Ted Kennedy Wanted a Good Death

A great NY Times piece about the way Ted Kennedy handled planning for his death—from his cancer treatment, to getting his advance directives in order, to spending his last nights eating ice cream and watching James Bond movies with his wife Vicki. 

I'm happy Kennedy had the time and the foresight to plan his last days like this, and I hope others will think a little about doing the same when their time comes when they read this story. 

A High-Profile Bioethicist!?!

What did these parents feed their children? One is White House Chief of Staff, one inspired an HBO show about Hollywood agents, and the another has become maybe the first ever famous bioethicist. 

The insanity of all of that aside, this NY Times piece on Dr. Ezekiel J. Emanuel and his role in advising President Obama's on healthcare legislation is a great read. If for no other reason, it is yet another example of how issues that need to be carefully, reasonably discussed get spun out into crazy, maddening, thoughtless rhetoric in the political arena.  

Betsy McCaughey's Daily Show Appearance

I'm posting Jon Stewart's interview with Betsy McCaughey, former Lieutenant Governor of the State of New York who is credited with starting the myth that the current healthcare reform bill will lead to senior citizens not getting medical care. In other words, she is the mother of the hysteria about elderly people being encouraged to sign DNRs even if they don't want to, being told they have to just sit back and die instead of receiving actual care. 

And according to political gossip, McCaughey inspired Sarah Palin's controversial remark about "death panels." 

The Daily Show With Jon Stewart	Mon - Thurs 11p / 10c
Betsy McCaughey Pt. 1
www.thedailyshow.com
Daily Show Full Episodes Political Humor Healthcare Protests

The Daily Show With Jon Stewart	Mon - Thurs 11p / 10c
Exclusive - Betsy McCaughey Extended Interview Pt. 1
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Daily Show Full Episodes Political Humor Healthcare Protests

The Daily Show With Jon Stewart	Mon - Thurs 11p / 10c
Exclusive - Betsy McCaughey Extended Interview Pt. 2
www.thedailyshow.com
Daily Show Full Episodes Political Humor Healthcare Protests

The interview shows how complicated this bill is, but also, how easy it is for it to be twisted to one person or another's purposes. Also, it's a great interview on Stewart's part, if you can stand watching a little confrontation. He does an excellent job of cutting through her double-speak and forcing her to point to exactly where the bill says what she is claiming it says. (Which by the way, it doesn't.) 

Apparently, McCaughey resigned her position on the board of directors of the Cantel Medical Corporation following this interview. 

But here's a silver lining: Maybe this hyperbolic, fear-mongering spin is finally backfiring, and now, people will actually start to really think about living wills and advance directives in a serious and calm manner. We can hope, right :)

Medical Futility Statues

Thaddeus Pope of Medical Futility Blog has worked on a piece that has just been published in a new book called The Many Ways We Talk About Death in Contemporary Society. 

Thaddeus' piece is titled "Medical Futility Statues: Can They Be Resuscitated?" A full table of contents is available here. 

Here's a publisher's description of the book as a whole:

"This interdisciplinary work examines the representation of death in traditional and 'new' media, explores the meaning of assassination and suicide in a post 9/11 context, and grapples with the use of legal and medical tools that affect the quest for a 'good death.' The contributors treat their interrelated topics from the perspective of their expertise in medicine, law, psychology, anthropology, sociology, political science, religion, philosophy, literature, media, and visual culture."

Congratulations Thaddeus. It looks like a fascinating read. 

Euthanasia

I wanted to share this with you all.

Hospice Physician in the comments section of last Friday's post, helped me clarify my paraphrased definition of euthanasia. 

"To address your quote below:

'when a medical practitioner directly brings about death by administering medicine to the patient'

This is true but to clarify even more, euthanasia is a deliberate act with the intention of causing death in a patient. There is an ethical principal called the "Rule of Double Effect" which states, a medical practitioner is not acting unethically by giving pain medication, for example, that may lead to death, if the intent is not to cause death but to relieve pain/shortness of breath or promote comfort."

