Eideard

Ever see a teabagger at an anti-war demonstration?

A DNR, or do not resuscitate order, is a legal document that ensures that resuscitation efforts will not be attempted if someone suffers a cardiac or respiratory arrest. End-of-life, or advance care planning, is a subject that far too many families avoid discussing until it’s too late…

Advance directives provide instruction for your family and physician about the types of treatment you want at the end of your life. Sadly, most Americans don’t have them. A 2003 report by the U.S. Agency for Healthcare Quality and Research found that less than 50 percent of terminally ill patients studied had an advance care directive in their medical record. Of those who had directives, between 65 and 76 percent of their physicians were not aware it existed.

End-of-life planning, unfortunately, has emerged as a hot button political issue. In 2009, House Democrats included a provision in the health care reform bill that would have allowed Medicare to reimburse doctors for end-of-life discussions. Former Alaska Gov. Sarah Palin derided the proposal as “Obama’s death panel,” falsely asserting that the government would act as arbiter on who would receive health care. Then-Minority Leader John Boehner claimed that encouraging these discussions would be a step toward “government-sponsored euthanasia.” Ultimately, the provision ignited such intense vitriol that congressional leaders dropped the provision from the final bill that was signed by President Obama.

Many of the arguments against advance-care planning, however, lack merit. The point of the provision was to foster conversation about dying between doctors and patients as well as informed decision making. In an October 2008 study by the Journal of the American Medical Association, researchers found that patients who had these discussions were more likely to accept their prognosis and preferred to receive comfort care, rather than aggressive life-extending therapies. Many choose hospice care, which treats the entire person, both medically and spiritually…

April 16 is National Health Care Decisions Day — an invaluable opportunity for families across America to begin to make informed health-care decisions or revisit the decisions that have been made…Figure out what you want, document your wishes, inform your loved ones and urge them to do the same.

The religious phonies who call themselves conservatives should butt out of everyone else’s life. Those of us who choose – who demand the right to choose – dignity as an end draws near don’t need volunteer saviors telling us what we can and can’t do.

The Kongressional Klowns who get in the way of Medicare don’t wish to see us have professional advice – or aid in the cost of getting that advice. They should leave the corporate cabal that runs American politics and get an honest job.

Thinking about death can be frightening, no matter your age or medical condition. As we get older, the reality of our own mortality tends to come into clearer focus; this doesn’t make talking about death or life-sustaining treatments any less frightening though.

It was fear — stoked by certain politicians — that led to the inaccurate and misguided “death panel” rumors that surrounded health care reform proposals last year.

Beginning January 1, Medicare will reimburse physicians who advise patients, in voluntary discussions, about their preferences for end-of-life care treatment during their annual Medicare “wellness visit.” This is advance care planning, and it is a good thing for seniors, their families and health care professionals.

It’s not new. A law passed in 2008 allowed end-of-life planning to be part of a patient’s “welcome to Medicare” exam. Health care reform turned the welcome visit into an annual wellness visit. And now regulations clarify that these important discussions will be covered should the Medicare beneficiary wish to take advantage of this opportunity.

Advance care planning allows a person to make his or her wishes and care preferences known before being faced with a medical crisis. Advance care planning is simply smart life-planning.

RTFA. Many important details and suggestions about planning for the end of your future.

You can be smart. Or you can be stupid.

When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1.

Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.

Congressional supporters of the new policy, though pleased, have kept quiet. They fear provoking another furor like the one in 2009 when Republicans seized on the idea of end-of-life counseling to argue that the Democrats’ bill would allow the government to cut off care for the critically ill.

The same dweebs who believed the agitprop back then will likely get their wedgies on, again.

The final version of the health care legislation, signed into law by President Obama in March, authorized Medicare coverage of yearly physical examinations, or wellness visits. The new rule says Medicare will cover “voluntary advance care planning,” to discuss end-of-life treatment, as part of the annual visit.

Under the rule, doctors can provide information to patients on how to prepare an “advance directive,” stating how aggressively they wish to be treated if they are so sick that they cannot make health care decisions for themselves.

While the new law does not mention advance care planning, the Obama administration has been able to achieve its policy goal through the regulation-writing process, a strategy that could become more prevalent in the next two years as the president deals with a strengthened Republican opposition in Congress…

“Advance care planning improves end-of-life care and patient and family satisfaction and reduces stress, anxiety and depression in surviving relatives,” the administration said in the preamble to the Medicare regulation, quoting research published this year in the British Medical Journal.

RTFA. Reflect on the fact that the average Tea Party nutball hasn’t gotten past 1611 when it comes to palliative care – much less understanding that terminally ill folk just might someone more than the parish shaman advising them on their legal and medical choices.

There are Republicans who know better; but, they are corrupt enough to let opportunism and vote-getting from the truly ignorant override anything approaching ethical standards.

It’s hard for physicians to determine with much precision how long anyone with a terminal disease can expect to live, but it’s particularly challenging when the disease is advanced dementia.

“People with dementia get sicker inch by inch,” said Lin Simon, director of quality at Gilchrist Hospice in Baltimore, the largest hospice organization in Maryland. “Trying to say, ‘Now, she’s ready for hospice’ is much harder.”

Yet doctors serve as the gateway to hospice, which provides palliative care for the dying and support for their families. Medicare regulations require a physician to certify that a patient entering hospice is likely to die of his or her disease within six months. Doctors are more likely to do so when the disease is cancer or heart failure, which have more predictable trajectories.

That’s the major reason that dementia patients — who can benefit from the better pain control, fewer hospitalizations (so often associated with aggressive treatments that confer no measurable benefit) and greater family satisfaction that hospice has been shown to provide — are under-enrolled in hospice programs…

A 2004 study in The Journal of General Internal Medicine estimated that fewer than one in 10 people dying of dementia receives hospice services. A study of Michigan patients with advanced dementia, conducted about a decade ago, found that just 5.7 percent of nursing home residents and 10.7 percent of those receiving home care died with hospice care.

Nationally, by way of comparison, more than 40 percent of Americans who die each year are in hospice care.

When people with advanced dementia do get a hospice referral, “they’re enrolled quite late, within a few weeks or even days of death,” said Dr. Susan Mitchell, a senior scientist at the Hebrew Senior Life Institute for Aging Research in Boston.

Better prognoses might mean less suffering.

RTFA.

Less bureaucratic fiddling with paperwork instead of solutions – might mean less suffering, as well. Less regulation designed by beancounters instead of physicians might help, too.

A New York grandmother who spent two years in in-home hospice care and on morphine is suing a hospital for misdiagnosing her with cancer, a lawsuit says.

Ramona Jimenez, 85, of Long Island says she was wrongly diagnosed with stomach and lung cancer at Brookhaven Memorial Hospital, bluntly told she had two months to live and sent home to in-home hospice care…

After two years, during which she became addicted to the morphine, Jimenez’s family finally took her for tests at Stony Brook University Hospital where doctors told the astounded family they found no evidence of any cancer.

“This is everyone’s nightmare,” said Andrew Siben, who is preparing a multimillion-dollar malpractice lawsuit for Jimenez against Brookhaven.

“This is a classic case of misdiagnosis … a calamity of errors. This woman’s whole life has completely fallen apart…”

In November 2008, Jimenez went to Brookhaven with a bad stomach ache, was tested and told she had “stomach and lung cancer and had just two months to live,” Siben said…

“When I started taking all the drugs, I went out of my mind,” Jimenez said. “They gave me a lot of morphine. I couldn’t remember who I was.”

Last May the family took her for tests at Stony Brook.

“They looked at Brookhaven’s pictures and couldn’t see any cancer either,” Jimenez’s daughter Brunelda Morua said.

“When they told me I didn’t have cancer, it was like a miracle. They took me off the drugs, except the morphine,” said Jimenez, who is now on a treatment to wean her from the painkiller. “My mind cleared up.”

Brookhaven is silent about the whole affair. They deserve the worst – given that another hospital reviewed Brookhaven’s own X-rays, etc, and found nothing.

Another great reason to get a second opinion right off the bat – when you get negative medical news.

Legislators have begun to recognize the medical, humanitarian and economic value of helping terminally ill patients and their families navigate treatment options as they approach the end of life.

Last week, over the objections of New York State’s medical society, Gov. David A. Paterson signed into law a bill — the New York Palliative Care Information Act — requiring physicians who treat patients with a terminal illness or condition to offer them or their representatives information about prognosis and options for end-of-life care, including aggressive pain management and hospice care as well as the possibilities for further life-sustaining treatment.

The good doctors were worried about thoughtful options getting in the way of the profits normally raked-in during the last couple months of anyone’s life in the United States.

A similar provision in the original federal health care overhaul proposal, which would have reimbursed doctors for the time it takes to have such conversations, was withdrawn when it was erroneously [deliberately] labeled by conservatives as a “death panel” option.

Last week, a study in The New England Journal of Medicine reported that among 151 patients with newly diagnosed metastatic lung cancer, those who received palliative care, which is care focused on symptoms, along with standard cancer therapy had a better quality of life, experienced less depression, were less likely to receive aggressive end-of-life care and lived nearly three months longer than those who received cancer treatment alone…

While some patients, especially those who are young or are the parents of young children, choose to pursue aggressive treatment for their diseases until their dying days, studies have shown that most terminally ill patients opt for comfort care after receiving honest information about their survival prospects and the benefits and risks of further disease-directed therapy.

RTFA. Lots of sensible information and discussion of an ordinary state government aiding the quest for terminal patients to get such information. Something which wouldn’t stand a chance in most states, especially those with an excess of influence given over to bible-thumping nutballs.

Something I’m proud to put on my life resume.

Researchers from Mount Sinai School of Medicine have found that patients admitted to hospice care who have an implantable cardioverter defibrillator (ICD) are rarely having their ICDs deactivated and are receiving electrical shocks from these devices near the end of life…

Mount Sinai researchers surveyed 900 hospices, 414 of which responded. Ninety-seven percent of the responding hospices admitted patients with ICDs. On average, nearly 60 percent of patients did not have the shocking function of the ICD deactivated. Only 20 percent of hospices had a question on their intake forms to identify patients with ICDs, and just 10 percent reported having a policy in place to discuss deactivation with patients and their families…

ICD shocks may cause physical and psychological distress for patients and their caregivers. Patients report that receiving shocks from an ICD is comparable to being “kicked or punched” in the chest. Receiving ICD shocks has been associated with the development of adjustment disorders, depression, post-traumatic stress disorder, and panic disorder. Family caregivers who observe patients being shocked report feelings of fear, worry, and helplessness, and have been shown to have increased rates of depression and anxiety. For patients with advanced disease, an ICD may no longer prolong a life of acceptable quality, and cause needless discomfort.

Ouch!

”Many patients have had these devices for years and see them as a sign of stability. It’s important to address this issue and emphasize the importance of the patient’s comfort at end of life,” Dr Goldstein explained.

OK, remind me to add this to the list if I ever get one of these critters.

Before they were Palinized — and turned into those nasty death panels ready to pounce on Grandma (that “goofy stuff,” as he now calls it), Congressman Earl Blumenauer had a good idea: help people prepare for the end of life.

As he wrote in The New York Times last weekend, the proposition was simple: “I found it perverse that Medicare would pay for almost any medical procedure, yet not reimburse doctors for having a thoughtful conversation to prepare patients and families for the delicate, complex and emotionally demanding decisions surrounding the end of life.”

So, when he began work on health care reform, he included a provision that would allow Medicare to cover a voluntary doctor-patient discussion (only once every five years) about things like living wills, power of attorney and end-of-life treatment.

Oh, the horror.

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