End Of Life Counseling

[Yaatee]

I think end of life counseling is great and hopefully if the government funds it, private insurance will too. Imagine if Terri Schiavo had a chance to make explicit, in writing, that she didn't want to be starved to death. 

Now let's say she directed the opposite, that wouldn't be right, but look what happened regardless. She's dead and the government didn't need a piece of paper from her or a "death panel" to make that happen. So an end of life directive can be the only thing standing between the government and your daily nutrition. Make sure you have one. 

You can opt for anything you want. If you want parenteral nutrition, all stops pulled, you can have it. Most people don't want these thing, if they are old, have chronic illnesses, and are suffering.  Ironically, people in hospice live longer with a better quality of life, once extreme interventions are abandoned.

Also ironically, Terri Schiavo had made it very clear to her friends, that if she were in the shape she ended up in, that she did not want to linger.  The girls were discussing the fate of a young woman they knew or had read about in the local newspaper.

Regarding starvation and thirst in end-stage dementia, there is no evidence that abstaining from or withdrawing nutrition either causes discomfort or hastens death. Indeed installing and maintaining feeding tubes have their own complications and sources of discomfort. Here's a position statement from the Alzheimer's Association.

http://www.alz.org/documents_custom/statements/Assisted_Oral_Tube_Feeding.pdf

Many if not most people don't "prepare for death".  They don't have health care proxies, written instructions, nor do they discuss their wishes with friends or family.  So that when the need arises, the family is unprepared for making these decisions, and the differences among family members often creates irreparable breaches.

Edited July 10, 2015 by Yaatee

[dominicansoul]

It is not a sin to allow "nature to take its course."  The Church allows a person to decide on whether or not they want "extraordinary" means to keep them alive. Thats what these "end of life" counseling sessions are all about.  

...at the same time, this can be abused by hospitals, doctors, nurses, etc.  So, I can understand the defensive attitude...  

I pray to St. Joseph for a peaceful, holy death... I'm a wuss... I'd want the good Lord to take me quick...

[beatitude]

It is not a sin to allow "nature to take its course."  The Church allows a person to decide on whether or not they want "extraordinary" means to keep them alive. Thats what these "end of life" counseling sessions are all about.  

...at the same time, this can be abused by hospitals, doctors, nurses, etc.  So, I can understand the defensive attitude...  

I pray to St. Joseph for a peaceful, holy death... I'm a wuss... I'd want the good Lord to take me quick...

Yes. When my grandmother was dying, she had a choice between a very invasive surgery that might have prolonged her life a bit but might also have finished her off, and just being made as comfortable as possible in her nursing home. She took the second choice. She'd already had a dozen surgeries, she was very ill, and she'd had enough of invasive treatment after invasive treatment. It seems that many Catholics don't realise that this is a legitimate moral choice, and that people in her position aren't obliged to take every single treatment possible.

[Nihil Obstat]

Not to mention, what constitutes ordinary means for one person could be extraordinary for another, in some circumstances.

[KnightofChrist]

Why are we debating on issues we agree on? Of course end of life counseling is morally good. Of course one can decline to take extraordinary means to save ones life and choose to die instead. But the purpose and authority of these 'panels' is far greater than just advise on end of life issues. I don't think many understand that. It will approve or disapprove treatments for all sorts of health problems. It will have authority in dictating what constitutes ordinary or extraordinary means. It will have authority in how our doctors can and cannot treat us and it will have the authority to decide when and when not someone is at the end of their life.

Edited July 10, 2015 by KnightofChrist

[Ice_nine]

It will approve or disapprove treatments for all sorts of health problems. It will have authority in dictating what constitutes ordinary or extraordinary means. It will have authority in how our doctors can and cannot treat us and it will have the authority to decide when and when not someone is at the end of their life.

are you sure about that?

 

[KnightofChrist]

are you sure about that?

 

Yes, for those who have insurance under the Affordable Care Act/Obama Care the government will be actively involved in dictating what treatments will and will not be given. There is even a cap on how many times patients are allowed to visit the hospital. Again one only need to look and the V.A. Hosptial system to see how well the US Gov runs healthcare. There is just one bad story after another, even though it's fallen from the Media's attention it's still bad and it was bad years ago when my grandfather was still living. They treated him like #### until the day he died. Anyway, I don't trust the Federal Government with my health.

[CrossCuT]

Yes, for those who have insurance under the Affordable Care Act/Obama Care the government will be actively involved in dictating what treatments will and will not be given. There is even a cap on how many times patients are allowed to visit the hospital. Again one only need to look and the V.A. Hosptial system to see how well the US Gov runs healthcare. There is just one bad story after another, even though it's fallen from the Media's attention it's still bad and it was bad years ago when my grandfather was still living. They treated him like #### until the day he died. Anyway, I don't trust the Federal Government with my health.

Could you link some ACA documentation that indicates this?

[Yaatee]

Why are we debating on issues we agree on? Of course end of life counseling is morally good. Of course one can decline to take extraordinary means to save ones life and choose to die instead. But the purpose and authority of these 'panels' is far greater than just advise on end of life issues. I don't think many understand that. It will approve or disapprove treatments for all sorts of health problems. It will have authority in dictating what constitutes ordinary or extraordinary means. It will have authority in how our doctors can and cannot treat us and it will have the authority to decide when and when not someone is at the end of their life.

Who is "it"?  "It" is Medicare and Medicaid and Blue Cross/Blue Shield that already determine all of these things, in determining what they will and won't reimburse.  There are no "Panels" or, depending on how you define them, they already exist and have for a long time. 

 

Yes, for those who have insurance under the Affordable Care Act/Obama Care the government will be actively involved in dictating what treatments will and will not be given. There is even a cap on how many times patients are allowed to visit the hospital. Again one only need to look and the V.A. Hosptial system to see how well the US Gov runs healthcare. There is just one bad story after another, even though it's fallen from the Media's attention it's still bad and it was bad years ago when my grandfather was still living. They treated him like #### until the day he died. Anyway, I don't trust the Federal Government with my health.

The ACA consists of numerous insurance companies already enlisted to provide medical care, only with many more members signed up.  The government simply helps with premiums, determining how much it will help based on income.  The ACA simply has extended medical care to millions of people not previously  insured because they couldn't afford it.  It is like Medicare or Medicaid for people under 65.  It also has included young people under the age of 26, another boon to millions. 

You are channellng Sarah Palin.

[KnightofChrist]

Could you link some ACA documentation that indicates this?

They'll be the one's writing the checks so of course they'll choose what they will and will not pay for.

But ok examples

The Government dictates what treatments can and cannot be used.

Sec. 1182. [42 U.S.C. 1320e-1] LIMITATIONS ON CERTAIN USES OF COMPARATIVE CLINICAL EFFECTIVENESS RESEARCH (a) The Secretary

(...)

Paragraph (1) shall not be construed as preventing the Secretary from using evidence or findings from such comparative clinical effectiveness research in determining coverage, reimbursement, or incentive programs under title XVIII based upon a comparison of the difference in the effectiveness of alternative treatments in extending an individual’s life due to the individual’s age, disability, or terminal illness.

The Government dictates what medication can and cannot be given

SEC. 3307. IMPROVING FORMULARY REQUIREMENTS FOR PRESCRIPTION DRUG PLANS AND MA-PD PLANS WITH RESPECT TO CERTAIN CATEGORIES OR CLASSES OF DRUGS. (...)

• (I) IN GENERAL- Subject to clause (iv), the Secretary shall identify, as appropriate, categories and classes of drugs for which the Secretary determines are of clinical concern.
• (II) CRITERIA- The Secretary shall use criteria established by the Secretary in making any determination under subclause (I).

 

The Government will dictate how dentist exam our teeth.

Section 4102– (2) NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY. The Secretary shall develop oral healthcare components that shall include tooth-level surveillance for inclusion in the National Health and Nutrition Examination Survey … the term ‘tooth-level surveillance’ means a clinical examination where an examiner looks at each dental surface, on each tooth in the mouth and as defined by the Division of Oral Health of the Centers for Disease Control and Prevention.

The Government dictates Hospital visits and payments will be reduced for repeat visitors.

SEC. 3025. HOSPITAL READMISSIONS REDUCTION PROGRAM.

(a) In General- Section 1886 of the Social Security Act (42 U.S.C. 1395ww), as amended by sections 3001 and 3008, is amended by adding at the end the following new subsection:

`(q) Hospital Readmissions Reduction Program-

`(1) IN GENERAL- With respect to payment for discharges from an applicable hospital (as defined in paragraph (5)(C)) occurring during a fiscal year beginning on or after October 1, 2012, in order to account for excess readmissions in the hospital, the Secretary shall reduce the payments that would otherwise be made to such hospital under subsection (d) (or section 1814(b)(3), as the case may be) for such a discharge by an amount equal to the product of--

`(A) the base operating DRG payment amount (as defined in paragraph (2)) for the discharge; and

`(B) the adjustment factor (described in paragraph (3)(A)) for the hospital for the fiscal year.

When the Government dictates that one has too many remissions they can dictate that that person be placed in a community based care transition program.

SEC. 3026. COMMUNITY-BASED CARE TRANSITIONS PROGRAM.

(a) In General- The Secretary shall establish a Community-Based Care Transitions Program under which the Secretary provides funding to eligible entities that furnish improved care transition services to high-risk Medicare beneficiaries.

(b) Definitions- In this section:

(1) ELIGIBLE ENTITY- The term `eligible entity' means the following:

(A) A subsection (d) hospital (as defined in section 1886(d)(1)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(1)(B))) identified by the Secretary as having a high readmission rate, such as under section 1886(q) of the Social Security Act, as added by section 3025.

(B) An appropriate community-based organization that provides care transition services under this section across a continuum of care through arrangements with subsection (d) hospitals (as so defined) to furnish the services described in subsection (c)(2)(B)(i) and whose governing body includes sufficient representation of multiple health care stakeholders (including consumers).

(2) HIGH-RISK MEDICARE BENEFICIARY- The term `high-risk Medicare beneficiary' means a Medicare beneficiary who has attained a minimum hierarchical condition category score, as determined by the Secretary, based on a diagnosis of multiple chronic conditions or other risk factors associated with a hospital readmission or substandard transition into post-hospitalization care, which may include 1 or more of the following:

(A) Cognitive impairment.

(B) Depression.

(C) A history of multiple readmissions.

(D) Any other chronic disease or risk factor as determined by the Secretary.

The Government will ration care, the following is testimony by Dr. Michael J. Smith M.D. before members of Congress (sorry I ran out of time and probably didn't do as well as I as I otherwise could in presenting the dangers of the ACA/Obamacare.)

– Section 6301 of the legislation permits the Health Secretary to disallow treatments or coverage that is not considered “reasonable or necessary.”  Doctors and their patients used to make those decisions; now government will.

I would like to know who will be this executioner.  Who will explain this to the family of my patient, who chose to pursue full treatment for his extensive stage IV metastatic colon cancer? It had spread to multiple sites in his lungs and his liver.  He chose to fight so he could be there for his family.  He was given only 6 months to live, but his will saw him thru another 8 years of life. It was a tough eight years but he chose them.  This month his most recent PET scan (a test potentially denied him?) revealed no evidence of disease.  Today he chooses to continue as a role model for those who chose to fight their cancer.

– An 18-member “Independent Payment Advisory Board” [Sec. 10320(b)] is given the duty, on January 15, 2015 and every two years thereafter, with regard to private health care, to make “recommendations to slow the growth in national health expenditures . . . that the Secretary [of Health and Human Services] or other Federal agencies can implement administratively” [Section 10320(a)(5)(o)(1)(A)]. The Board is directed to limit private health care spending so that it is below the rate of medical inflation. In turn, the Secretary of Health and Human Services is empowered to impose “quality” AND “efficiency” measures [Section 10304] on health care providers (including hospices, ambulatory surgical centers, rehabilitation facilities, home health agencies, physicians and hospitals) [Section 3014(a) adding Social Security Act Section 1890(b)(7)(B)(I)] which must report on their compliance.  In layman’s terms, this amounts to doctors, hospitals, and other health care providers being told by Washington just what diagnostic tests and medical care is considered to meet “quality” and “efficiency” standards – not only for federally funded health care programs like Medicare, but also for health care paid for by private citizens and their nongovernmental health insurance. Source

You are channellng Sarah Palin.

