End of life palliative care doesn’t kill grandma it extends her life, according to a groundbreaking study led by Dr Jennifer Temmel at Massachusetts General Hospital and published Thursday in the New England Journal of Medicine. Consultations with doctors about pain management for cancer-afflicted terminally sick patients– so-called death panel-style recommendations– translated to three additional months of life, partly the researchers believe, because the patients taking on the “death panel” recommendations were living better: they were less depressed; they got more sleep; they saw more of their families.
It’s “the opposite of all that rhetoric about ‘death panels,’ ” the New York Times quotes Dr. Diane E. Meier, director of the Center to Advance Palliative Care at Mount Sinai School of Medicine. “It’s not about killing Granny; it’s about keeping Granny alive as long as possible — with the best quality of life.”
The Times explains what palliative-care consultations are all about in a way few Democratic legislators and the president failed to do in the wake of Sarah Palin’s Facebook and Twitter assault on end-of-life care as some kind of socialist euthanasia scheme.
“Palliative care typically begins with a long conversation about what the patient with a terminal diagnosis wants out of his remaining life. It includes the options any oncologist addresses: surgery, chemotherapy and radiation and their side effects. But it also includes how much suffering a patient wishes to bear, effects on the family, and legal, insurance and religious issues. Teams focus on controlling pain, nausea, swelling, shortness of breath and other side effects; they also address patients’ worries and make sure they have help with making meals, dressing and bathing when not hospitalized.
Hospice care is intensive palliative care including home nursing, but insurers and Medicare usually cover it only if the patient abandons medical treatment and two doctors certify that death is less than six months away.
During the debate over President Obama’s 2009 health care bill, provisions to have Medicare and insurers pay for optional consultations with doctors on palliative and hospice care led to rumors, spread by talk-show hosts like Rush Limbaugh and Glenn Beck and by the former vice-presidential candidate Sarah Palin, that the bill empowered “death panels” that would “euthanize” elderly Americans.
Legislators eventually removed the provisions. In practice, Medicare and private insurers do pay for some palliative care, said Dr. Gail Austin Cooney, a former president of the palliative medicine academy. “But it’s piecemeal,” she said. “The billing is complicated, and for many physicians that’s enough of a deterrent to not bother.”
Temmel’s findings may bring some clarity to researchers and health care professionals and to some lawmakers interested in the subject beyond ideology and election campaigns. The trick is to translate it for the Palin-obsessed public.