraided by some very temperance-minded priests in very intemperate ways. I wonder if the martini was a sign of assimilation, of genteel drinking that was acceptable. Of course, one got just as potted. But one did so with grace and sophistication and acceptable bonhomie.
And of course there is James Bond. One of the best winks in the wonderful 007 relaunch, Casino Royale, comes when an angry Bond (Daniel Craig, in the best thing to happen to Bond since Sean Connery, still my fave) demands a vodka martini from the bartender. The barman politely asks, “Shaken or stirred?” Bond replies, more or less: “Do I look like I give a damn?!”
Bang on.
First, in working with a number of senior groups and seniors, my exoerience is that many frail and sickly seniors are not afraid to let go, but as moralists so long ago (or maybe not so long ago) wanted the chance to “die with dignity.”
I don’t know any doctors or nurses who are anxious to promote euthanasia, i know a number anxious to reduce terrible pain.
I think much of the argument here is burnished by politics and distanced perspective. I wonder how many of our posters have any knowledge of the National Council on Aging, on whose board the Monsignor sits; I suspec the is somewhat more well informed on senior issues.
(A footnote: we used to refer to gibsons as”onion soup.” Matiniis were popularly referred to as “tunis” – some of that sense of humor should be given to those who need to lighten up a little.)
Trying to stay out of this for the most part, as my rants don’t seem to be hitting the mark. But here’s another stab, then I’m off to do something productive:
Msgr Fahey’s comment tells us nothing except what he’d miss if he got real sick. And I don’t see where that offers any moral guidance re end-of-life care.
Neither does his comment offer any insights that might help patients and doctors make decisions about their care when treatment options are exhausted.
The bottom line, as I see it, is that how a patient feels about his illness and what should (or should not) be done to treat or care for him are two separate issues.
Dad was transferred to hospice three months ago when he refused to go to the doctor or hospital during a medical crisis at home. I called his doctor to tell him the score, and Dad was immediately transferred to hospice care. That day.
The decision to move him to hospice was NOT made because Dad was ready to give up the ghost on crisis day, but because a) there is nothing about his condition that his various doctors have been able to improve in the last five years, and b) going to his various specialists and having batteries of follow-up tests which all confirmed that “yep, you’re gettin’ worse like we thought, and here’s the tests to prove it” was sapping what little strength he has left.
The problem with his care for the five years before his transfer to hospice was that all the medical activity–I won’t call it treatment, because none of it improved his condition–gave us the illusion that “something was being done.” It was an expensive illusion, and, in my view, it was an abuse of Medicare and Dad’s top-notch supplemental coverage, a waste of Dad’s time, and a burden on him and my mother.
BUT how do you tell patients they’ve reached the end of what medicine can do for them without sounding like a ghoul? It’s a tough conversation, so it’s easier to continue the medical activity, even though the patient would be far better off without it.
FWIW, Dad can pray, hug, drink (no hard liquor though), watch “Rio Bravo,” do Sudoku puzzles, tell tall tales to my kid, flirt with his social worker, and call up local officials to bitch them out when he sees something on TV that pisses him off. And some days he feels very blue and yearns for things he cannot do anymore. However, his overall outlook has improved because he is less worried about when his next doc’s appointment is, and because he has better palliative care meds.
Sorry – I think that Fr. Fahey’s statement is elegant and to the point.
What we need on this blog is about 20 VPs of Ethics from CHA who probably meet, on average, 10-20 families a week plus MDs to decide about the ongoing and future care of a loved one (most often elderly). It is excruciating, painful but can be life giving, supportive, and help bind the family together. There are no simple answers to these questions – no manual spelling out black and white answers; no one lurking behind hospital doors to tell you what to do.
For a whole host of reasons, families can not decide to do everything under the heavens; most families love and care but have common sense; do not want to put mom/dad through more pain when mom/dad are completely unaware of where and who they are. This is NOT rationing; it is applying the Christian rules of mercy, comfort, and love.
Is drinking gin the same as having a sense of humor? Is that what is going on?
