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Richard Erlich: ‘Death panels’ vs. ‘living wills’

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10:58 AM Wednesday, August 19, 2009

A while back, I started a column on terrorism with, “You are going to die.” For the to-do on “death panels” in the debate on U.S. health-care financing, I’ll recycle the thought, but without self-plagiarism and more poetically.

So, as Queen Gertrude tells Hamlet, “All that lives must die,/Passing through nature to eternity.”

In “Hamlet,” there’s much to fear about being dead; many of us, though, fear less the destination of death than the last part of “passing through nature” — that is, the process of dying.

Included in that fear may be the fear of being in the control of people who don’t much care about us and who might want to speed our deaths: Greedy relatives or some sort of private or governmental “death panel” that will decide to just let us die.

Alternatively, or in addition, we may fear being trapped in a helpless body, tormented by an ironic alliance of those who love us, combined with medical ideologues and/or control freaks who see each patient’s death as a defeat (and possibly the drying up of a revenue stream).

Death and dying and serious illness are the ultimate loss of control, but that loss needn’t be total. We can at least make our desires clear. Or we can if we’re lucky, and careful.

This is why “living wills” with “durable power of attorney for health care” are popular or, more exactly, are popular among those who know about them and can afford the small cost of executing the documents.

Such living wills allow us to designate someone to make medical decisions for us when we can’t, and allow us to make clear how we want handled what may be our final days.

We can specify that every available means be used to keep us alive. We can specify that somewhere along the line we’re to be just kept as comfortable as possible and allowed to die in peace.

OK?

If OK, then it was right for the federal government to encourage end-of-life counseling under current law and it’s right to help fund counseling as called for in the new House proposal.

Demonizing such counseling as “death panels” has worked, politically, and may deny funding for counseling in this year’s legislation. In some cases, the opposition comes, I think, to fulfill a rigid doctrine that human life, or some humans’ lives, must be preserved at all costs — literally — and by any means necessary, even at the cost of needlessly prolonged suffering.

In all cases, though, spreading lies about “death panels” is wrong in itself and evil if it succeeds.

We are all going to die, and the process will not be pleasant. Let’s resist efforts that can make dying far worse than it need be. Whatever we believe about death, we can agree to help people express their desires on how, if there are options, we want to die.

Richard D. Erlich is

English

professor emeritus

t Miami University in Oxford.

tired

, he

lives in Ventura County, Calif.

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CORRECTION: Concerning No Mo Bho's reference to "a govt panel, like NICE in Europe that decides what meds are allowed to people, what procedures, etc. all based on cost to the govt."

No Mo Bho's reference could be to the UK's National Institute for Health and Clinical Excellence <http://www.nice.org.uk/>, which works out to "NICE." *That* s/he and the Brits can argue about.

I was wrong in assuming a reference to C.S. Lewis (and to think Brits know their own authors!).

Richard D. Erlich
3:22 PM, 9/6/2009

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Concerning No Mo Bho's reference to "a govt panel, like NICE in Europe that decides what meds are allowed to people, what procedures, etc. all based on cost to the govt."

I couldn't find "NICE" on Snopes.com as an internet rumor, but I'll note "the National Institute for Coordinated Experiments (NICE) from C. S. Lewis's novel That Hideous Strength: A Modern Fairy-Tale for Grown-Ups (1945).

NICE is a nasty bureaucracy in a novel by C.S. Lewis; I've never heard of it in the real world.

Richard D. Erlich
11:46 AM, 9/6/2009

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Should we continually emergently admit renal patients that routinely skip their dialysis treatments to go binge drinking, not adhere to their diets and then arrive at the hospital in respiratory failure. Need to be put on a ventilator, put in an ICU and go through hundreds of thousands of dollars? Should we keep allowing this behavior?

Chris
4:13 PM, 8/20/2009

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The public screams and screams about the cost of their taxes and when the Government tries to regulate wasteful spending we say "don't cut my benefits/rights". Shoud we do open heart surgery on the patient that has metastatic lung, brain, liver (whatever organ) because the patient/family wants to do everything possible?

Chris
4:09 PM, 8/20/2009

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The prof isn't correct in thinking the death panel is end of life counseling. I'm all for that part. The 'death panel' is harsh for sure but is in reference to a govt panel, like NICE in Europe that decides what meds are allowed to people, what procedures, etc. all based on cost to the govt. Same thing as a death panel in substance when they decide an oldster can't get the expensive and best heart drug but has to accept a lesser, obsolete generic. And who do you appeal to ?.Govt deosn;t listen.

NO MO BHO
11:32 AM, 8/20/2009

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