Between the Lines

Cal Thomas is a pretty sharp guy.

During the 1960s and early 1970s he worked as a reporter at NBC News. His column began in 1984 and appears in more than 500 newspapers throughout the United States. He is a panelist on Fox News Watch, a Fox News Channel program critiquing the media, and until September 2005 hosted After Hours with Cal Thomas on the same network. He also gives a daily radio commentary, which is heard on more than 300 stations.

Sarah Palin is smart enough to figure out how to quit mid-term as governor of Alaska and makes millions of dollars by signing books that she didn�t really write, making rather nonsensical speeches to Tea Party followers and demonstrating through her television show on TLC that you really wouldn�t want to depend on her to help you survive if you ever got lost in the wilderness of �her Alaska.�

So, Thomas should know better than to believe everything that comes out of Palin�s mouth. He wrote recently that Palin deserves an apology from the ridicule she received when she said that the new health-care law would lead to �death panels� deciding who gets life-saving treatment and who does not.

Thomas writes that Palin was correct as she enunciated, in her rather unique way, that yes, death panels are a part of the health care bill.  He claims that under a new policy not included in the law for fear the administration�s real end-of-life game would be exposed, a rule issued by the recess-appointed Dr. Donald M. Berwick, administrator of the Centers for Medicare and Medicaid Services, calls for the government to pay doctors to advise patients on options for ending their lives. These could include directives to forgo aggressive treatment that could extend their lives.

Thomas also wrote, concerning the myth of death panels, �Ah, but it�s not a myth, and that�s where Palin nailed it. All inhumanities begin with small steps; otherwise the public might rebel against a policy that went straight to the �final solution.� All human life was once regarded as having value, because even government saw it as �endowed by our Creator.� �  Thomas writes. �� Do you see where this leads? First the prohibition against abortion is removed and �doctors� now perform them. Then the assault on the infirm and elderly begins. Once the definition of human life changes, all human lives become potentially expendable if they don�t measure up to constantly �evolving� government standards.�

Slow down, Cal. Take a breath. And stop listening to Palin, geez.

Here�s a more factual, less impassioned take on the rules currently in place in the new health care law concerning this topic.

Right now, Medicare will pay a doctor for one end-of-life planning session with a Medicare patient. That may include help on how to prepare an "advance directive," a patient's instructions to his doctors about what to do if the patient becomes too sick to make his own medical decisions.

Starting Jan. 1, Medicare will pay for an annual session, if needed, as part of a broader �wellness� visit.

That�s it. The counseling sessions are voluntary. The government won�t tell doctors what to discuss with their patients. It won�t pressure physicians to push patients into living wills or advance directives.

By the way, do you have a living will? Have you discussed advanced directives with your spouse or family members?

The smart thing to do, if you haven�t had such documents drawn up, or had these discussions, is to make a New Year�s resolution to get those things taken care of.

Research shows that end-of-life planning is valuable: A recent British Medical Journal study concluded it �improves end-of-life care and patient and family satisfaction and reduces stress, anxiety and depression in surviving relatives.�

The study also noted that �patients welcome advance care planning and expect health professionals to initiate discussions.�

That doesn't always happen, of course. Many patients don�t have these conversations with their doctors, says Dr. Robert Berenson of the Urban Institute.

In a 2009 Urban Institute study, Berenson and his co-authors suggested a raft of ways to pay for health care reform, according to a recent report in the Chicago Tribune.  They estimated that the government could save $90 billion over 10 years, not by denying care but by better managing end-of-life care. That means helping terminally ill patients avoid futile treatment and manage their pain once they choose to stop treatment. It also means focusing on comfort and emotional support, not on exhausting every option technology offers.

Every day � and perhaps you�re fortunate not to have to deal with this today � but every day in this country, families, patients and doctors must make excruciating decisions. Should medical treatment of a loved one be extended even if the odds don�t look good? Should a less aggressive course of care be pursued?

Is it time to tell your loved one�s doctor to issue a do not resuscitate order?

Everything gets thrown into the mix when it comes time to make such decisions. The patient�s wishes. The medical treatment that is available. Finances. Religious  beliefs. One�s sense of morality.

The new rule in the health care bill changes none of that. Thomas should know better.

As far as Palin, well, it�s hard to determine just what she DOES know.

Just thinking about living wills and advanced directives is tough. Having discussions about end-of-life issues with doctors may be even more difficult.

It�s something, however, that eventually must be done. It�s hard to see how Thomas or Palin can criticize a ruling that will let patients know that they can largely control what is and is not done in the final days of their lives, and that families won�t be forced to make agonizing decisions.

That�s a tremendous relief for many patients, and the families they leave behind.

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