Death Panels

The life as a child of two lawyers is different than most. I once lied about breaking a couple of window shingles on the outside of my parents' house (it was obviously those two boys up the street). My mother father sat me down at the kitchen table and went to work as expert litigators. I swore on a Bible and all that jazz, and I wouldn't be surprised if they turned off the AC just to get me to sweat a bit. The only difference was that I had no counsel myself, no one on my behalf to yell, "OBJECTION!" The tag-team prosecution took about 3 minutes of persecution to cross the witness down to tears, and a notarized confession was then hereby therefore ergo henceforth drafted.

When I wanted to raise my allowance as a 10 year old, I essentially had to construct a legal proof showing precedence through common and constitutional Swendiman law to get a $0.50 a week increase. Even now, I have to watch my language when I come home (and I don't mean my French). My mother cringes when I say "I did good" or "It was real tough" (it's "well" and "really" Robby; we raised you better). They couldn't get me to say "yes sir" or "yes ma'am" until I started working EMS.

I say all that to say this: when I was 18 my parents made me write a will. It wasn't complicated – I signed one hundred percent of all my assets over to my sister (even my chess trophies) - but it was an important life lesson. I also detailed in a living will how I do not want to be kept on a ventilator or a feeding tube. I never want to be a vegetable, and I don't want to frozen for all eternity so 500 years later I can be revived. Some people put off thinking about death until it's too late. At eighteen I had little choice. Bad things happen. You never know when you could spontaneously drop dead from a congenital heart defect or be hit by a drunk driver on the way home from work. There are things in life that you can't plan for... but you can be prepared.

Comparative-effectiveness research (CER) became all the buzz politically because people thought it meant the government would begin to ration care. Medicare would pull the plug on life-saving treatments, and Granny's case would be sent to the government "Death Panels," where she would invariably lose, and her life would be ended by the Obamistas. CER was demonized to the point where lawmakers even had to change the name to "patient-centered outcomes research" to erase the death squad stigma. Two-thirds of all Medicare spending occurs in the last 6 months of a patient's life, so obviously in order to cut costs, let's just get rid of Granny before the 6 months begin!

It reminds me of my favorite anti-Obamacare war cry, "Keep the Government out of my Medicare!"

Love it.

In the simplest terms, CER takes a look at two medications, procedures, or what have you, and sees which is better for the patient. If two pills are given for a heart condition, and one does not work as well, why is it on the market? CER looks at different subpopulations to account for variables across different ages, ethnicities, and health statuses, then makes recommendations to providers using evidence-based practices - the gold standard for American medicine. No one's out to kill anyone, or stop Granny from getting her new hip. I support CER because I want to know what is best for my patient, regardless of cost. And if some overpriced, ineffective treatments get left in the dust, then too bad. Tell the drug companies and medical device makers to come up with something better. I care about Granny.

But it's going to take more than that. As Americans, I think we have to take a look at how we value quality of life. Does Granny really want make it to 120 if she is in pain for the last third of that? Okay, if she does, but many times family members and doctors are guilty of pushing medicalization for Granny, when she perhaps it is not in her best interest. Ask Granny what she wants? I think many times we would be surprised. As a future physician, I think my care needs to be dedicated to the patient's needs, not the family's wants.

If I live to 80, then frankly I think my death should be a celebration. Eighty years! That's incredible. I got to walk this earth for the better part of a century, and hopefully I made a difference. I never want to be a burden on my kids, and I don't want to live the last 20 years of my life not remembering them. I'll take peace over procedures.

Now if I'm 40, stent the hell out of me.

Just write a living will; make your wishes known. It'll make decisions for your family members and health care providers a whole lot easier down the road. And maybe that will bring you and your loved ones some extra peace.

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A very interesting article about death can be found here:
http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html

Both my thoughts and this author’s are perhaps over-simplified, but some sentiments do ring true.