End-of-Life Lessons From the Cheapest Place to Die

Aug. 10, 2009— -- What was once a personal conversation between a family and their doctor has turned into a public battle over whether the government should be involved in such sacred decisions.

The debate over the government's involvement was prompted by a proposal in some of the health-care reform legislation on Capitol Hill that would allow Medicare to reimburse doctors for talking with patients every five years about what type of end-of-life care they want.

At town hall meetings, in e-mails, online and on talk radio, inflammatory and often incorrect claims about the proposal are popping up faster than the Democrats can refute them.

"Adolf Hitler issued six million end of life orders," says a man at a Pueblo, Colorado rally against Obama's health care reform, in one popular YouTube clip. "He called his program the Final Solution. I kinda wonder what we're gonna call ours."

Former Alaska Governor Sarah Palin weighed in over the weekend writing in a FaceBook post:

"The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's "death panel" so his bureaucrats can decide, based on a subjective judgment of their "level of productivity in society," whether they are worthy of health care. Such a system is downright evil."

Conservatives critics are calling it a path towards government sponsored euthanasia.

"You see when discussion about whether or not the continuation of one's life has a nexus with the U.S. treasury saving money, that's a very dangerous recipe for those who can often time be the most vulnerable amongst us," explained Republican Michigan Congressman Thaddeus McCotter.

But the proposed legislation -- contained in House committee versions of the health care bill -- does not call for a "panel" or a "board" to make decisions. It simply allows doctors to be paid for talking to their patients about decisions that might eventually have to be made by them or their families.

On Saturday President Obama said the criticism is misleading Americans.

"Let me start by dispelling the outlandish rumors that reform will promote euthanasia," Obama said. "That's simply not true."

"The intent here is to simply make sure that you've got more information and that Medicare will pay for it," the President said at another townhall meeting with seniors.

About 33 percent of an American's total medical spending comes in the last year of life. Obama has argued millions of dollars could be saved if Americans simply talk more about what they want for end-of-life-care.

Model for End-of-Life Care?

Those types of discussions are a normal, everyday occurrence in La Crosse, Wis.

"It's not unusual to hear that kind of conversation here in the coffee shop," said Todd Ondell, 60, owner of Grounded Specialty Coffee. "I think it's an awareness that the community has about those types of conversation and the fact that they have to have them."

In 1991, Gundersen Lutheran hospital in La Crosse initiated the program that is known around the country as "Respecting Choices" to urge families to talk about how they should care for their loved ones before a crisis hits. The program has now spread city-wide.

Typically, hospital staff members begin meeting with patients when they are 55 or 60 years old.

"Once someone has a medical crisis, we don't have time to have these discussions," said Bud Hammes, director of medical humanities at Gundersen Lutheran hospital. "This is really meant to help patients and their families to receive the right amount of care at the right time so that we neither over treat or under treat any patients"

The discussions are also saving people money, according to Hammes. In La Crosse, the average expenditure on health care in the final year of a person's life is about $18,000, compared to the national average of $25,000. Chronically ill Medicare patients spend on average $46,000 in just the last six months of life.

Family Decisions

Years ago La Crosse resident Ann Kottnour, 53, spoke to her mother Margaret Peterson, 89, about what she wanted the end of her life to be. Together they wrote a medical directive outlining Peterson's specific requests.

"By the time we completed it her health had started to fail," said Kottnour.

Peterson has Parkinson's disease and dementia and when she ended up in a nursing home following a medical emergency in January, Kottnour brought her home, knowing her mother did not want to die there.

"We have a tendency to always want to make it better, and to treat anything and everything that we know how to treat. And there are times when people just want to be done," said Kottnour, a nurse. "As we all age I think we should have the choice if we think it's our time to let go."

When Joe and Janice Hauser moved to La Crosse at age 70, every physician told them to speak to a counselor and begin creating a medical directive.

"I think it's important to all have down on paper, so your physician knows and your family knows what you want," Janice Hauser said.

These conversations have resulted in more than 85 percent of La Crosse residents having a medical directive in an electronic file by the time they die.

While some ask for aggressive life-saving measures, most patients ask for limitations on their care in the final months of life.

"When you really help inform patients, really help them make these decisions, involve their families so it's really a shared decision and everyone's on the same page, people don't want to die hooked up to machines," Hammes said.

Kottnour said she just wants her mother to die with dignity.

"Our mother has given to us all of our lives and has been there for us and so I feel that it's our turn to give some back and be able to follow through with her wishes," Kottnour said.