Expect political controversy. The Obama administration plans to pay doctors to hold end-of-life planning conversations with patients, a controversial decision that will almost certainly revive the “death panel” debate that has long dogged the Affordable Care Act.
Expect political controversy. The Obama administration plans to pay doctors to hold end-of-life planning conversations with patients, a controversial decision that will almost certainly revive the “death panel” debate that has long dogged the Affordable Care Act.
Medicare rolled out new rules Wednesday (on page 246 of this document) that would reimburse physicians who talk to elderly patients about what options are available at the end of life — whether they would want life support, for example, or whether hospice care would be of interest. Doctors would get paid, under these new rules, for helping patients complete an advanced directive.
The reimbursements would begin in 2016.
Health-care experts near universally agree that these conversations are important. But right now, most Americans don’t have advance care directives that explain what type of treatment they’d like. That leaves families to make heart-wrenching decisions on their behalf.
Opponents of a proposed California bill to legalize the practice argue that it may make it easier for people with disabilities to end their lives—and leave them vulnerable to coercion
Opponents of a proposed California bill to legalize the practice argue that it may make it easier for people with disabilities to end their lives—and leave them vulnerable to coercion
When he was 19, Anthony Orefice hit a telephone pole on his motorcycle going 100 miles per hour. Doctors told his family he wouldn’t survive. He did, but the accident left him paralyzed from the chest down, unable to do what he loved—surf, snowboard, or ride dirt bikes.
“All you are thinking is the worst, worst, worst—everything you can’t do,” said Orefice, who lives in Valencia, California. “I wanted to be dead.”
More than two decades after breaking his back, Orefice, 40, is married, has a 7-year-old son, and owns a medical-supply business. He also counsels patients newly disabled from spinal-cord injuries. “Depression,” he often tells them, “is part of the healing process.”
As California legislators consider a bill that would allow terminally ill patients to get prescriptions to end their lives, disability-rights advocates are speaking up in opposition. They worry that if it becomes law, depression and incorrect prognoses may lead people with serious disabilities to end their lives prematurely.
California lawmakers advanced a right-to-die bill Thursday, giving hope to those who want the nation’s most populous state to allow terminally ill patients to end their lives under doctor’s care.
The state Senate passed the measure 23 to 14, sending it to the Assembly with a vote that marked progress for advocates seeking to expand aid-in-dying laws beyond a small group of states.
The issue gained traction nationally after 29-year-old Brittany Maynard moved from California to Oregon to end her life in November. Maynard was dying of brain cancer and documented her final weeks in widely viewed videos posted online.
Gerald Dworkin: I am finishing the six months a year that I live in California. While here I have been working on the campaign, led by an organization called Compassion and Choices, to get a bill passed by the California legislature–SB128. This is a bill to allow medically-assisted dying in the state of California
Gerald Dworkin: I am finishing the six months a year that I live in California. While here I have been working on the campaign, led by an organization called Compassion and Choices, to get a bill passed by the California legislature–SB128. This is a bill to allow medically-assisted dying in the state of California
It is modeled on the measure passed by referendum in Oregon in 1994 by 51% of the voters. A legal injunction halted implementation of that law until 1997 when the Ninth Circuit lifted the injunction. In 1992 Californians rejected a referendum legalising assisted-dying, and the legislature has rejected similar bills four times.
Some form of medically assisted-dying is now legal in Oregon, Washington, Montana, Vermont , and one county of New Mexico. This latter reminds me of Woody Allen’s view on the existence of God. He exists everywhere except in certain parts of New Jersey.
The methods of legalization differed from state to state. Oregon was by referendum. Montana was a Supreme Court ruling. Vermont was by statute. Washington’s ballot initiative passed by 58% of the voters.
My own interest in these issues has been long-standing. In 1998 I wrote, together with two other philosophers, a book called Euthanasia and Physician-Assisted Suicide. Two of us argued for its moral and legal permissibility; one against. I should note that the use of the term “Physician-assisted suicide” is now politically incorrect, for tactical reasons. I understand that the popular prejudice against suicide makes it more difficult to rally support for the bills I favor. And even some potential users of such measures object to their death-certificate reading “suicide.” But to list the cause of death, as many such bills do, as the underlying disease process seems to me simply a lie. What caused the person diagnosed with terminal cancer to die now, rather than somewhat later, is the secobarbital the patient took. But learning to keep silent about such terminological matters was only one of many lessons I had to learn.
