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Week of 10.9.09

Life Panel? Death Panel?

What exactly is a death panel? The truth about end-of-life planning.

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The Weekly Q
How did private discussions between seniors and their doctors about end-of-life choices for the very ill or dying become a flash point in the national health care debate?

This week, NOW travels to Wisconsin to sit in on some of these sessions and see how health care reform could profoundly affect the lives of American seniors.

The not-for-profit Gundersen Lutheran Hospital has two decades of experience in this area. Their "Respecting Choices" initiative has become one of the most comprehensive end-of-life planning programs in the country.

Two families grappling with the most difficult and complex life and death issues gave NOW on PBS extraordinary access to their discussions and their decisions.

Web Features

Living Wills and Advance Directives
Get advice, help and information about your state.

The Hidden Dangers in Living Wills
Dr. Fred L. Mirarchi says living wills can compromise patient care.
In the News

The Huffington Post: Palin: Obama's "Death Panel" Could Kill My Down Syndrome Baby

The New York Times: False 'Death Panel' Rumor has Some Familiar Roots

The Raw Story: Stewart confronts industry shill who created 'death panel' rumor

USA Today: Life and Death: Hospital ethics panels help families decide

The Washington Post: The Unwitting Birthplace of the 'Death Panel' Myth

Related Links

Gundersen Lutheran Medical Foundation: Respecting Choices

Sue Shessel's Blog Pinky Pie

"On Our Own Terms: Bill Moyers on Dying"

Viewer Comments

Commenter: aaron the farmer
thank you so much for showing this issue in a respectable way.

if only the shiftless and feeble-minded people at the corporate medias had half as much respect as you guys here at PBS have for the truth. this country wouldn't be in the sad shape we are in

Commenter: Colin M. Grant MSW RSW
Living Wills, or as we call them in Alberta [ref: Office of the Public Guardian]"Personal Directives" - is a legal instrument we use in our Province to have our medical and perhaps also end-of-life decisions in written form to indicate to our health care providers what our wishes are in respect to values, preferences and even directives when we are no longer cognitive or capable to express them.

I worked in that office for over 25 years before retiring 4 years ago. Never in all that time did we face criticism that we were "death panels" or promoting them.

In fact we have become Canadian leaders in this type of planning and our Legislation has become a model for other jurisdictions.

I congratulate NOW for bringing out this story and applaude those who spoke for and about the topic. I dream of the day when ALL adults and families have the option to set down, in writing, their wishes for that time when a decision about your health needs your input and your no longer competent to state it. Thats all that a Living Will is about. Dear USA neighbours, please dont let those who are terrorizing you with horrible and fear mongering about the value of a Living Will - they have nothing to do about death panels. I beg of you to ignore their rhetoric. In fact, I can tell you, its a huge relief to complete yours and I encourage you do do it sooner than later.

Commenter: George Kuhn
I admire and respect the reporting on your program, and on the Bill Moyers Report. I can get complete transcripts of the latter and I'd like to be able to get transcripts from your current programs. [Ed: View the transcript for this program.]

I belong to a Democratic Club in Missouri, who don''t watch PBS all that much. I am regarded as a left-winger, because for example, I am for a universal health/single payer program. I am currently attempting to survey the membership as to their sources, but I'm pretty sure there are plenty who depend on Fox News and,or the "Main Stream" media.

I'd like to be able to quote from your transcripts in my news letter to them. I will of course give complete credit for any quotes I use.