Perhaps there are actual serious matters at hand. Let’s say I’m a monsignor. Well, you know what I mean. And I’m the chairman of the board of a nonprofit on aging. And in the middle of a national debate on healthcare, a debate in which life issues figure prominently, I make a flip remark about how quality of life is worth more than life.
The message, ably picked up by my pro-secularism friends at RNS, is this: Catholics are willing to deal on end-of-life issues.
“Pro-secularism” at RNS?! Kathy, I think you could use some gin. I don’t know how on earth you read into this single quote such malevolence, but I’d prefer you dial it down a notch on the heat and attempt a bit of light, if you can’t manage light-hearted.
No, seriously, I know those guys. They’re nice, well-intentioned, and secularist. I mean no malevolence. It’s a reasonable position.
Ask them their opinions on religion in the public square, I’m fairly sure they’d score hands-off, without apology.
I would like some bourbon, and perhaps some recognition that each of my comments has contained at least one little joke, in an effort to keep things happy.
The malevolence regarded Msgr. Fahey, and what you take as the upshot of his remark.
Your remarks about RNS are just your usual, and to be taken so. Or perhaps that was your little joke.
Perhaps you could carefully analyze Msgr. Fahey’s remarks and explain what he really means, and how that differs from the way I’ve taken his upshot.
About RNS: it’s a long story. But I seriously mean no malice or disrespect.
As for humor, although I’d love to play Where’s Waldo all day, and find all the little jokes that I’ve hidden, so carefully disguised that you and others can’t seem to locate them, I’ve just run out of time! So bye for now!
how a patient feels about his illness and what should (or should not) be done to treat or care for him are two separate issues.
I think they should be the same – I’d sure want them to be the same if I was the patient. My mom died of lung cancer and I took care of her. She never gave up hope of getting better even when the docs had given up. I certainly wasn’t going to tell her she was being unrealistic or that she should give up treatment. I also had four elderly cats :) all of whom died around the same time. I took care of them too, gave them subQ fluids for kidney disease, medications for high blood pressure, hyperthyroidism, and cancer, and eventually decided when they were suffering so much that they would rather be dead. I hated making those decisions and I would not want to make them for a person.
Crystal, I’m sorry about the loss of your mom.
And the cats, too. As a cat owner, I know that the loss of a pet isn’t a trivial thing.
“The problem with his care for the five years before his transfer to hospice was that all the medical activity–I won’t call it treatment, because none of it improved his condition–gave us the illusion that “something was being done.” It was an expensive illusion, and, in my view, it was an abuse of Medicare and Dad’s top-notch supplemental coverage, a waste of Dad’s time, and a burden on him and my mother.”
Jean, I’m so sorry about your father’s suffering, and the suffering it must have meant for you, your mom and the rest of the family.
If you don’t mind my asking: was he given a diagnosis five years ago that his illness was terminal, and that no treatment would be able to reverse it? Or has it been five years of uncertainty that only in retrospect seems a waste on many levels?
I think the good Monsignor is simply giving an end-of-life treatment of this:
Wherever the Catholic sun does shine
There is food and laughter and good red wine
At least I have always found it so,
Benedicamus Domino.
Life on earth has a flavor that, when gone flat (like salt), directs us to the next stage of life. There is nothing fully sacred about life before death unless you deny the life after death.
Christians who forget that need to re-examine their beliefs in the resurrection.
Let’s say I’m a monsignor. … And in the middle of a national debate on healthcare, a debate in which life issues figure prominently, I make a flip remark about how quality of life is worth more than life. ”
Exactly. If the monsignor had resisted the urge to speak that 2nd, colorful sentence about the martinis and hugs, this discussion would be a lot shorter.
FWIW, Sarah Palin blogged a detailed (amply footnoted!) response to the President’s claims about how innocuous these end-of-life consultations would be. The part that is of interest is her claim that, as written, the legislation states that the doctor could initiate the discussion.
http://www.facebook.com/sarahpalin?v=app_2347471856&viewas=6190&ref=search
I should have also written that it’s not that I think one should want to be alive no matter what one’s quality of life. I have no problem, for instance with people who decide they would rather die – assisted suicide. I just would like a person to be able to make that decision for themselves (as long as they are able), not have someone else make it for them.