I'm always a fan of further clarity. Thanks Hospice Physician!

Details, please

Newsweek has this piece that is supposedly debunking seven myths of the current healthcare debate. 

While debunking the myth that the House bill requires suicide counseling, this article states:

"Euthanasia, on the other hand, is legal in only three states, making it even more unlikely to be a major part of the federal health plan."

Pardon me, Newsweek, but euthanasia is not legal in any state. But death with dignity is legal in a handful of states.

The proper terminology makes a huge difference. Euthanasia in general means a mercy killing, but in practice usually refers to when a medical practitioner directly brings about death by administering medicine to the patient. Most people think of what vets do with their pets when they hear the word euthanize.

Death with dignity is a more specific phrase that refers exactly to the recently passed into law procedures in which the patient is prescribed medicine that they can take on their own to bring about their own death, on their own terms, at their own time, when they're comfortable doing so. And all along, the patient can decide not to go through with the practice. 

General euthanasia is not legal in any state. The specific act of death with dignity is legal in certain states. 

Besides which, since death with dignity is such a heated topic, and something that has the potential to make a revolutionary difference in the amount of choice and control people have over the way in which they approach death, they manner in which we speak about it is incredibly important. We need to be careful about what we're referring to and be clear about what we're talking about. I realize this was a side issue in this article, but a news magazine should be better at articulating the details. Simply calling it euthanasia is flippant, careless, and inaccurate.   

Death with Dignity Panels

So, I've gone from thinking I wouldn't post anything on the healthcare-reform debate to posting on it twice in two days. 

The Senate has removed the portion of their bill that allows Medicare to pay doctors for counseling sessions with patients regarding advance care and end-of-life planning. (Right now, it's still in the House version of the bill.) 

Just to be clear, these counseling sessions are happening already. End-of-life planning often occurs when someone becomes terminal. Patients will sit down with their team to discuss their options for resuscitation, hospice care, pain management, comfort, etc. 

What this particular bill provision addresses is not the actual conversation but Medicare coverage of the conversation. By paying doctors for time they are now not getting paid for, they may be encouraged to hold even more end-of-life consults—thus allowing more people to openly discuss how to create the best death possible for themself, making this blogger very happy. 

And yet, proponents of it are pushing fear in our faces, speaking as though passage would magically make death come sooner. As though the government is going to be paying off doctors to tell patients it's time to go. 

The American Medical Association supports this provision. The National Hospice and Palliative Care Organization supports this provision. These are two highly reputable organizations. Plus, to insinuate that individual doctors would go against their ethical, sworn duty to "first do no harm" and actually give up on patients because they're given money from Medicare, is incredibly insulting. 

Sarah Palin has infamously gone so far as to call these "death panels," which is so absurd, I don't even know how to address the claim.

When I hear these arguments, I can't help but flash back to some of the anti–death with dignity arguments. 

One of the big arguments against death with dignity—one of the fallacy, weak arguments—is that insurance companies will use the legislation to push people into death so that they don't have to pay for continued treatment. (Remember the Martin Sheen ad?) 

Well, if you replace "insurance company" with "the government" and "death with dignity" with "healthcare reform," this is basically the same argument being paraphrased and reshot at us. 

It's inaccurate, and it's fear-based, and it's a shame that it looks like it might pull the public away from more information and better choices. 

When it's Your Neighborhood

I was just reading details about the 72-year-old shopkeeper in Harlem who killed two robbers while defending his shop. 

I'm shocked by how violent this whole situation is, even for New York City, even for Harlem—which you know if you've lived in New York, can be pretty good or can be pretty bad, depending on which block you're on. And I never knew Harlem well enough to know how this particular block is. 

