The Death of Death Panels

The demise of the recent “death panels” debate was quick and painless — unlike so many of the deaths that will occur among those who will now be without the benefit of their doctor’s knowledge of the dying process. The fear-mongering of the likes of Sarah Palin, Newt Gingrich and Chuck Grassley is nothing less than heinous, not because of their flat-out lying (we’re used to that from politicians) but because the real consequence of the demise of end-of-life counseling under health care reform is the comfort and care denied to the intended beneficiaries.

As a pastor, I have had any number of occasions to be with a family through the dying process. I have noticed distinct advantages to those who have hospice care or who have the clarity of an advance directive. The patient and the family spend the final months of the person’s life with an intentionality that escapes those who are not counseled by hospice staff. Those not in hospice care are much more likely to spend their final weeks and days in a hospital ICU than at home surrounded by loving friends and family. Those patients who are not enrolled in hospice often undergo painful yet fruitless procedures that become the obligation of hospitals and providers because there is no clear written instruction provided. Relatives are in anguish because they have never had a clear conversation in which the patient has declared his or her preferences of how to be cared for in the last weeks and days of life. Conflicts erupt in this vacuum of information that tears a family apart at the very time it needs to hold together most.

Every religious institution should be outraged at the termination of the proposal for end-of-life counseling. As clergy members we are trained in grief counseling but we are not prepared to talk to our parishioners about the medical details of their condition or the process of dying they are likely to encounter given a particular disease. That is a conversation that should be held with a medical provider. That conversation, which can take place in the presence of a spiritual counselor, allows us in the clergy to do our job more effectively. We are also sufficiently trained theologically to counsel our members that a compassionate death is a divine grace. Choosing how one will live until one dies is part of the free will with which we were endowed by our creator. Any proposal that better informs us about the options for life’s final days is one which empowers Grandma and blesses all her children.

Many families do not enroll in hospice or complete advanced directives simply because they do not know about them. The provision, now stricken from the Senate Finance Committee health care reform proposal, would have reimbursed doctors who had voluntary consultations about end-of-life care with patients every five years. Sen. Grassley crassly cautioned last week that end-of-life counseling for terminally ill patients would result in a “government program that pulls the plug on grandma.” He tried his noble best to save his dignity by ignorantly asserting that end-of-life counseling should take place “20 years before.” Before what?, I ask. Before you die? First of all, I don’t know anyone who knows when he will die. Young people suffer catastrophic accidents that often pose questions of end-of-life care. But more important, given the rapid advances in medical technology, to fail to have a regular consultation (say every five years) with your physician about end-of-life options is dangerous and irresponsible. To make that kind of monumental decision based on 20-year-old information might certainly lead a person to make a very wrong choice.

What troubles me most is the fact that a proposal supporting living wills, hospice care and advanced directives (provisions supported by these same Republicans in recent years, ex-Gov. Palin even having declared a “Health Care Decisions Day” in Alaska) can be defeated by lying, distortion, fear and ignorance. If a proposal this well established and broadly supported can be turned into a “death panel,” what hope is there for the more innovative proposals in health care/insurance reform?

President Barack Obama’s political strategy may well be to let “Lazarus” stay in the tomb for three days (or until the House-Senate conference) in hopes that without all the hoopla of “death panels” the provision can be resurrected by cooler heads. Now with the looming death of the “public option,” Lazarus’ tomb is getting crowded. I’m not sure if Jesus himself can bring real health care reform back from the dead.

The Rev. Madison Shockley is pastor of the Pilgrim United Church of Christ in Carlsbad, Calif., and a director of The Center for Progressive Christianity.