Peterson\u2019s Ph.D. is in theology and ethics from Duke University. She received her first education in end-of-life care twenty years ago, as her first husband was living with and then dying of AIDS. She chronicled that experience in a memoir, Sing Me to Heaven: The Story of a Marriage<\/a>.<\/p>\n Her second husband and former faculty colleague, Dr. Dwight N. Peterson, with whom she is the author of Are You Waiting for \u201cThe One\u201d? Cultivating Realistic, Positive Expectations for Christian Marriage<\/a>, has been in failing health for some years and entered hospice care (at home) in July of 2012. Peterson blogs daily about their end of life experience at www.caringbridge.org\/visit\/dwightpeterson<\/a>.<\/p>\n **********<\/p>\n Medicare recently announced<\/a> its intention to reimburse doctors for time spent talking with patients about their wishes for medical treatment near the end of life.<\/p>\n This plan was hailed by leaders of prominent medical organizations as an acknowledgement that advance care planning is an essential element of the practice of medicine.<\/p>\n The plan is opposed by the National Right to Life Committee, on the grounds (as stated by a NRLC spokesperson) that \u201cthere is pervasive bias against treatment that is occurring in advance care planning that involves nudging individuals to reject lifesaving treatment.\u201d<\/p>\n Let\u2019s step back for a moment and think about what is going on here.<\/p>\n \u201cAdvance care planning\u201d means conversations between patients, families and physicians about the kinds of medical treatment that a person wishes to have as his or her life draws to a close.<\/p>\n It involves asking questions like:<\/p>\n As things stand now, Medicare does not reimburse doctors for having conversations like this It\u2019s like paying a lawyer to draw up a trust or will or contract, but not paying the lawyer to talk with the client about what the client\u2019s goals and values are, and what kind of trust or will or contract might express the client\u2019s values and help achieve the client\u2019s goals.<\/p>\n In the absence of such conversation, even the best lawyer would be able to provide only the most generic service, and the client\u2019s goals would likely not be accomplished.<\/p>\n So also with medical care. If the doctor isn\u2019t paid to talk with the patient, the doctor is going to go with the default option, whatever that might be.<\/p>\n Which brings us to the objection of the National Right to Life Committee. The objection of the NRLC is that if doctors are paid to talk with patients about patients\u2019 wishes for the end of life, those conversations may result in patients opting to reject \u201clifesaving treatment.\u201d<\/p>\n So better not to talk about it. If end of life conversations don\u2019t happen, then patients will get the default option, which is \u201clifesaving treatment.\u201d<\/p>\n What could be wrong with this?<\/p>\n Lots, as it turns out. \u201cLifesaving treatment\u201d at the end of life can mean medical treatments that increase suffering while resulting in no benefit to the patient.<\/p>\n Take CPR, for example. In elderly persons with multiple chronic health conditions, CPR is not a benign intervention (meaning something that won\u2019t hurt and might help). On the contrary: in this population CPR is virtually guaranteed to result in a range of serious and painful injuries, and has a success rate approaching zero.<\/p>\n And yet, if patients don\u2019t specifically opt out, CPR is what they get. \u201cI would be doing the CPR with tears coming down sometimes, and saying, \u2018I\u2019m sorry, I\u2019m sorry, goodbye,\u201d says one doctor<\/a> of clinical experiences early in her career. \u201cIt just seemed like a terrible way to end someone\u2019s life.\u201d<\/p>\n Why is the default option in end of life care so brutal? And why is it that people who think of themselves as being \u201cpro-life\u201d are too often the most vocal advocates for such brutality?<\/p>\n![\"SMTH\"](\"https:\/\/peteenns.com\/wp-content\/uploads\/2015\/08\/SMTH.jpg\")
<\/a>Today\u2019s post is the 1st of a 5-part series, \u201cMaking Peace with Mortality,\u201d by Dr. Margaret Peterson<\/a>, associate professor of theology at Eastern University.<\/p>\n\n
![\"MKP\"](\"https:\/\/peteenns.com\/wp-content\/uploads\/2015\/02\/MKP.jpg\")
<\/a> with patients. Medicare pays doctors for doing things to care for patients, but not for talking with patients about the patient\u2019s goals and values and how these might inform decisions about how to care for the patient.<\/p>\n