Death, Dishonesty & The GOP

In an effort to defeat universal health care, conservatives are engaging in a campaign of lies that will ultimately cause more families to suffer needlessly at a most painful time. As someone who worked for years with end-of-life care issues, and spent years working in the HIV/AIDS community, I cannot let it pass.

It's easy to play on people's fear of death. It's even easier when you're willing to lie outright as conservatives are doing [1] in the health care debate.

A campaign on conservative talk radio, fueled by President Obama's calls to control exorbitant medical bills, has sparked fear among senior citizens that the health-care bill moving through Congress will lead to end-of-life "rationing" and even "euthanasia."

The controversy stems from a proposal to pay physicians who counsel elderly or terminally ill patients about what medical interventions they would prefer near the end of life and how to prepare instructions such as living wills. Under the plan, Medicare would reimburse doctors for one session every five years to confer with a patient about his or her wishes and how to ensure those preferences are followed. The counseling sessions would be voluntary.

But on right-leaning radio programs, religious e-mail lists and Internet blogs, the proposal has been described as "guiding you in how to die," "an ORDER from the Government to end your life," promoting "death care" and, in the words of antiabortion leader Randall Terry, an attempt to "kill Granny."

Though the counseling provision is a tiny part of a behemoth bill, the skirmish over end-of-life care, like arguments about abortion coverage, has become a distraction and provided an opening for opponents of the president's broader health-care agenda. At a forum sponsored by the seniors group AARP that was intended to pitch comprehensive reform, Obama was asked about the "rumors." He used the question to promote living wills, noting that he and the first lady have them.

Democratic strategists privately acknowledged that they were hesitant to give extra attention to the issue by refuting the inaccuracies, but they worry that it will further agitate already-skeptical seniors.

Where the consequence is needless suffering, I do not share Democratic strategists hesitance to refute inaccuracies.

That anyone would direct your doctor in "guiding you in how to die" is a lie.

That it amounts to "an ORDER from the Government to end your life" is a lie.

The truth is not that Democrats want to "kill Granny," but that Republicans want to ensure that "Granny" suffers needlessly in death, and that her family — in the midst of their pain — deal with the confusion of not knowing what kind of care "Granny" does or doesn't want, and what kind of measures she does and doesn't want taken.

Only a party that believes the Terri Schiavo spectacle was a boon to their cause could engage in a campaign to virtually ensure that many, many more such cases will happen — though most will not play out before news cameras, or serve as a political sideshow for the extreme right. They are risking the same result they got from the Schiavo story — that even more Americans will be appalled at a crass, politically driven intrusion into a deeply personal matter.

Grandma will die, someday. So will we all. It's perhaps the one indisputable reality every single person on earth has in common. We don't, however, like to think about it. So we don't think about it until it's too late, and our families suffer as a result. Republicans seem to want to make sure that continues to be true.

That's because the measure they're exploiting to defeat health care reform is really intended to facilitate more people getting advance directives. An advance directive [2] is simply a document that serves to state what medical treatments you want or don't want, and what measure you do or do not want taken if you are unable to make medical decisions for yourself. In other words it speaks for you when you cannot speak for yourself.

In addition, a medical power power of attorney allows you to designate someone you trust to make medical decisions for you if you are unable to make them yourself.

The question isn't "How do you want to die?" The question is simply: "What kind of care do you want, and what measures do you want taken if — at the end of life — you are unable to speak for yourself?"

It's a decision that, in the absence of an advance directive or a living will, falls to a spouse or the closest family members. In the absence of an advance directive and/or medical power of attorney, families are often torn apart with fighting over their loved-ones wishes and trying to determine what those wishes were, leading to years of courtroom battles, while their loved one lingers.

Health care reform advocates don't want to "Kill Granny." Neither do conservatives. I'll even give them the benefit of the doubt that they don't want your family battling it out over Granny's hospital bed, or in court for years and years, as Granny lies there, no longer able to say what she wants. But that's the ultimate outcome of their dishonest campaign.

I saw it up close and personal when I volunteered in the HIV/AIDS community, while in college. I saw partners who had spent decades together, and spent years caring for one another, kept apart because they were "not family" and had no legal standing that anyone was obligated to recognize. One man knocked on the door of the organization where I worked, and when I answered told me with tears in his eyes that he had just been barred from his partner's bedside by the man's estranged family, and even ejected from the home the two of them had shared. He had no legal standing as a spouse, of course, and the couple had no legal documents that might have given him the right be there.

Legal spouses don't have that problem. The reason that 30 or more courts ruled in Michael Schiavo's favor is because he was the legal spouse. Without that even the legal status of having a medical power of attorney, let alone being legally married, the people whose pain I witnessed were extremely vulnerable. Even couples who have those documents, like Janice Langbehn and Lisa Pond [3], are vulnerable if they travel — or go anywhere at all — without them.

My husband and I both have advance directives stating what measures we want and don't want taken, in the event that we are unable to make those decisions ourselves. We each have medical powers of attorney, designating one of us to make make medical decisions for the other, if either of us is unable to make those decisions for ourselves. We have them because our experience has taught us how necessary they are, and the consequences of not having them. We have them because we know how vulnerable we are, and how vulnerable our children are without them.

The truth is that most Americans are vulnerable in this regard. According to a FindLaw.Com survey, 67 percent of Americans don't have a living will [4]. That means more than two-thirds of Americans may have little to no say in the care they receive or the measures that are taken if they are terminally ill and/or incapacitated.

That's perhaps one of the worst aspects of the Republican's dishonest campaign. It has the potential to make people even more vulnerable, not merely by leaving their wishes undocumented, but by using fear to discourage people from even talking about this most personal decision with one of the most appropriate people: their doctor. After all, a personal physician who knows her patient's wishes, can be an effective advocate and help family understand the most compassionate ways to honor their loved one's wishes.

That's why, wherever you stand on health care reform, I urge you to please use this as a "teachable moment." Sit down with your doctor and/or your family now — while you can still speak to them and they can still hear you — and talk about what care you want and don't want, and what measures you do or don't want taken, if you are ill or injured and unable to speak for yourself. Talk about who you want to make decisions for you if you are unable to speak for yourself.

Make sure you have an advance directive. (You can download copies of your state's advance directive forms here [5].) Make sure you have a medical power of attorney. Make sure everyone knows.

At the same time, don't let the right insert politics into a matter that's ultimately between you, your family and your doctor. The measure that members of the conservative fringe are exploiting in the process does nothing more than encourage doctors and patients to have that most-important, most-avoided conversation.

They're lying as a means to a political end, and it will cause more families to suffer needlessly. It's not just inaccurate. It's not just wrong. It's immoral.