Sunday, November 22, 2009

Is 60 Minutes Advocating Death Panels?

Tonight, 60 Minutes led off with a segment titled, "The Cost of Dying."

According to the report, Medicare paid $50 billion in 2008 to cover doctor and hospital bills during the last two months of patients' lives. It is estimated that 20 to 30% of these expenditures had no meaningful impact.

I think we can see where this is going.

60 Minutes correspondent Steve Kroft spoke with Dr. Ira Byock, the Director of Palliative Medicine at Dartmouth-Hitchcock Medical Center in New Hampshire:

"Families cannot imagine there could be anything worse than their loved one dying. But in fact, there are things worse. Most generally, it's having someone you love die badly," Byock said.

Asked what he means by "die badly," Byock told Kroft, "Dying suffering. Dying connected to machines. I mean, denial of death at some point becomes a delusion, and we start acting in ways that make no sense whatsoever. And I think that's collectively what we're doing."

And wouldn't you know it but Dr. Byock has a website called Dying Well. Not surprisingly, 60 Minutes did not see fit to mention this detail.

Later in the segment, Dr. Byock was speaking with a patient named Charlie Haggart who wanted a double kidney/liver transplant. Byock didn't think Haggart was a candidate and besides it would cost $450,000:

At a meeting with Haggart's family and his doctors, Dr. Byock raised the awkward question of what should be done if he got worse and his heart or lungs were to give out.

He said that all of the available data showed that CPR very rarely works on someone in Haggart's condition, and that it could lead to a drawn out death in the ICU.

"Either way you decide, we will honor your choice, and that's the truth," Byock reassured Haggart. "Should we do CPR if your heart were to suddenly stop?"

"Yes," he replied.

"You'd be okay with being in the ICU again?" Byock asked.

"Yes," Haggart said.

"I know it's an awkward conversation," Byock said.

"It beats second place," Haggart joked, laughing.

"You don't think it makes any sense?" Kroft asked the doctor.

"It wouldn't be my choice. It's not what I advise people. At the present time, it's their right to request it. And Medicare pays for it," Byock said.

When it comes to expensive, hi-tech treatments with some potential to extend life, there are few limitations.

By law, Medicare cannot reject any treatment based upon cost. It will pay $55,000 for patients with advanced breast cancer to receive the chemotherapy drug Avastin, even though it extends life only an average of a month and a half; it will pay $40,000 for a 93-year-old man with terminal cancer to get a surgically implanted defibrillator if he happens to have heart problems too.

"I think you cannot make these decisions on a case-by-case basis," Byock said. "It would be much easier for us to say 'We simply do not put defibrillators into people in this condition.' Meaning your age, your functional status, the ability to make full benefit of the defibrillator. Now that's going to outrage a lot of people."

"But you think that should happen?" Kroft asked.

"I think at some point it has to happen," Byock said.

"Well, this is a version then of pulling Grandma off the machine?" Kroft asked.

"You know, I have to say, I think that's offensive. I spend my life in the service of affirming life. I really do. To say we're gonna pull Grandma off the machine by not offering her liver transplant or her fourth cardiac bypass surgery or something is really just scurrilous. And it's certainly scurrilous when we have 46 million Americans who are uninsured," Byock said.

Perhaps extending Haggart's life wouldn't be his choice. But it's not his choice to make. At the present time, it's their right to request it. But if Dr. Byock has his way it won't be your right. Why? Because the good doctor and the government think they know what is best for you.

Dr. Byock might find the phrase "pulling Grandma off the machine" offensive but I find his arrogance offensive. It's the sort of arrogance that does not inspire confidence and trust in the medical profession. I fear that our most vulnerable will bear the brunt of this arrogance.

Dr. Byock might also find "pulling Grandma off the machine" scurrilous but so is his claim that 46 million Americans are uninsured. His claims are scurrilous because the number of uninsured is actually closer to 30 million when you take illegal immigrants out of the equation. They are also scurrilous because he assume that none of those 30 million find themselves in Mr. Haggart's condition. It suggests that if not for the Mr. Haggarts of the world then the uninsured would be insured.

Well, Mr. Haggart died this week when his condition deteriorated significantly his family saw fit not to resuscitate him. It's one thing for his family to make that determination. It's quite another that it be mandated by doctors through government decree.

It looks like Sarah Palin's fears are well founded and that we are well on our way to death panels. Steve Kroft and Dr. Byock might not call it a death panel. But if it walks like a duck, it quacks like a duck and swims like a duck then it's a duck. If Dr. Byock wants to accuse me of being scurrilous then let him quack.

No comments: