A Chat Now Could Mean More Control At Life's End

We haven't had a discussion with our family doctor about end-of-life planning. But if he were half as soothing as David Casarett, a palliative medicine specialist who talked Tuesday with All Things Considered's Melissa Block, maybe we wouldn't mind.

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How does one of these chats get started? No scary death panel to confront. "Usually I try to begin these conversations by talking about patients' hopes and fears," Casarett explains. "What's important to people? What they would like their future to look like? What they're afraid of? What they'd like to avoid?"

So what about all this death panel talk and the notion that health overhaul would put the government into the euthanasia business? Casarett says he's "still mystified" that allowing Medicare to pay for end-of-life counseling somehow got twisted into death panels deciding when to pull the plug.

To Casarett, the claims that these conversations about end-of-life options and preferences somehow represent a government intrusion make no sense:

Really these sorts of discussions are about autonomy. They're about freedom. They're about independence. They're about having a say in your own health care. They're about values that are about as American as anything else I can think of.

He doesn't worry much that all the negative chatter will keep individuals from talking with their doctors. The real problem he sees is on Capitol Hill. In about a week, he says, end-of-life discussions have "become a political third rail that I think politicians in Washington will want to avoid." That, he says, would be "a real shame."



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