Kathy. you’re obviously a kid —tell me about about the nartini and hugs when you’re 85 and healthy as possible. Monsignor(God save the mark!) is my kind of guy,
Perhaps the monsignor was glib because these ridiculous claims about “death panels” that Sarah Palin and others are spreading are simply not worth taking seriously. The fact that Sarah Palin continues to pretend they are doesn’t change that. Once we’ve addressed the outrage of, for example, Palin’s claiming that the president is threatening the life of her baby, and the damage that kind of rhetoric does to public discourse, perhaps then we will be at leisure to parse the implications of a joke made by a priest about how he enjoys martinis and hugs.
No, seriously, Kathy, I know those guys. And you couldn’t be more hilariously misinformed.
And if the doctor DOES initiate the conversation …. so what? I would hope that a good, caring famaily doctor would take the opportunity when appropriate and get the thinking started. Some families don’t want to “alarm Mom/Dad” by even broaching the subject. Then when it is too late and no one knows what Mom/Dad had in mind, outside of some vague reference to “don’t let me suffer” or “don’t let them pull the plug”, the horrible and nasty agonizing about what to do starts.
I have made it perfectly clear to my partner and my doctor via a Durable Power of Healthcare exactly what I will accept and won’t accept. To avoid the subject is just plain stupid. I did mine early in life. If a doctor has an elderly patient who is seen to be in a deteriorating mental or physical state, he/she SHOULD raise the subject in a time, place and manner appropriate to the situation.
To quote Sarah Palin as an authority on anything other than flimflammery is odious.
What I learned from seeing my father die, compared to the deaths of other people I know, is that at the end of life, less is truly more. There is nothing that will kill you harder and often faster than the brutal treatment accorded to those who have crossed over the threshold of being able to get better.
What is difficult is knowing when and accepting that “end of life” has arrived. It doesn’t help to have doctors, especially oncologists, who are heavily financially incentivized to pretend that hope abounds when it doesn’t. Spending your last three good months organizing photo albums, watching old movies, or traveling to a place you always wanted to see is a lot nicer than puking your guts out with chemotherapy that isn’t going to extend your life.
Spending your last three good months organizing photo albums, watching old movies, or traveling to a place you always wanted to see is a lot nicer than puking your guts out with chemotherapy that isn’t going to extend your life.
That would be my feeling for myself, but shouldn’t each person get to make their own choice? I agree with Jimmy Mac that people should make their wishes clear, in writing. My mother was not a Christian and I don’t know if that had anything to do with her feelings about dying, but she was the kind of person who never wanted to give up, who wanted to live forever, and because of that she ended up suffering a lot – it took almost 2 years from diagnosis to death, with chemo and oxygen tanks, and 14 different drugs – but that was her choice and I respected it.
Well of course. But if no one will tell you that you have reached that point you aren’t likely to be able to plan your time accordingly, are you?
“And if the doctor DOES initiate the conversation …. so what? I would hope that a good, caring famaily doctor would take the opportunity when appropriate and get the thinking started.”
Sure. I agree with that.
It’s also possible, though, that not all doctors are “good, caring family doctors”. It’s even possible that some are empty suits from the hospital or nursing home. Here is Charles Lane’s take on it, from the Washington Post (ht to whoever wrote Sarah Palin’s Facebook post on the subject):
“Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive — money — to do so. Indeed, that’s an incentive to insist.
“Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit “formulation” of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would “place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,” I don’t think he’s being realistic. [7]”
If Charles Lane’s take on this is correct, then this section should be reformulated. Or deleted. Why does a health care bill need to provide for end-of-life consultation at all? Is that a service that a doctor customarily bills for?
I remember my own father’s crossing of that brutal threshold, nearly 3 decades ago. “This time he didn’t go into the hospital to get better, but to get comfortable”–that was when reality set in.
It’s a very significant marker.
One more thought on end-of-life consultations: it’s extremely common for a mother pregnant with a baby with Down’s Syndrome to hear this palliative-care recommendation from her doctor: “Get an abortion”. Doctors’ views on the sanctity of the gift of human life are all over the map.
