[Bob Ray Sanders] Talking frankly about planning for end-of-life decisions

“You come into this world on the way out.”

All my life, I have heard that axiom. Even as a child, I understood it meant I would die. Of course, as a youngster, I assumed that day would be many years away.

Over time, I learned that death is not reserved for the old. Children, young adults and people in their prime could also get a visit from the Grim Reaper.

Death is no respecter of persons ― no one can escape it, including the rich and powerful accustomed to buying or ordering anything they need or want. People can’t buy their way out of this.

Sometimes, especially after long suffering, death can be a welcomed relief. Most times, I suspect, it is a dreaded, frightening unknown that causes many to fight it, rather than embrace it, right to the very end.

As one who has watched relatives die, I hope that when my time comes I can go like those who accepted their fate, made their wishes known, surrounded themselves with loved ones and fond memories, and got the kind of end-of-life care that made their leaving a bit more comfortable and less painful.

This is a subject many people don’t like talking about, but we should discuss it, particularly at a time when a national debate over health care has degenerated into false claims about government-run “death panels” that would decide when Grandma should die.

That is nonsense, but it worked well enough that a provision to pay doctors to talk to patients about end-of-life care was stripped from the health care reform bill that Congress passed.

I sit on the board of a nonprofit hospice. Most, if not all, of the board members have had close relatives who received hospice care. We have seen firsthand the benefits to patients and relatives alike.

Most people who have experience in helping to care for a terminally ill person, with the assistance of hospice, are offended by the political demagogues who misrepresent end-of-life care.

And, frankly, many doctors find this subject hard to discuss with patients. Some need training in how best to do it, while others are compassionate masters of explaining options that patients have as they prepare to die.

Although the end-of-life provision was taken out of the health care law, a Medicare rule that went into effect New Year’s Day will provide payment to physicians to have such discussions with patients annually.

“The new rule says Medicare will cover ‘voluntary advance care planning’ to discuss end-of-life treatment, as part of the annual visit,” The New York Times reported.

“Under the rule, doctors can provide information to patients on how to prepare an ‘advance directive,’ stating how aggressively they wish to be treated if they are so sick that they cannot make healthcare decisions for themselves.”

As news gets out about the provision, no doubt some will see it as the Obama administration using the back door to establish those dreaded “death panels” that Congress rejected.

To propagate such obvious distortions is not only disingenuous, but also a disservice to those who are very ill, their families and the medical profession, whose mission should be to provide the best care ― not the most expensive, aggressive or invasive care ― for all patients.

The Times article, quoting research from the British Medical Journal that was included in the preamble to the Medicare rule, said:

“Advance care planning improves end-of-life care and patient and family satisfaction and reduces stress, anxiety and depression in surviving relatives.”

From experience, I know that to be a fact.

If you haven’t had that discussion with relatives, make a vow to do so as we begin this new year.

By Bob Ray Sanders

Bob Ray Sanders is a columnist for the Fort Worth Star-Telegram. Readers may write to him at: 400 W. 7th Street, Fort Worth, Texas 76102, or via e-mail at bobray@star-telegram.com ― Ed.

(McClatchy Newspapers)

(McClatchy-Tribune Information Services)