Wednesday, September 9, 2009

Talking About Death: Where Are the Grown-Ups?

Barbara at Compassion & Choices blog admonishes us to just grow up:

I have written that some national leaders apparently prefer to confine us in perpetual childhood, so we need never acknowledge, grieve over or plan for our own deaths or the deaths of those we love. A peculiarly childish approach to end-of-life issues permeated the August recess, complete with terrifying fabrications and fear-based tantrums. In their coverage of town hall discussions media outlets reinforced a perception that we are children, more interested in playground bullies and shouting matches than in substantial discussion of the issues and the facts. The Washington Post ombudsman writes that its readers think their recent coverage has focused too much on the combat and too little on what’s actually being proposed.


What does being treated as an adult look like? One sign is the medical system gives you full and frank information, compassionately supports you through painful emotions and trusts you to make decisions for yourself, based on the facts. H. Gilbert Welch, head of a research team at Dartmouth University wrote last week in the Los Angeles Times, “American men have been engaged in prostate cancer screening for almost two decades with relatively little effort given to communicating the trade-off between the benefit and the potential harm of unnecessary treatment. The time has come to make that trade-off clear.” So far no one has accused Dr. Welch of establishing death panels, but if he keeps advocating for enhanced communication and patient choice, he may have reason to worry.

Powerful forces resist bestowing authority on individuals to choose appropriate medical care for themselves. Behind the hyperbole about “death panels” lies a more nuanced attack on advanced directives themselves. The language is more subtle but its intent is unmistakably patronizing. These advocates would “protect senior citizens,” from their own stated wishes, claiming seniors are “vulnerable people,” “easily susceptible to pressure,” and not capable of making important decisions. This line of thinking asserts advance directives should be “only one factor a doctor takes into consideration” because the patient who wrote it “didn’t know at the time what it would be like.” Some even assert your living will should be ignored completely because others know what’s best for you. Father knows best.

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