Jim, Dad has had COPD for 20 years. It’s an irreversible, genetic condition. His mother had it, his uncle had it, I have it, my niece has it, my kid has it.
The problem with the disease is that the meds can slow the progress of the disease, but long-term use begins to shut down kidneys, enlarge the prostate, affect the heart and blood, creates severe osteoporosis, etc. So you reach a point where the treatment becomes toxic.
We knew 25 years ago where this was likely to go, and we also knew, having been with my grandmother when she died, how useless treatment becomes after a certain point, and how difficult death is when doctors keep trying treatments instead of palliative care.
So, no, I’m not looking at this with the 20/20 vision of hindsight.
Crystal, perhaps I made my point badly. In saying that how the patient felt about his disease ought not to drive his treatment, I simply meant that patients sometimes should be helped to keep going even if they feel like giving up on certain days. About 10 years into the disease, when there were still new things to try, Dad talked about drinking a pint of Yukon Jack and blowing his head off because he couldn’t mow the lawn anymore.
On the other hand, sometimes patients need to be offered a reality check about where their disease is going. Dad’s doctors–and we as a family–have been ducking the “is this doing any good” question” for some time now. Part of that discussion also needs to include reassurance that even at the end there are options that can make death seem less frightening. No less sad, but certainly less horrific.
Jean and Barbara,
Sorry – I didn’t mean to be so snippy. Bad memories of my mom and her ilness are my only excuse. I was so angry at her for more of less doing suicide on the installment plan (smoking) and she was so scared …. lots of baggage I’m dragging around.
Yes, citing Sarah Palin for backup is rarely a wise move:
http://www.talkingpointsmemo.com/livewire/2009/08/sarah-palin-thanks-but-no-thanks-on-that-death-panel.php?ref=fpa
This debate would be hilarious if it weren’t so deadly serious.
Jim P:
Lane Is being very disingenuous when defining “purely voluntary” as being only something that the patient initiates.
The patient may not even have a clue that (s)he has the right to define the conditions of their life’s end. Their kids/next of kin (if they even exist) may be unwilling to broach the subject.
Do you know of any priest who will talk about this with an elder parishioner without the parishioner first suggesting it? If he does, it that conversation no longer “purely voluntary?”
To assume that oldsters are so blinded by the glamour of a doctor’s white coat so as to not “just say no” to a suggestion that they start to think about the end is not to describe too many oldsters that I know. However, if one waits until the very last moment when dementia or overwhelming physical incapacity sets in, then it is too late all the way around.
Exceptions wherein a doctor has been discovered to pressuring oldsters to pull the plug can be handled in the same way that doctors attempt to force unwanted/unneeded surgery, etc. Hospitals could insist that any end of life counseling to someone without next of kin has to take place in front of a disinterested third party.
To say that a potentially nefarious exception should eliminate the overwhelming positive good of getting people to think about and plan for their last days is about as cruel as you can get.
End of life directives rarely come down to such concepts as “plug pulling.” End of life counseling is just as likely to let an elderly person express a firm desire NOT to pull a plug so that when their children are standing at their bedside wondering what their parent would like them to do, they have a clue. Most end of life documents do not (and could not) predict the exact medical crises that will need to be resolved in a person’s life. And most decisions are made by the elderly themselves, who can CHANGE THEIR MIND if the decisions they made five years ago are no longer operative. The point of such counseling isn’t to force — much less enforce — the precise decision a person might make — pull the plug or no — the point is to get someone thinking about what kind of choices they might be required to make so that they will be in a better position to make good and thoughtful decisions when the time arises, and let their family members know what informs those decisions. It also allows a person in the early stages of dementia to discuss with their loved ones what they would like to have done on their behalf.
I don’t care if this provision is in a health care reform bill. It would be good policy to at least pay doctors who take the time to have these discussions, but it’s not a big deal to me. But the discussion surrounding it is just further evidence of how psychotic our national political condition has become.
