A recent NYTimes article by Jane Brody http://www.nytimes.com/2011/06/07/health/07brody.html?scp=1&sq=law%20end-of-life&st=cse addresses the important but controversial topic of end of life and the doctor/patient discussion with an added twist–should it be mandated by law?
I am certainly a physician who feels strongly that end of life / palliative care issues continue to be inadequately discussed and debated. But this is an issue/problem not just for the medical establishment but for society as a whole.
I am ambivalent about how the issue should be handled.
What upsets me and most of my colleagues is the mandatory nature of the law. We are already feeling besieged by insurance and governmental interference in our private practices and how it has negatively impacted on the doctor/patient experience. We are overburdened by paperwork and bureaucratic nonsense. We are threatened by legal action if we fail to conform.
With presumably good intentions the government mandated HIPPA laws to protect patient confidentiality have often gone to excess. If I have a sick patient and his/her spouse is the only person officially listed, in theory I can't discuss their status with a child or parent–even if it is perfectly clear to me that they should be able to hear my opinion. I worry about similar unforseen consequences with this new legislative mandate.
On the other hand I do concur that my medical colleagues are woefully derelict in their duties to discuss palliative care and end of life issues with their patients.
The causes for their lack of attention is numerous. Some are just ignorant/unaware of the need to be a part of the discussion. Others have their own ethical/religious opinions which may lead them to avoid or reject such discussions completely. Still others may find economic reward by continuing aggressive medical therapies. I believe this last category represents a small percentage of physicians, but they are to be roundly condemned for their tactics.
The issue is how to deal with the discussion.
My preference is for an aggressive educational process–one that is directed to both my medical colleagues and more importantly, to the public.
The mass media which revels in scandal and voyeuristic exposures of the distorted and disturbed lives of would-be celebrities should be opening the public's mind to the importance of end of life issues.
Oprah should have done more. Hopefully Dr. Oz will do so. Other media outlets need to contribute to the public discussion. Awareness is key.
I would like to encourage the public to raise these issues with their physicians and other health care providers.
My patients do not take their health care passively. Nor should they.
I would rather see this discussion continue to expand and grow……but without the imposition of more regulations and laws.