Commenter: Sue Hernandez RN
I was watching the NOW program on the topic of the Living Will and end of life planning with very ill people, from all,walks of life. I was very surprized to hear that most people were ignorant of the facts and that they were uninformed about the Wills and the choices they could have,and make. I've been working in the medical field for > 20 yrs and the first thing you are taught on, in any health care setting is to go over these important decisions. The first thing the MD asks you when he gets to the hospital is about these important papers.. It didn't matter what the age,Dx. or prognosis, he wanted, all Dr.'s wanted the paperwork to be on the front of the chart,he wanted,or she, for the papers to be explained in detail to the patient and the family present. We ( I state this as an RN collectively with my collegues)always did this asap, after we did our admit eval. of the patient.I worked at a big Medical Center, Our Lady Of The Lake Regional Center,Home Health, and at Carville Hospital for Hanson's Disease, and this always a policy to follow out. The only time the nurse didn't go over this, was when the patient,and or the family wanted to speak to the MD first. That's what surprised me so much, to know so many people ignorant of these facts, and they had the power to the end to die with dignity and still be cared for with someone in the medical field always willing to go that extra mile, to make sure they didn't suffer.
Thank You,for allowing me to make my thoughts known, and I am one of the burnt out nurses I see you will be speaking to. May God Bless PBS

Commenter: Bud Hammes
This show explained accurately how we make great efforts to know and honor our patient's preference about their future care. This has been an effort involving all health professionals in the community and many other institutions including our religious groups. The succes of this program in La Crosse has been because of the colloboration of all groups and health professionals in the community.

I would recommend that people consider to start advance care planning by talking with those people who are closest to you...perhaps this is your family, perhaps it is a group of friends. I would suggest that you consider completing a power of attorney for health care. This is a document where you legally appoint a person who can advocate on your behave when you cannot make your own decisions. If you want a place to begin go to:

Commenter: John Cappola
Your broadcast on End of Life Planning highlights the ignorance of the American population. We protest, anger, and politicize a personal issue that strikes the very hearts of us all. Every day at some moment of our lives we have to make that fateful decision for ourselves or for a loved one. A living will? A Do not Resuscitate (DNR)? I know. My deceased mother made her wishes explicit and I will also.

Commenter: dbesikof
I favor healthcare reform and believe in living wills. That said, it was chilling to see Gundersen Lutheran cited as a positive example in this area. I have personally observed their advocacy of living wills and their zeal for rapid discharge of patients. Some examples: While she was still heavily medicated after a knee replacement a hospital chaplain called on my mother. Instead of praying with her, he insisted she execute a living will. The Gundersen focus on rapid discharge of patients is so intense thatpatients are sent home where proper care is not available, before they are sufficiently recovered. My mother was discharged so soon after a hip repair that her hip came apart in a nursing home and she had to have a total hip replacement. More than once, I have observed patients being wheeled to their cars on gurneys after discharge. My father was taken by ambulance to Gundersen from a nursing home, with kidney failure and other massive medical problems. He had a living will. When he refused dialysis, the pressure to discharge him became intense, even though it was undisputed that there were no nursing home beds with the skilled care he needed in the entire area. At one point they even tried to send him to a nursing home where his roommate would have had airborne staph infection, without disclosing this to us. The honesty of the social worker at that facility was the only way we knew. She said she couldn't bear to have him admitted without telling us. While I was away from his bedside, a chaplain came into the room and said a prayer over my father and pulled the IV from his arm, without our consent. The IV was not there to prolong his life, but simply to keep him comfortable. A medicare nurse sat daily at the nurses' station and reviewed care given. The only time she approached my father was when he had a crisis. Then she would talk to me about how nice it would be for him to die at home. Clearly, if most nursing homes could not care for him, we certainly could not. A physician who told me he dealt with "difficult discharges" was assigned to me, not my father. I was told that my father's presence would constitute "medicare fraud" if he was not discharged, as he had stayed more than the allotted number of medicare days and was going to die rather than recover. I told them it would be my pleasure to represnt them, if that should occur, as I am an attorney. I tried to pay them for care he needed that medicare would not provide. They would not accept payment. They wanted him discharged. When he finally died, he had been there a bit over fourteen days.

I am told that the hospital now has hospice beds, in part as a result of my father's experience, and that the staff has corrected some of the matters I called to their attention.

