Should we provide financial incentives to doctors that specifically talk with their patients about end-of-life planning and decision-making?  What if the recommendations were made with an eye towards reducing the health care costs of treatments & responses under certain circumstances (such as the cost benefit of having patients commit to a do-not-resuscitate order).    President Obama thinks we should, despite a pretty heated flare-up on the issue.  

Several things strike me as interesting.

The NYT article quotes the Obama administration as saying that "Advance care planning improves end-of-life care and patient and family satisfaction and reduces stress, anxiety, and depression in surviving relatives."  I'm willing to go along with that.  My question, however, is whether or not it's the doctor that should be having these discussions with the patient.  My gut instinct is to say no.  This is a discussion for the family to have, not for the doctor to have with the patient.  The doctor ought to be a resource, providing information to the family to assist with the decision-making processes and letting them know what options are available to them.  

Know who else ought to be a resource?  Your pastor.  Because just because you have the ability to make a certain decision or choose a certain option doesn't necessarily mean that it's in keeping with what you claim to believe in theological terms.  

The family is being pushed out of the responsible role here in favor of a government compensated representative (the doctor).  I don't know about you, but any time I've tried to see a doctor in the past 20 years, I"ve seen one for all of about 7 minutes a shot.  They don't know me from Adam, and yet these are the people that are going to sit down and have a heart to heart talk with me about my end of life options?  

No thanks.  Unless it's a family doctor that someone has known and dealt with for an extended period of time, where there's a relationship that extends beyond whatever is in the medical file, no thanks.  It's not at all appropriate.  Families need to step up and take responsibility together.  Sure that's an awkward thing.  But if you don't do it, someone else is apparently going to be paid to do it.  And you may not like the results of that consultation.  

Another fascinating quote is on the second page of the NYT article.  "Dr. Donald M. Berwick, Administrator of the Centers for Medicare and Medicaid services" asserts that "Using unwanted procedures in terminal illness is a form of assault."  Huh?  Attempting to provide medical care to someone who just happens to be suffering from a terminal illness is now tantamount to assault?  Does that mean that family members who lobby for care for an incapacitated relative could be somehow held responsible if the relative regains capacity and is angry that they were treated?  What in the world is this sort of statement intended to convey?  How does this jive with the Hippocratic Oath?  (and, on an unrelated note, check out how frighteningly the Oath has changed - probably in the last 50 years - in order to remain politically correct and in lock-step with the assaults on the dignity and value of human life!!!)

But that's not weird enough.  Dr. Berwick continues.  "In economic terms, it is waste."  Well, maybe.  What do you mean by that?  And at what point does treatment for an illness for which there is no cure become waste, and who decides that?  Arguing against a kidney transplant for someone who is going to be dead in 6 weeks from cancer might indeed seem wasteful.  But what if the transplant is for someone who has cancer in remission?   At what point is a treatment wasteful, since that person's going to die?  And how do we reconcile this with the basic truth that we're all going to die at some point?!  

Once again, these are important questions that aren't simply health-care related.  They are theologically loaded guns.  How you answer these questions personally or as policy says a lot about what you believe, and trust me, people in your family are watching you as you make these decisions.  These decisions can be watershed moments for sharing your faith and what you believe about life and death and the relationship between the two.  Relegating these discussions out of the family circle and into sterility of an examination room with someone who may not even know you very well is dangerous and insulting.  

All these things need to be talked about.  Families benefit and grow stronger when they are faced together.  Why not compensate families to have these conversations, rather than paying doctors?  Surely that's an idea that would benefit a whole lot more people!