Were "death panels" a teachable moment for palliative care?

Source: Palliative Care Foundation

This past summer, thanks in large part to Sarah Palin, we were inundated with sound bites about death panels, pulling the plug on grandma, and saving the government money by dying a little sooner.
Palin’s emotionally manipulative Facebook post appeared on August 7. “The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil.”
A great deal of misinformation was bandied about, and unnecessary fears were purposely inflamed to gain political advantage. There may be a silver lining to this cloud, however.

A teachable moment?

Dr. Eric Widera, who writes for the blog GeriPal, did a clever comparison of search terms using Google Insight. Searches for the term “death panel,” he found, peaked in August and then died out.
Searches for the terms “palliative” and “palliative care” also spiked in August, but interest in the subject has continued to rise. Google Insight reports a 160 percent increase this year in searches for the words “palliative care definition.”
The public is educating itself about an important aspect of health care that was previously obscure. As Widera comments, when it comes to the provision in the health care bill that would have reimbursed physicians for discussing end of life issues with patients, we may have lost the battle but the war is far from over.

What is palliative care?

Palliative care is the use of modern medicine to reduce suffering. It aims to improve the quality of life for patients and their families when there is a life-threatening illness.
Sometimes the treatment for disease – such as chemotherapy, radiation therapy, confinement to a hospital – increases a patient’s physical discomfort and emotional distress. The aim of palliative care specialists is to design a program that maintains a patient’s quality of life. It’s not limited to patients who are terminally ill.
You can read a nice statement of the aims of palliative care on the University of Utah Health Care website.
The World Health Organization includes the following points in defining palliative care:

• Provides relief from pain and other distressing symptoms
• Affirms life and regards dying as a normal process
• Intends neither to hasten or postpone death
• Integrates the psychological and spiritual aspects of patient care
• Offers a support system to help patients live as actively as possible until death
• Offers a support system to help the family cope during the patient’s illness and in their own bereavement
• Uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated
• Will enhance quality of life, and may also positively influence the course of illness
• Is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

The GeriPal blog

GeriPal – A Geriatrics and Palliative Care Blog – is a recent addition to the growing Internet resources on aging and end of life issues. Among its stated objectives is a desire “to change the world.”
That’s certainly admirable at this time and in this culture. Judging by the “death panel” farce this summer, it appears Americans are extremely uneasy when reminded that they’re going to die. Members of the baby boom generation, who ushered in the idealization of youth, are rapidly becoming “senior citizens.” A change in attitude towards aging and death is inevitable, and the blogging community will certainly make a substantial contribution to that change.
One recent post on GeriPal is called “Overuse of Pain Medications in Hospice and Palliative Medicine.” It discusses an article from The Lancet that was co-authored by one of GeriPal’s regular bloggers.
The article uses Tolstoy’s novella, The Death of Ivan Ilyich, to consider the question: Can a “good death” include physical and existential suffering? “Tolstoy’s character finds redemption in his suffering; he remains conscious through the agony of a prolonged and painful death and ends up with a greater understanding of life. … [S]uch a moment of clarity may no longer occur if we rely on practices that promote complete freedom from suffering through the over use of pharmaceuticals.” An interesting and thought-provoking question.
I’m reminded of another recent essay in The Lancet that discusses, among other things, burnout among doctors who work with the dying. It cites Steven Hsi’s memoir, Closing the Chart. “Despite the compassionate care he received, Hsi was most troubled by his physicians’ failure to ask the crucial questions: ‘What has this disease done to your life? What has it done to your family? What has it done to your work? What has it done to your spirit?’ As suggested by Hsi, physicians faced with questions of unexplained suffering and death are loathe to ask existential questions that have no biomedical answer.”
GeriPal is a blog that’s not afraid to ask the existential questions.
Related posts:
Health care: Reminding people of death triggers irrational emotions
The doctor/patient relationship: What have we lost?
The video of Neda Soltan’s death
The death of a child
Ich Habe Genug on Thanksgiving
Death be not visible