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Wednesday, December 29, 2010

Letters To The Editor, New York Times

Here are all the arguments summarized in a few letters. The rational ones, the completely irrational one and the totally confused one. And the insurance companies make end of life decisions everyday, out of sight and non-reviewable. Read on.

Making Choices for End-of-Life Care
Published: December 28, 2010

To the Editor:
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Jordan Awan

Re “Obama Institutes End-of-Life Plan That Caused Stir” (front page, Dec. 26):

The new Medicare regulation covering physicians’ discussions with their patients about end-of-life issues is once again under attack by right-wing ideologues. The new rule is specifically designed to give patients the opportunity to explain their wishes about end-of-life care to their personal physicians. It represents a thoughtful and valuable step toward allowing patients to control decisions about their own health care.

Yet Elizabeth D. Wickham of LifeTree obstinately and perversely insists, “Patients will lose the ability to control treatments at the end of life.”

This is an astonishing distortion, comparable to the canard last year that the Obama administration was planning “death panels” to decide who was worthy to receive health care.

Peter Rogatz
Port Washington, N.Y., Dec. 26, 2010

The writer is vice president of Compassion and Choices of New York, which counsels patients on end-of-life care and choices.

To the Editor:

It strikes me odd that counseling on end-of-life care (advance directives), a service that I have provided perhaps a thousand times over my 35-year medical career, is front-page news.

The plan by Medicare to reimburse for the service will not change the content of the doctor-patient discussion. Whether it changes the frequency of the discussions remains to be seen.

Charles Cutler
Norristown, Pa., Dec. 26, 2010

The writer is an internist.

To the Editor:

Those who oppose the idea of doctors discussing end-of-life treatment with their patients during routine annual checkups should consider the alternatives. Many elderly persons, and their spouses and children, are reluctant to initiate such a discussion until a medical crisis occurs, when it may be too late to have any such discussion.

These patients will be unable to consider alternative courses of treatment and make decisions for themselves, leaving their spouses and children, who have their own emotional and financial agendas, to make those decisions on their behalf.

Doctors, on the other hand, can and should initiate this difficult discussion before a crisis occurs, so that the patient can have time to consider the alternatives and make decisions for himself, rather than leaving it to his spouse or children while he lies in the intensive-care unit or nursing home bed.

Doctors, who do not have the same emotional and financial stake as family members, can outline the options in a knowledgeable and dispassionate manner, and elicit their patients’ wishes without embarrassment, tears or fears.

Joan G. Engel
West Hartford, Conn., Dec. 26, 2010

To the Editor:

I read your article about “end-of-life planning” and I am completely appalled. I have been a longtime supporter of President Obama, but it appears as if death panels are becoming a reality.

My mom, 93, recently received a diagnosis of colon cancer, and her doctors recommended an operation to remove the tumor. It was successful and she can now expect to live several more years.

Who are we, or any doctor, or any president to judge when the end of life is and when to deny aggressive care?

Laurine Laxer
Key West, Fla., Dec. 26, 2010

To the Editor:

The proposal in the health care reform legislation to encourage physicians to counsel patients and their families regarding end-of-life issues was welcomed by the vast majority of health care providers. Its exclusion from the final bill was a disservice to Americans.

Modern medicine has much to offer to critically ill patients, but too often life-supporting technologies are employed with little or no hope of recovering to a meaningful existence. Pre-emptive contemplation and advisement is essential to a person’s well-being.

Advance directives, or “living wills,” are statements made by an individual dictating his or her wishes for end-of-life treatment and offer great comfort to families who are confronted with difficult choices in a crisis.

People’s end-of-life wishes should be discussed in advance with their physician, who knows them well, rather than nervously discussed with an unfamiliar provider with whom they have no personal relationship.

David C. Goering
Lawrence, Kan., Dec. 27, 2010

The writer is a hospitalist.

To the Editor:

Those Republicans who deride the idea of voluntary end-of-life counseling ought to redirect their attention to Gov. Jan Brewer of Arizona, who signed into law a measure cutting state Medicaid financing for certain transplant operations. That’s where the real “death panel” convened.

Amy Laiken
Chicago, Dec. 26, 2010

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