I think most of the tiny segment who read this blog know that I prefer civil conversation but there are times when enough is enough. I despise liars. In my profession it is intolerable to lie considering the stakes involved. Wish it were so in politics.

There are many questions that need careful debate and consideration before we set on a healthcare reform plan. But liars are setting the agenda.

Case in point: Representative Earl Blumenauer (D, Oregon 3rd) added an amendment to the healthcare reform package being discussed in Congress. It was an addition that was universally favored by healthcare professionals and advocates of the elderly Simply stated it allows for reimbursement to clinicians when they have end of life discussions with patients in their offices. This is important legislation for a number of reasons.

As a physician I have seen the havoc wrought to patients and families when end of life issues don't get hammered out before it's too late. A lot of suffering and heartache is the result when the wishes of a patient are not known and respected. A lot of futile and expensive care gets provided to those who would not have wanted it if someone had bothered to have the conversation with them when they were alert. Physicians are not required to provide futile care but in the end it sadly is seen as far easier just to do it rather than trying to explain the subtleties of futility in endless depositions and to armies of lawyers over the next several years.

All hospitalized patients are required to have a 'code status' determined in writing when admitted as part of the metrics used to determine 'quality of care'. In the absence of information it is an American legal presumption that people would prefer to try everything to live unless otherwise recorded. This contrasts to Great Britain where just the opposite is presumed.

What Earl Blumenauer's amendment does is finally pay clinicians to provide counseling services to patients so that they can make informed and prudent plans for unfortunate contingencies should they arise. This is a very good thing. It gets the need for these conversations out in the open where it needs to be. I know from 20 years of experience that having these conversations helps both the patient, their families and their care givers. It results in more appropriate and humane treatment of the elderly. (There is a fine line between preserving life and prolonging suffering that all clinicians know too well. We have seen far too many people on the wrong side of that line.)

It's also a good sign that emphasis is finally being shifted toward true healthcare rather than our system of sick care. Caring for the overall needs of the individual rather than just trying to patch them up when ill or injured is a laudable goal that has been hampered by a lack of financial support. As the old saw goes, "an ounce of prevention...". Valuing the important work of counseling patients is an important part of healthcare reform.

It is not euthanizing the old. To say that it is - is a lie. And a particularly hateful and crass one at that.

All around the country ads and emails are flying claiming that this is a plan to euthanize the old. That is a lie. The people that started this rumor are liars.

Absent a plan of their own, or beholding to special interests who line their pockets, the opponents of reform efforts have nothing to offer but lies. Do yourself and everyone else a favor - call them out as liars.

As I said, there are plenty of issues to debate about healthcare but lies and liars have no place at the healthcare table. In 3 years the baby boomer generation starts reaching Medicare age. Unless something other than neocon bashing or insurance industry pandering gets done before then, the country will be on a slope to bankruptcy.


Harvey said...


Right on!!!
As a Cancer surgeon, I have been faced with these terrible problems more times than I can count. Recently, I have gone through this from the other side (my mother-in-law). In her case, my wife, who is a nurse, was able to see to it that the necessary understandings and documents were in place for her mother's final illnesses. Even so, there were several situations regarding care decisions in which I was able to intervene on her behalf, whereby unnecessary and/or excessive measures, which were clearly not in her best interest, could be avoided.
Anyone who would object to end-of-life counseling for patients and their families, especially since they are not forced to avail themselves of this counselling, clearly sees fit to put either their own "religious" biases or, worse, financial interests above the mercy and palliation that patients can be provided by trained and caring professionals. If such is true, lying is far from the biggest "sin" that they are committing.

Stacy S. said...

Pliny, you wouldn't happen to be talking about my favorite EX-governor - would you??

Anonymous said...

Well said.

Pliny-the-in-Between said...

Actually I wrote this as an attachment that is going out to refute some of the emails my father-in-law receives from his upstanding moral brethren (he's a great guy which is why he's sending this back out) before I read Palin's latest.