Sarah Palin's Death Panels are Back...

The Wall Street Journal published an op-ed today by Sarah Palin on the report released by the National Commission on Fiscal Responsibility.  And once again, she has invoked the notion of government-sponsored “death panels.” 

She writes that the findings of the Commission:

“[…] implicitly endorses the use of "death panel"-like rationing by way of the new Independent Payments Advisory Board—making bureaucrats, not medical professionals, the ultimate arbiters of what types of treatment will (and especially will not) be reimbursed under Medicare.”

The controversy over these alleged “death panels” raged during the summer of 2009 as our nation fought to come to a consensus on healthcare reform.  

At the center of the controversy was the following statement made by Ms. Palin on her Facebook page:

“The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

These “death panels” were actually proposed funding for consultations between physicians and patients in order to discuss issues concerning end-of-life care.  Palin’s statements were later voted the biggest lie of 2009 by the non-partisan website, Politifact.com.

So what’s the harm in categorizing end of life discussions as “death panels?”  For one, you’re putting physicians in the role of the executioner.  Conversations regarding a patient’s wishes at end-of-life, including the transition to palliative care, are an integral part of a patient’s treatment.  These conversations respect and promote patient autonomy, by allowing patients to obtain information from their physician regarding their prognosis and treatment options in order to make informed decisions concerning the course of their healthcare.  In many terminally ill patients, this includes conversations on death and dying. 

Accepting death is probably one of the most difficult, and intimate, decisions an individual will ever face.  And this week we said goodbye to a woman who did so bravely, Elizabeth Edwards.   I’m afraid that Ms. Palin’s continued reference to “death panels” undermines the difficult decision that many persons with cancer have to make – the acknowledgement that the fight is over and the preparation for what lies ahead.  At the recommendation of her physician, Elizabeth Edwards made the decision to discontinue treatment and spend the remainder of her time in this world at home surrounded by her loved ones.  Many similarly situated patients choose to continue treatment and endure the harsh side effects of aggressive cancer treatment. 

When a particular cancer treatment has not produced the desired results, the promise or possibility of a new treatment or experimental drug gives a great deal of hope to the patient.  Especially when proposed by the patient’s oncologist.  The possibility of offering additional therapy can also be therapeutic for the oncologist, who is in the role of “fighting” the disease.  But there is a point, a point that Mrs. Edwards also faced, when treatment does become futile.  And this is an objective conversation that should be had between the patient and the physician. 

In her article, Palin refers to Independent Payments Advisory Boards, which would recommend proposals to reduce Medicare spending.  I would argue that reducing healthcare spending and seeking cost-effective medicine is not evil, Ms. Palin.  Even in a perfect world – with limitless resources and talented oncologists– we simply do not have the ability to cure every patient.  And just because we have the means of continuing treatment, doesn’t mean that we should – especially when it comes at the expense of the quality of one’s life. 

It is unfortunate that Ms. Palin continues to reference death panels and demonizes the initiation of end-of-life discussion with terminally ill patients.  These discussions are an important tool for patients in making decisions regarding their healthcare, often prevent unnecessary treatment and procedures, and accelerate the transition to palliative care.

There is a great deal of trust in the relationship between the patient and his oncologist.  I think there is something to be said about the subject of palliative care being introduced by the physician, rather than initiated by the patient.  No person with cancer, especially one who is a provider of a family, wants to feel like they are giving up on their fight against cancer by electing to embrace palliative care.  And I am certain that many members of the medical community do not appreciate the association with “death panels.”