Protect value of human life
'I will treat the sick according to my best ability and judgment, always striving to do no harm. Whenever I care for a terminally ill patient, I will provide optimal comfort care until natural death.
'I will also support my patients' wishes not to prolong the dying process with futile care. I will never give a deadly drug to anyone even if asked, nor will I suggest suicide.
'I will always affirm and guard these ethical principles with integrity, recognizing that every human life is inherently valuable.'
This pledge is posted in our offices as a constant reminder that each exam we conduct, each conversation we have and each treatment we order is to be centered on the premises that each human life has inherent value.
This is our promise to our patients.
On the surface, H.R. 1898 has good intentions. It makes sense to reimburse physicians for time spent helping patients with end-of-life decisions, because these conversations may not be compensated. Our concern with H.R. 1898 is this: We have seen, time and again, that interventions focused on end-of-life care have the potential to become instruments for assisted suicide and euthanasia advocates.
Sadly, not every purchaser, payer, clinician and health administrator holds the ethic that human life has inherent value.
Hospice is one example. Hospice is one of the best things to happen in the history of our nation's health system. Having dedicated nurses and physicians who are experts in palliative care has been a significant step forward in patient care. Unfortunately, hospice has also been misused. There are three populations at risk for abuse:
• The old: Hospice can become a 'verb.' We have personally witnessed nurses and physicians tell elderly patients - who have a self-limited illness - that they have lived a good life and should be 'hospiced.'
• The expensive: We have seen physicians pressured to coerce their patients to go on hospice as a cost-saving measure.
• The difficult: We have witnessed physicians threaten non-compliant patients with hospice if they don't follow a specific regimen of care.
We also have experience with Physicians Orders for Life Sustaining Treatment (POLST) and advance directives and have seen misuse where 'do not resuscitate (DNR)' is translated to 'do not care.' This leaves elderly patients to suffer from easily treatable conditions.
Unfortunately, there are many peer-reviewed studies that document how a DNR label translates into fewer care interventions - specifically, less use of antibiotics as well as fewer transfusions, fewer hospitalizations and transfers to the intensive care unit - even when a patient would want these interventions. More damning still is the reality that those who are labeled DNR, while hospitalized, are more likely to die - both during and after hospitalization. These disparities are found even when studies control for severity of illness.
We are concerned that H.R. 1898 will save money at the expense of the most poor and vulnerable among us. Before we could consider supporting H.R. 1898, it would need to include explicit patient protection by barring discussion of medical killing - either passively through withholding care or actively by taking steps to hasten a patient's death.
Unless there is a change in the basic ethical principles of health care-providers or legislation that protects the vulnerable, cost-reduction attempts like this bill will facilitate active or passive medical killing as a primary cost-reduction strategy.
We need to pause and consider health care reform in a careful manner. If we are to make a real step forward in the betterment of the human condition, it must start with the realization that each human life has inherent value.