Spare your family the trauma of making your own end-of-lifedecision. If you don’t have a living will, you can no doubt get a form from your hospital’s social work department, or see your lawyer for a custom made one. And discuss with your family a very long time ahead of time (years if possible) just what ypu mean by its provisions. No, you can’t draw these things with fine lines, but I know from my mother’s death that any help from you will be appreciated. I’ve had a living will for almost 20 years.
About greedy doctors urging you to withdraw treatment too soon. Have no fear. Think about it — if a greedy doctor lets a patient die, he has one less patient. And that much less income.
Crystal, I’ve got my own baggage (complete with rifle and Yukon Jack), so no need to apologize. Family rancor does not dissolve into a misty happy ending when somebody gets terminally ill. I envy families in which there are no drama queens (or kings).
Ann, yes, The System will keep you going–or at least keep testing you, until you tell them to stop. They’re much more likely to ignore you if you have no insurance. Dad went on hospice with his top-notch insurance about the same time as an uninsured friend was diagnosed with leukemia. One was hectored with too much care because he has top-notch supplemental insurance on top of Medicare. The other one died from neglect, with doctors putting her off, refusing to make appointments, stonewalling treatments, etc.
And Barbara is right. The elderly can change their minds. My mother-in-law revoked her DNR order, then suffered a massive stroke and was unable to communicate, locked-in syndrome, brain damage. She was put on life support and nobody really knew what to do. Hellish.
Cute quotes about hugs and martinis trivialize these conditions and decisions. Charity requires me to assume that Msgr Fahey has more substantive things to say on the topic than the above.
What Jean said. Though the uncertainty and risk of not having insurance when my father died was horrible, it did mean that people were very straightforward about the potential of any care that he received (fortunately — ha ha that’s what it means to be fortunate when you don’t have insurance in the best health care system in the universe — stage IV pancreatic cancer that has spread to the liver is a certain terminal diagnosis).
What people need to understand is that the incentives are stacked completely in the opposite direction, in favor of too much needless care, and even in the Medicare program, that care is not free to the beneficiary.
Today’s NYT (widely circulated and on line at msn. for example) shows the “death panel” mantra is the product of consevative commentators trying to oppose Obama rather than reality based.
People who want tocriticize Msgr. Fahey are cherry picking a single line (like those who criticiized -with their great seriousness -Sotomayor on the “wise Latina” comment.) If these critics were present at a national/state or other major conferenc eand discussion, there would of course be humor and also real give and take when needed.
All of us understand, through some expeience, the end of life issues dear ones face. We deserve better discsion that the likes of the ex-Alaska governor to have intelligen tdiscourse on the matter.
“Yes, citing Sarah Palin for backup is rarely a wise move:
http://www.talkingpointsmemo.com/livewire/2009/08/sarah-palin-thanks-but-no-thanks-on-that-death-panel.php?ref=fpa ”
Hi, David,
The part of the Palin post that interested me was the Lane quote I pasted above. The TPM post you linked to doesn’t address it.
It’s entirely possible to be in favor of end-of-life directives (as I am, and apparently as Sarah Palin is) and yet oppose the part of the bill in question.
“Do you know of any priest who will talk about this with an elder parishioner without the parishioner first suggesting it? If he does, it that conversation no longer “purely voluntary?””
Fair point, Jimmy Mac. But let’s note a couple of things:
* Priests are frequently paid as much deference as doctors, so the dynamic seems similar. It’s not a peer-to-peer conversation, at least not necessarily. Doctors and priests are viewed as persons of authority. People don’t listen to them and respond to them in the same way as they listen to their brother-in-law or their neighbor. A priest or a doctor may initiate a conversation with the purest and most innocent motives, but the other party to the conversation is liable to read all sorts of other meanings into it. It’s part and parcel of being a doctor in a lab coat, or a priest in a white collar, or a cop in a uniform.
* Here’s the crucial difference, though; I don’t know a single priest who has a financial incentive to initiate such a conversation. Priests don’t get paid by the consultation. But this bill gives doctors something else to bill the government for – a government that notoriously underpays health care providers for health care.
