Health Care Reform and End of Life Counseling
There is an interesting and controversial part to the House health care reform bill that involves end-of-life counseling. The proposed provision is touted as being an advantageous opportunity for those who are seriously ill to request a personal consultation with their doctor about their preparedness for the future they face. The promoted improvement is that this professional consultation would be paid by insurance. All the rage over this provision comes from the suspicion that the government would influence the doctors to use this consulting opportunity to convince the seriously ill or elderly that they shouldn’t pursue further expensive and extensive treatment. Therefore, some conclude, we would be sending our terminally ill and unproductive out to die.
After reading the language of this part of the bill and hearing the explanations from both sides, I am convinced that this is not some kind of a diabolical government plot to let grandma die. However, I am still concerned that society feels we need to pay extra for such health coaching or consultation by our doctors. The reason that this kind of counsel from our doctors would be an insurance claim is because most doctors are treating only our disease symptoms and not our whole person. Specifically, if a person is being treated for cancer by an oncologist, that oncologist should be counseling that patient on every aspect of the cancer experience and not just on how he plans to attack the tumor. Oncologists should take the time to talk to a terminal cancer patient about their lifestyle, their finances, and their desires for or rejection of an extended life of pain and suffering. This is integrative oncology, and it should be part of the core doctor-patient relationship and not billed as extra chargeable minutes. An integrative oncologist cares for his or her cancer patients on a personal level including emotional, psychological, spiritual, as well as physical welfare.
Paying a doctor for a 15 -minute consultation about end-of-life decisions reflects a disregard for the whole-person treatment that the doctor is supposed to be doing anyway. That is one thing I see wrong with the proposed health care reform and wrong with our nation’s present model of medical care.