What's wrong with Sarah Palin? I always find it amazing the sexist way people dump on her. I just wonder if you're one of them or not.

[superblue]

Yes. When my grandmother was dying, she had a choice between a very invasive surgery that might have prolonged her life a bit but might also have finished her off, and just being made as comfortable as possible in her nursing home. She took the second choice. She'd already had a dozen surgeries, she was very ill, and she'd had enough of invasive treatment after invasive treatment. It seems that many Catholics don't realise that this is a legitimate moral choice, and that people in her position aren't obliged to take every single treatment possible.

it isn't a legitimate moral choice to just give up when there are cures. we are obligied to protect our lives for as long as possible, i am not focusing on your case as i have no clue what your story is about, and have stated that indeed there are exceptions to the rule that the church has approved in rare cases.

Not to mention, what constitutes ordinary means for one person could be extraordinary for another, in some circumstances.

which is why the Church has already addressed that topic.

It is not a sin to allow "nature to take its course."  The Church allows a person to decide on whether or not they want "extraordinary" means to keep them alive. Thats what these "end of life" counseling sessions are all about.  

...at the same time, this can be abused by hospitals, doctors, nurses, etc.  So, I can understand the defensive attitude...  

I pray to St. Joseph for a peaceful, holy death... I'm a wuss... I'd want the good Lord to take me quick...

never said it was a sin.

Believe what you want. I was there. You weren't. 

Do you even know what you are talking about?  

more than you, but thanks for asking.

K I had my fun with this i am out. wuss out on death if ya want, enjoy having the government decide if you live or die, have a big laugh about it,  just don't expect to get a pat on the back an a medal for being so progressive.  I am considering dieing naturally too; i figure 40 is old enough and since my body is going to fail in time; i can just go for a nice stroll off a short bridge and spare myself the agony of old age and horrible diseases. Who knew you guys could win me over to your logic, congrats.

 

[Era Might]

enjoy having the government decide if you live or die

We've had government death panels for thousands of years, usually we just call them capital punishment. 

[CrossCuT]

Someone needs a cookie

[dominicansoul]

it isn't a legitimate moral choice to just give up when there are cures.

Well....yes and no...

CCC 2288 Life and physical health are precious gifts entrusted to us by God. We must take reasonable care of them, taking into account the needs of others and the common good.

I think the word there is "reasonable care."

If I was to find out I had Stage IV cancer, and fighting it would probably make me even more sick than I've ever been, (chemo is a poison, you know,)  with no guarantee that I will be cured....It's my decision to either fight the cancer or let it take me, I have no moral obligation to do everything I can to cure it.  IF I had kidney disease and had to have dialysis 4 days outta the week, and doing the dialysis would definitely prolong my life, but it takes a toll outta me and there is no cure for the disease, I could decide to stop the dialysis and let the disease take me.  I think these are examples of "extraordinary measures." 

If I was an elderly woman and found out I needed surgery on my innards but it was dangerous and may not make a difference, I can choose not to have the operation.  I could set my eyes forward to meeting my Lord alot sooner and get prepared... Again, this would be another "extraordinary measure." 

I don't believe it would be immoral to make these types of decisions...

 

[Yaatee]

 

They'll be the one's writing the checks so of course they'll choose what they will and will not pay for.

But ok examples

The Government dictates what treatments can and cannot be used.

The Government dictates what medication can and cannot be given

 

The Government will dictate how dentist exam our teeth.

The Government dictates Hospital visits and payments will be reduced for repeat visitors.

When the Government dictates that one has too many remissions they can dictate that that person be placed in a community based care transition program.

The Government will ration care, the following is testimony by Dr. Michael J. Smith M.D. before members of Congress (sorry I ran out of time and probably didn't do as well as I as I otherwise could in presenting the dangers of the ACA/Obamacare.)

 

What's wrong with Sarah Palin? I always find it amazing the sexist way people dump on her. I just wonder if you're one of them or not.

You don't have to be sexist to dislike Sarah Palin (that was a dealbreaker in voting for what's his name) --You just have to not want ignorant,  incurious, poorly educated people to run the country.