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Making the end of life part of health care

Posted on 07/23/2015

Boston Globe — The news earlier this month that Medicare plans to reimburse doctors for conversations with patients about medical treatment at the end of life represents an important step forward for public policy in health care. It also signals a welcome shift to a more open attitude toward a subject most people would rather avoid. In short, the agency is proposing to support open discussions with medical professionals about the way we want to die. Decisions by Medicare, which insures 55 million older Americans, often set the standard followed by private insurers as well.

In recent years, more attention has been drawn to end-of-life issues — specifically, what kind of treatment do we want, or not want, in life’s final stages. What’s more, how do we make our wishes known, how do we guide our caregivers so that they’ll know what we want when we can no longer speak for ourselves? It’s a topic that’s been uncomfortable for physicians as well as patients and their families. As the surgeon and author Atul Gawande pointed out in his best-selling “Being Mortal,” it’s a subject he himself avoided as a physician until he was faced with the terminal illness of his own father.

Perhaps the low point in the discussion about public health policy regarding end-of-life issues came in 2009, when Sarah Palin coined the term “death panels” to describe provisions in the proposed Affordable Care Act. But last year, a nonpartisan committee reported that major changes were needed to confront the issue. “The bottom line is the health care system is poorly designed to meet the needs of patients near the end of life,” said David M. Walker, a Republican and former United States comptroller general, the committee’s chairman. “The current system is geared toward doing more, more, more, and that system by definition is not necessarily consistent with what patients want, and is also more costly,” Walker told The New York Times.

Read the rest of the Boston Globe’s editorial on Medicare’s proposal to reimburse health care providers for having end-of-life conversations with patients.