In the heart of every parent lives the tightly coiled nightmare that his child will die. It might spring at logical times—when a toddler runs into the street, say—or it might sneak up in quieter moments. The fear is a helpful evolutionary motivation for parents to protect their children, but it’s haunting nonetheless.
The ancient Stoic philosopher Epictetus advised parents to indulge that fear. “What harm is it, just when you are kissing your little child, to say: Tomorrow you will die?” he wrote in his Discourses.
Some might say Epictetus was an asshole. William Irvine thinks he was on to something.
“The Stoics had the insight that the prospect of death can actually make our lives much happier than they would otherwise be,” he says. “You’re supposed to allow yourself to have a flickering thought that someday you’re going to die, and someday the people you love are going to die. I’ve tried it, and it’s incredibly powerful. Well, I am a 21st-century practicing Stoic.”
Sandy Bem, a Cornell psychology professor one month shy of her 65th birthday, was alone in her bedroom one night in May 2009, watching an HBO documentary called “The Alzheimer’s Project.” For two years, she had been experiencing what she called “cognitive oddities”: forgetting the names of things or confusing words that sounded similar. She once complained about a “blizzard” on her foot, when she meant a blister; she brought home a bag of plums and, standing in her kitchen, pulled one out and said to a friend: “Is this a plum? I can’t quite seem to fully know.”
Sandy was a small woman, just 4-foot-9 and 94 pounds, with an androgynous-pixie look: cropped hair, glasses and a wardrobe that skewed toward jeans and comfortable sweaters she knit herself in the 1990s. As she watched the documentary, her pulse thrumming in her ears, a woman on screen took a memory test. Sandy decided to take it along with her. Listen to three words, the examiner said, write a sentence of your choice and then try to remember the three words. Sandy heard the three words: “apple,” “table,” “penny.” She wrote a brief sentence: “I was born in Pittsburgh.” She said aloud the words she could remember: “apple,” “penny” . . . . The simplest of memory tests, and she had failed.
The next month, Sandy’s husband, Daryl, from whom she had been amicably separated for 15 years, drove her from Ithaca to the University of Rochester Medical Center for cognitive testing by a neuropsychologist named Mark Mapstone. Mapstone showed Sandy a line drawing and asked her to copy it, and then to draw it from memory 10 minutes later. He read her a list of words and had her recall as many as she could. He gave her two numbers and two letters and asked her to rearrange them in a particular order: low letter, high letter, low number, high number. Thank goodness that last one wasn’t timed, she thought to herself, as she focused all her mental energy on the task. She felt as gleeful as a kid who had earned a gold star when Mapstone said, “Yes, that’s right.”
Tom Mayo and Arthur Caplan: This week, the Texas Legislature considered restoring to pregnant women a right every other adult Texan already enjoys: the right to make health-care treatment decisions in an advance directive or through the next-of-kin who speaks for them
Tom Mayo and Arthur Caplan: This week, the Texas Legislature considered restoring to pregnant women a right every other adult Texan already enjoys: the right to make health-care treatment decisions in an advance directive or through the next-of-kin who speaks for them
House Bill 3183 would eliminate all vestiges of the “pregnancy exclusion” from Texas’ Advance Directives Act. If it passes, the bill would remove the basis on which a Fort Worth hospital in 2013 kept brain-dead and pregnant Marlise Muñoz on life support for two months. This was done despite her husband’s insistence that his wife would not want to be hooked up to machines under those circumstances.
Eventually, a trial court agreed with her husband and declared that the pregnancy exclusion and the entire Advance Directives Act did not apply to a patient once she had died. That was only after Marlise Muñoz’s family had to endure the unimaginable pain of watching her corpse deteriorate before their eyes. Little wonder that they support “Marlise’s Law” and were in Austin to testify in support of the bill.
HB 3183, however, would do much more than prevent future abuses of brain-dead women as Texas law now stands. If the pregnancy exclusion is not removed from the Advance Directives Act, it could be used as a basis to ignore the treatment wishes of any pregnant patient with a terminal or irreversible medical condition who lacked decision-making capacity. If the bill passes, Texas would become one of 20 states that, sensibly, allow treatment decisions for a comatose pregnant patient to be based on her own expressed preferences or the treatment decisions of a surrogate decision-maker.