Doctors should bill for making life-or-death decisions

  • Article by: Ford Vox , Bloomberg News
  • Updated: August 28, 2013 - 12:18 PM

As an intern admitting emergency- room patients to a Cincinnati hospital, I saw it happen again and again: Late-stage cancer patients in the midst of medical crises would roll into our ER in need of a ventilator as expected complications mounted.

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pumiceAug. 28, 1312:58 PM

From the article: "The more money we spend in that [last] week [of life], the lower patients and families rate their quality of life, studies show." Prolonging death is the least effective as well as the most costly choice at the end of one's life. Who wouldn't choose in-home hospice over the ICU?

pumiceAug. 28, 13 1:02 PM

The headline is very misleading--the doctor would advise a patient and her/his family of options. The patient would make the decision.

sarahanneAug. 28, 13 1:58 PM

So how is this different from when Obama proposed Doctors getting payed for discussing end of life decision - which directly lead to the claim of "Death Panels"? There are few things which make more sense then this.

xjritterAug. 28, 13 3:12 PM

Thanks to Sarah Palin and her distorted claim that Obamacare would subject older patients to death panels, now the Congress must act and create a separate law to enact what was grandstanded out of the bill in 2009.

rlwr51Aug. 28, 13 3:55 PM

There is another side to this. I have had two recent experiences where doctors have wanted to put relatives on hospice when contracting pneumonia. In the case of my aunt they said it could be temorary but they immediately drugged her into unconciousness until she died of pneumonia. They refused to involve her oncologist in the decission. In the most recent case the same thing was suggested for my father. His rapid heart rate and the posibility that his cancer had metastasized was the given reason. He/We declined the offer of hospice care. The day he was going home from the hospital I found out that he had been admitted for pneumonia. I had been lead to believe it was because of his heart. His pneumonia was treated, he got better and was up and around, blowing bubbles for his grand-daughter and going to the mailbox - and got chewed out by the home visit nurse(that he agreed to as an alternative to hospice) because he wasn'r "sick enough" to use that service. If they had been able to get him in hospice they could have quit treating him for his pneumonia and he would have died.

mandansmomAug. 28, 13 5:04 PM

"If they had been able to get him in hospice they could have quit treating him for his pneumonia and he would have died."

The comment illustrates perfectly the need for advanced directives written with the assistance of medical providers. In such a document, you can say, "give me antibiotics to treat pneumonia, but if it comes to a respirator, I don't want that", or whatever else you want. An advance directive doesn't have to call for Hospice, and Hospice doesn't have to entail "nothing that might cure a complication." Americans, professionals and lay people alike, need to discuss these topics openly and get educated about end-of-life options.

mandansmomAug. 28, 13 5:13 PM

rlwr51, your comment illustrates perfectly the need for advanced directives, written with the help of a medical professional. An advanced directive can go any which way: do everything, do nothing, or something in the middle, such as treat pneumonia up to the point of a respirator, but not that. Likewise, there is much room under hospice care to provide fluids, nutrition, antibiotics, medications, depending on the circumstances as defined by patient and family. We need to be able to educate patients, families, and professionals better. As someone else said, you can thank the GOP for blocking this 3 years ago.

rlwr51Aug. 28, 13 5:23 PM

Pneumonia used to be called the old people's friend, now they can start calling it the insurance company's friend.

jjsbrwAug. 28, 13 6:41 PM

This will never go anywhere with the GOP. The words "advance directive" and "death panels" are inextricably linked politically. What's so frustrating is that studies have shown that not only do advance directives result in more satisfying end-of-life care, they end up saving everybody a boatload of money. Studies have shown that if we made advance directives mandatory for medicare and medicaide recipients, the saving would be at least $50 billion and maybe as much as $80 billion per year. Indeed, this one simple move could extend the solvency of medicare another 20-40 years. That said, what are the objections to making advance directives required to receive medicare.

mandansmomAug. 28, 13 7:59 PM

"what are the objections to making advance directives required to receive medicare."

Seems pretty obvious to me. It would require us to admit to mortality and, heaven forbid, discuss it! 'Muricans can't be mortal; we're special. Surely, immortality is just around the corner for us. Better to make medical decisions in crisis mode than to think about how we'd like to die and make it known to our loved ones and our doctor.


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