A Sign of Changes Ahead?
A recent New York Times article “Coverage for End-of-Life Talks Gaining Ground” (found here: http://www.nytimes.com/2014/08/31/health/end-of-life-talks-may-finally-overcome-politics.html) sparked some ideas we thought we would share with you. Below is the Letter to the Editor that we sent in response. What are your thoughts?
As an agency providing palliative care social work interventions in Colorado state, we daily experience the benefits of planning prior to medical crisis. These advance care planning conversations allow for hope, relief of anxiety, and support of a patient’s loved ones by starting from a place of positive intent: Let’s always continue to hope one’s health will improve, but let’s also map out potential medical situations and allow people to choose what would be acceptable paths of care. What we see, generally speaking, is that naming aloud the possibilities reduces their stranglehold and power on people’s fears and imaginations. In the sacred space formed during these conversations—which include involving the patient-defined family—these are times of great intimacy, faith and humor. We get to focus on what makes a person his- or her individual self, and work backwards from there in order to adequately discuss what lies ahead rather than increase fear of the unknown.
A few important points we beg your reader to consider:
- Appropriate reimbursement and allotment of time allows professionals to truly provide informed consent. A patient always has the right to opt-out, of course, but what’s more important is that this gives those who are looking for more thorough information about what to expect in the weeks/months/years ahead the opportunity to do so.
- The photograph that accompanies this article unfortunately gives the impression that Ms. Zebrowski is uncomfortable or cornered into the conversation, which we expect misrepresents her experience and relationship with Dr. Hinterberger.
- While this proposal is certainly a step in the right direction, we couldn’t agree more with Dr. Diane E. Meier of the Center to Advance Palliative Care (CAPC) that these conversations are part of a process over time, an ongoing discussion as the medical landscape one faces changes. To assume that a one-time conversation and reimbursement will be sufficient flies in the face of what we know about medicine as well as human nature.
The danger here is to further polarize this issue rather than to grasp what is truly at hand. These proposed measures mean allowing physicians and allied professionals such as social workers to provide detailed information and facilitating meaningful, humanizing conversation to more adequately prepare for the future.
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