Doctors and end of life care

(NECN: Anya Huneke) – Since former Vice Presidential candidate Sarah Palin wrote the words “death panel” on her Facebook page last week, a debate has been raging over a section of the House health care reform bill. The provision seeks to reimburse doctors for consultations with patients about end of life care. In his three decades in medicine, Dr. Allan Ramsay has had to have many challenging conversations with his patients. Dr. Allan Ramsay: “We get consulted to see patients who have critical, life-limiting illnesses.” As medical director of the palliative care service at Fletcher Allen Health care in Burlington, Vermont. He focuses on symptom and pain management as well as advanced care planning– Something he didn’t learn much about in medical school. But medicine has changed, he says, and allows, along with technology, patients to live much longer. Allan “We have critical care, life-supporting therapies here that can keep people alive no matter what.” Making those conversations about end-of-life care, he says, that much more important. They’re also at the center of a controversy rooted in Washington, and rippling across the country. A provision in a health care reform bill moving through congress has been a point of contention for some- including former Alaska Governor Sarah Palin. The disputed section – called “advanced care planning consultation” – would authorize Medicare to reimburse doctors for voluntary consultations with patients about end-of-life care. Palin – on her Facebook page – wrote that such a proposal would lead to health care rationing… referring to the consultations as “death panels.” Sen. Bernie Sander(I) Vermont: “All of that is lies- absolutely untrue. It’s asinine, unacceptable behavior.” Vermont Senator Bernie Sanders is upset about what he – and others, including president Barack Obama – call wild misrepresentations of the legislation. Pres. Obama: “The way politics works is that people who want to keep things the way they are are trying to scare the heck out of folks.” Amidst all the controversy, the Senate Finance Committee has decided to scrap the end-of-life provision from its version of the bill. the panel’s top republican says the concern is that it could be misinterpreted and implemented incorrectly. Dr. Ramsay believes behind the decision are fear and misunderstanding, two things Sen. Sanders says are running rampant as this issue continues to gain traction and makes its way through Congress – some versions with, some without the end-of-life provision. Sanders: “If you heard when you were 55-years-old you’d be asked to die- that a death panel out there was going to encourage you to end your life.” The truth, Dr. Bob Macauley, Fletcher Allen’s director of clinical ethics says, is that the consultations would be an option, not a mandate for patients, once every five years. And the reimbursements from Medicare would allow doctors to participate in them more easily and comfortably. Physicians are overworked- they have 15 minutes to see a patient… and after they get through what brought them in- they don’t have time to go into a long discussion- because, if it’s done well, do take a lot of time, and they can’t bill for that time. William McAllister is nearing the end of what he says has been successful treatment for cancer. He knew there was a chance he wouldn’t beat it, though. So he was glad to have a conversation about his wishes for care. At the heart of this issue, some say, is quality of life– which only improves when patients decide how they’d like to be treated at the end of their lives. But critics maintain the plan aims to save money at the expense of peoples’ lives– which dr. Macaulay says is only half true. He hopes this legislation will help change that, but it’s clear that won’t happen without a fight.