A living will is for the benefit of the person who makes one. It is not a device designed for the convenience of doctors or hospitals. Based an my firsthand experience and observation of Gundersen's conduct, it is a conflict of interest to have their chaplains and dcotors draw up living wills for their patients.

Commenter: Jane Ganter
I made my first living will when my daughter worried about my getting injured on a one-week bicycle trip (Cycle Oregon). That was about the time of some high-profile disputes about end-of-life care that went to court. So, on the chance that she might end up in court, I regaled her friends with my wishes so they could testify if she needed them. The bicycle trip was a wonderful, accident-free vacation. When Oregon came out with a new form a few years later, I filled out one of those. When I was hit by a bus in Mexico in 2002, I had "innumerable" broken ribs, punctured lungs, broken facial bones, cardiac arrest, traumatic brain injury, etc. My daughter had the presence of mind to take the document with her to the San Antonio trauma center to which I was transfered and where I was treated for a few weeks. She and two of her brothers were my guardian angels and advocates. The medical professionals warned them that I'd need round-the-clock care for at least six months after I came back to the world. Ha! As soon as my jaw was unwired, I switched to day care (that was about 4 or 5 weeks after discharge), I "graduated" from outpatient rehab about 3 months after my assault by bus, and drove to the Shakespeare Festival (about 175 miles from home) a couple weeks after that. My kids made all the right decisions. Not only that, they hadn't lived in the same place for about 25 years, and shared a motel suite harmoniously. I'd like them even if we weren't related.

All of that was after I had been the only family member available to be with a dying aunt (her siblings were either ill or caring for an ill spouse). She wanted no part of the feeding tube, but her doctor kept stuffing back up her nose and down her throat. When I told him she didn't want it, his response was one I'll never forget: "Just because she's in end-stage renal failure doesn't mean I'll let her starve." When I got home I immediately told my doctor we had to talk about end-of-life care.

Death panels, indeed. How to live while living is the name of the game.

Commenter: Shirley D. (BSN, RN)
Since the late 80's I have talked about end-of-life issues with patients and/or their families. I stress to them that these decisions are for situations in which the patient is most likely not going to survive or, if they do survive, it will be on life support. Does the patient want to "live" on that machine? If the patient cannot sustain life on their own, and it's probable they never will, do they want the machine stopped?
Patients must know that the machine can be stopped but their care will be continued. Treating them with respect, taking care of their physical, emotional, spiritual needs will be continued until they die a natural death. If God wants to perform a miracle, He can do it with or without the technology we have. There are times when curing doesn't work but we can always care.

Commenter: Olive Lohrengel
Thank you for your program on end of life counceling and being sure to have a living will telling specifically what your wishes would be. I was fortunate enough to have a physician who specialized in geriatrics. She brought an attorney to her facility to discuss with a group of seniors the papers we needed to have filled out, signed and witnessed. The attorney helped us understand these papers and what they meant to us and to our family in case of needAt the time, my health was good, but a few years later, I had bypass surgery and realized what a good move she had given me the opportunity to take.

I was very upset when I started hearing that some people were claiming the plans to pay doctors to have this discussion with their patients meant that the plan was to save money by pulling the plug on the critically ill, unwanted old folks who had reached the end of our productive lives. So, I especially appreciate your having the doctor who explained in a very simple manner why he believed this was the right thing to do.

Commenter: Marianne
My mom passed away this past June of terminal lung and brain cancer. She was in hospice care for 9 months, at home, surrounded by her family, friends, and pets. I am so thankful that we knew her wishes and were able to carry them out.

Commenter: Sarah Redmond
Living Wills are important, but so is your choice of hospitals. If you want to control your exit, please think twice about going to a Roman Catholic hospital.

Life Panel? Death Panel?

Living Wills and Advance Directives: What You Need to Know

The Hidden Dangers in Living Wills

U.S. Colleges: Going Green Despite Red Ink

Issue Clash: Health Care and Seniors

Ezekiel Emanuel on Universal Health Care

AARP: Talking About Money with Your Parents

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