The debate about euthanasia has gone too far.
Someone's intent to do a good and necessary deed has now been transformed into a hideous misrepresentation that not only affects our humanity and dignity as a nation, but goes to the heart of the physician-patient relationship and the responsibility that physicians have to provide healing and comfort as well as treatment.
That's our oath, and that's what we are supposed to do. Recognizing that imperative is not something that should be punished as an evil act.
Perhaps some background would be helpful in framing the issue:
Medicare is supposed to only pay for medically necessary and effective care. It is not allowed to provide other services such as screening or prevention unless specifically authorized by Congress.
End-of-life counseling falls under the category of non-covered services, but probably gets into the payment mix as part of other billing codes doctors use to get paid for more routine "evaluation and management" services.
Providing explicit payment for this service will encourage appropriate and needed discussions between physicians and patients on this very important, difficult and humanitarian topic.
For years, many of us have been concerned about end-of-life issues, such as living wills, pain management and hospice care. Counseling our patients as they age about their options -- and equally important, understanding what our patients' wishes may be -- is an honored part of the physician-patient relationship, especially for primary care internists, family physicians and oncologists. The reality is that we have not been as successful as we need to be in encouraging these discussions.
We have tried for years to get people to sign living wills and provide durable powers of attorney for health care. Medical professionals need guidance -- preferably in advance of the moment -- on what patients want done, either at the time when their lives are coming to an end or when they may not be able to speak for themselves.
There is nothing inhumane or inappropriate about that discussion. It is a discussion that no one wants to have, and one that is never easy. But it is the right thing to do, and there are plenty of medical and patient organizations who have devoted considerable effort to encourage these discussions.
There is nothing about the discussion that is preordained to limit care. In fact, some patients and families want "everything done" even when medical professionals find that directive to be against their own ethical instincts.
I learned these lessons early in my career as a medical oncologist. Having discussions about end-of-life is an unfortunate reality in cancer care.
What surprised me at the time -- when there was less I could do for many patients than is the case today -- was the number of patients and families who told me they were more interested in comfort than they were in treatment. They wanted to be certain someone would be there to care for them through their last days or months and ease their pain and suffering more than they were concerned about getting the next drug, which more likely than not would have given them more discomfort than hope and relief from their suffering.
Those discussions had an incredible impact on me as a person and a physician, and the experiences remain with me today.