Where did President Obama get the (good) idea to offer the elderly an every-5-year consultation with a family doctor about end of life care in our proposed health reform bill?
From the Netherlands and from Germany, among other countries. All over Europe — just like in the US — people are deciding, while they’re still healthy, what they want done when they are too sick or too near death to make rational decisions.
In Germany this kind of advance planning is packaged — of course — in just one very long word: Sterbensbegleitung. The Dutch have a similar one: Stervensbegelijding. In both cases the literal meaning is blunt: advising individual on dying. And planning for death.
Does this kind of candor scare people away? To the contrary, according to a Dutch doctor with whom I’ve spoken: “It’s a professional area for certain Dutch doctors — and not only physicians in Holland but in Germany and Scandinavian countries as well,” he points out.
How did all this come about? Back in the ’60’s, family physicians grew weary of wading into territory that was then pretty untrodden and frightening: how to advise the terminally ill about their end-of-life choices. And even more difficult: whether or not to up a pain-ridden dying patient’s morphine dosage so massively that it would end his misery.
To fill this vacuum, a a whole new group of specially trained physicians, lawyers and medical ethicists arose. Whenever serious issues emerge concerning a terminal patient’s desires, this is the group that weighs in: first asking the patient what he or she wants – or, if a rational consultation with the dying is impossible because of physical or mental constraints that prevent discussion, consulting with the dying individual’s family.
So the short answer to those who question the wisdom of proposed sticking end-0f-life consultations into a health care bill is: yes it’s a fearsome responsibility and a novel one at that.
But only in the United States.
One of my favorite subjects… true but short tale.
Thanks for the format Judy!
I live near Nashville Tennessee and was having a light dinner at a local eatery. A gentleman was sitting a the table next to mine and I noticed a british accent. We were both eating alone and since I am without the shyness gene I inquired about his accent and what brings him to this side of the pond. He informed me that I was the one with an accent and that he is here from London studying American hospices….how is that for fate? Anyway, we had an interesting conversation and I asked him how iis it that we in America have such a hard time discussing end of life in a meaningful way? His response was this….”you have a nurse and intense teaching for birth, yet you ignore the end of life, why not have teaching and coaching prior to the end and not just at the begining?” Good question