But even if it were a rough neighborhood, for four men to enter a shop in the middle of the afternoon, announce their intent to rob the place, and pistol whip one employee, and then for that to be followed by the elderly shop owner opening fire with a shotgun on all four robbers, killing two and injuring the others. Man! That's graphic. 

I feel bad for the neighborhood. Something like that would be tough to shake off. It would be difficult to go back to the illusion of safety and invincibility—something we all need to some extent to go through everyday life. 

Once, when I lived in Seattle, there was a fatal police shooting on my street. Just that left me feeling like an exposed nerve for a couple of weeks. I don't know how you would reclaim your sense of home and community after having this down the street. 

Take a Pain Pill

Hospice Blog has an excellent post today about President Obama use of the term "end-of-life care." 

The Hospice Guy has noticed that Obama uses end-of-life care to refer to the elderly simply seeking healthcare, instead of differentiating between people who are actually in their last days, needing care that will take them through to their death. And in so doing, he worries that Obama is confusing the intent of hospice as a place where people can go to die in peace and as much comfort as possible once they have CHOSEN to die. 

As the Hospice Blog points out, Obama's use of the term is almost a window into how little he really knows about the day-to-day realities of the medical world. And whether you're for or against public healthcare, it's a little scary to think of anything but the utmost experts revising our healthcare system. Here's the video he shares.

(Please note: the title of this YouTube film is misleading. Obama is, of course, not that dismissive to the woman.) 

The woman asked if her mother, at 99, could have had a pacemaker under public healthcare, even though she was old because she had much higher than normal quality of life. I think the bigger question she was getting at was, what if it looks bad on paper, but when you see the patient in person, you can understand where a procedure makes sense—hence the reason she says, "A picture is worth a thousand words." And Obama's answer is disappointingly to infer that the surgery was not going to help (even though it did) and to tell her mother to take a pain pill!? 

He's telling her, no, right? I've watched this about five times trying to get through the political speak, but that's what's happening here, I think. He's saying, no, in essence, that the bigger concern is trimming the waste from the healthcare system and her individual mother matters less? Other interpretations? 

I love that people are discussing healthcare in such a high-profile way right now—especially when it comes to end-of-life matters like resource allocation in the last years, what constitutes quality of life that is good enough, etc. But I hate that the discussion is being handled with such vitriol. And I hate even more that a bunch of politicians, mostly constitutional lawyers, with voters and elections on their minds are going to decide how healthcare issues should be managed. 

I hope the legislators are consulting some good healthcare professionals behind the scenes. 

Never trust a corpse

I meant to catch this movie at the Seattle International Film Festival, but just didn't get around to it. So I'm excited to see this review at NPR.org; it gives me hope that wider release is on the way, and I might get a second chance.

I Sell the Dead recounts the exploits of two grave robbers as one of them is about to face the guillotine for his crimes. The horror film is supposed to be more comedy than gore, which is why I'm interested ... not to say that it isn't ghoulish and frightening. 

During SIFF, it played at a midnight showing, and from what I can glean, that pretty much characterizes the type of movie this is: fun, startling, a little gross, not too serious, dealing with the undead. What more could you want in the witching hour? 

It is directed and written by Glenn McQuaid and stars Dominic Monaghan and Larry Fessenden.   

Here's the trailer. 

Palliative Care Grand Rounds

The latest edition of Palliative Care Grand Rounds is up at Risa's Pieces, the thoughtful blog written by Risa Denenberg. 

Lots of great links to bloggers taking on the current healthcare discussion, in terms of end-of-life issues. And as always with PCGR, links to new bloggers you probably didn't realize were out there. 

New Blog from a Hospice Physician

Check out this brand new blog (started July 19th) called Hospice Physician's Blog. 

As the title suggests, it's written by a hospice physician, and has entries on the doctor's experience explaining the benefits of palliative care to reluctant family members, whether chemotherapy is always used in the most effective way, and whether physicians always know when their patients are dying. 

It's always good to have another palliative-care focused blog in the community.