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Human Exceptionalism

Life and dignity with Wesley J. Smith.

Dying “Like Doctors” Should be Voluntary



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The New York Times is on a crusade to get their readers to consume fewer health care resources as they reach the end of life. Its latest effort toward attaining this end; an op/ed piece, “How Doctors Die: Showing Others the Way,” by NPR healthcare reporter Dan Gorenstein.

Reading the article, we learn that doctors tend to stop efforts at curative treatment sooner than the rest of us. Good for them. But what does that mean?  Not as much as the title implies. From the column:

There is no statistical proof that doctors enjoy a better quality of life before death than the rest of us. But research indicates they are better planners. An often-cited study, published in 2003, of physicians who had been medical students at Johns Hopkins University found that they were more likely than the general public to have created advance directives, or living wills, which lay out specific plans for care if a patient is unable to make decisions.

The problem is that Futile Care Theory laws and protocols explicitly permit doctors and bioethicists to ignore advance directives when the patient’s request is to receive extensive treatment rather than forego it.

Oh well, never mind. Technocratic advocacy in this field is all about cutting health care spending:

Patients and families often pay a high price for difficult and unscripted deaths, psychologically and economically. The Dartmouth Atlas Project, which gathers and analyzes health care data, found that 17 percent of Medicare’s $550 billion annual budget is spent on patients’ last six months of life.

“We haven’t bent the cost curve on end-of-life care,” said Dr. David C. Goodman, a senior researcher for the project.

Then there is the obligatory support for Obamacare:

The Affordable Care Act could accelerate those trends. Ezekiel Emanuel, the former White House health policy adviser, has said he believes that new penalties for hospital readmissions under the law could improve end-of-life care, making it more likely “we make the patient’s passage much more comfortable and out of the hospital.”

To be clear, I support people creating advance directives, and as a former hospice volunteer, agree that people often enter such care too late, rather than too early.

But these matters should be voluntary. The New York Times and many of its fellow travelers disagree, arguing for health care rationing to force people to do what they think is the right thing. (I don’t know Gorenstein’s position.) We must combat that agenda without tiring.



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