When the Politics of Dying Lacks Dignity
This famous line from the 1967 movie Cool Hand Luke is spoken twice. The second time they are Luke's last words before being shot. He laughs, a wry acceptance of fate as he is taken into custody after his final escape. When the prison warden first speaks the line after striking Luke, he does so because Luke is "refusing to sacrifice his dignity," failing to understand as a prisoner, Luke has no choice.
How we "escape" life when death comes knocking isn't always easy, can be brutal, but need not sacrifice individual dignity. Unfortunately, our politicians' failures to communicate with honesty and civility about dying have completely distorted the proposal to include voluntary end-of-life counseling within health care reform or as an additional Medicare service.
During the 2009 health care reform debate, Sarah Palin famously called the voluntary counseling, "death panels," and the phrase was quickly reinforced by conservative bloggers and right-leaning media, ultimately becoming short-hand even for mainstream journalists. Now, with so much misinformation about end-of-life counseling in circulation and facing conservatives focused on repealing health care reform, the Obama Administration has dropped the end-of-life counseling proposal entirely.
What we've got here is a failure to communicate. It's evidence of just how broken our political system is that something so simple, beneficial, and economical has become a silver bullet with which conservatives hope to dismantle all of health care reform. So politically poisoned, the administration had to walk away.
In the title of an article on Religion Dispatches, Peter Laarman, Executive Director of Progressive Christians Uniting, asks "Why Can't We Take Death Seriously?" He eloquently addresses the real issue: our refusal to face death thus allowing politicians to play on our fears. Laarman writes:
Here is what needs to be said loud and clear--and religious leaders should be leading this conversation in death-phobic America:
We merely give death more power by pretending we can evade or escape it. And what's more, it is horribly unfair to friends and family members for those of us who are growing older not to make sure that we have our affairs in order by way of clear health care directives.
Syndicated columnist Mort Kondracke describes the significant savings end-of-life planning can achieve and how they are being lost to demagoguery:
Really, there are two issues here—end-of-life counseling and "rationing"—that ought to be debated separately. Both have big cost implications, but counseling also can be part of a cultural change, already under way, that leads terminally ill people and their families to choose a humane "good death," avoiding painful (and expensive) heroic measures to keep patients alive.
Voluntary counseling sessions as part of a Medicare beneficiary's annual physical could lead a senior, healthy or ill, to equip himself or herself with an advanced medical directive ("living will") and complete a durable power of attorney appointing a surrogate to make medical decisions in case of incapacity.
A recent study in the New England Journal of Medicine found that nearly 70 percent of older adults have living wills detailing their end-of-life wishes.
The use of hospice care at the end of life—where patient comfort and access to family is emphasized over merely keeping the patient's heart beating—also has increased significantly.
There are significant savings to be had by opting to spend one's last days in a hospice as opposed to an intensive care unit—perhaps $50 billion a year nationally—but the opportunity to choose is what's even more important.
Laarman also castigates the Obama Administration for retreating from the Medicare proposal, citing a Boston Globe editorial that calls the decision "lamentable." While frustrating, from a communications perspective the assumption the administration is "caving" is misguided. Any person in Obama's shoes would assess the political climate and make the exact same call: the debate is distorted; cut your losses, live to fight another day.
The failure to communicate is not only a function of the right-wing. Many overzealous commentators on the left are saying "the real death panels," are now responsible for two preventable deaths in Arizona. Republican Governor Jan Brewer's severe budget cuts resulted in two patients on transplant waiting lists being dropped. As their conditions worsened, a medical fact that would have moved most to the top of the list, they were no longer eligible due to budget cuts. As tragic as the situation is, by resorting to the same "death panels" phrasing, the left distracts from the real discussion Americans need to have: health care rationing happens everyday within insurance companies.
As frustrating as our broken political system is, when it comes to communicating complex ideas, just having the conversation is itself a victory. It forces proponents to become better at making the case, and over time, with repetition, the truth emerges and those responsible for the misinformation are exposed for the frauds they are. Proponents must use these moments to educate the public, and in the process, restore honesty and civility to policy debates, and like Cool Hand Luke, refuse to sacrifice our dignity.