It’s troubling. If a doctor wants to initiate an advance-directive converstaion with a patient, it shouldn’t be a billable item. That ensures that the doctor’s interest is the patient’s well-being.
Whatever a doctor receives in compensation from discussing end of life care will pale in comparison to the compensation he will receive in conducting unnecessary tests and invasive treatment, especially chemotherapy. Oncologists make more than 50% of their income from the chemotherapy drugs that are dispensed in their office. Any patient who turns down chemotherapy is a net loss. Indeed, I doubt if this provision would have all that much impact for this very reason.
Jim P. ==
I was my brother’s guardian, and well before he died I made an appointment with his MD to discuss his end-care. I wanted to be sure that my brother’s wishes were clear. It never occurred to me that the consultation would not be covered by Medicare or his Blue Cross. The MD certainly never sent him a bill.
What do other people do? Talk to the doctor’s in the hallways of the hospitals if they can catch them there? It isimply incomprehensible to me that such consultation would not be considered part of the patient’s medical care.
By the way, my brother had also signed a living will 20 years before, so I wasn’t sure if his instructions in it still held. So I talked to him about it. His mind was not good — some of his thinking processes were very bad. But he knew exactly what he *wanted*. And I think he welcomed the opportunity to talk about it. Furthermore, just talking with him about what he wanted and didn’t want also sent him the message that I intended to honor his wishes,
“What do other people do? Talk to the doctor’s in the hallways of the hospitals if they can catch them there? ”
Perhaps it happens the way most things happen in hospitals: the nurses talk to the patient and/or the patient’s family about it because the nurses are actually around. That was how it worked with my father-in-law’s DNR. The nurses had the form, and a family member signed it.
The hospital where I did my chaplaincy internship has a person on staff for ethical consultations about treatment. I’m told that these consultations can take place at the patient’s bedside. Whether or not physicians bill the patient for these consultations, or whether an insurance policy would reimburse, I don’t know.
For those of you still following at home, RNS editor Kevin Eckstrom has responded to Kathy’s amusing “they’re well-intentioned secularists” charge: http://www.religionnews.com/index.php?/rnsblog/get_this_lady_a_drink/
Huh! The reports are true, then. Investigative journalism is in fact dead.
The next question is whether having a secularist agenda–which, I repeat, is imho a perfectly legitimate way of being in public–is nonetheless intrinsically linked with flippancy and rudeness, We shall continue to await counterevidence.
No. The question is: why are you comfortable calling these people you claim to know “secularists”?
Oh, there’s always more than one question. Another would be, why are you acting like secularism is a bad thing?
Keep dodging.
You are slipping, Kathy–somehow I think you used to be better at this game.
You guys waste a lot of energy.
I don’t have a grudge against RNS. In fact I owe them–Eckstrom in particular. In fact, partly because of his fairness as a reporter there was a time when I thought religious communication was a way I could spend my working time. But it isn’t, for just this reason: the pull to secularism is too strong in the industry as a whole. Jim Wallis will always trump Richard Neuhaus in mass media. Vaguely religious ethics will always trump devotion. I’m not sure why that’s true but it is.
For about the tenth time, I don’t think it’s a *wrong* way to be, live, work, or act in public. But I do think it means most of the clerical money quotes are going to lean towards dismissing the theological basis of things, in favor of such Hallmark reasoning as we find in Msgr. Fahey’s “colorful remark.”
There you go again. What gives you the idea that Kevin Eckstrom is secularist? What gives you the idea that Jim Wallis, an ordained minister, is secularist? If someone’s ethics is insufficiently religious (whatever that means), does that make them secularist? How would you know? Have you forgotten how often the mass media phoned Neuhaus for quotes? The man never once dismissed “the theological basis of things,” whatever that means.
So you couldn’t try your hand at religion reporting because you’d be sucked down into the secularist muck? Surely you’re made of stronger stuff.
For what I hope is the last time, I don’t think it’s “muck.” But, it’s not for me.
However, come to think of it, there is a niche for Catholic reporting that could not be covered by an organization like RNS, nor by in-house diocesan organs, nor by pamphleteers for political change.
Let me give this some thought…