Stewart v. McCaughey

[tongodeon]

I really enjoyed the last Daily Show before their 3 week break. Not because of Jon Stewart - he's usually good but I actually think he was wrong about a lot of stuff and didn't do well even when he was right. I liked his guest Betsy McCaughey. I ended up watching the entire interview twice all the way through, not counting extensive rewinds and

Comments

[cdk]

I feel like I must be missing something. I'm not sure what sort of document I could create that would let someone withdraw medical care from me when there's any reasonable expectation that I can make those medical care decisions myself. How does "adherence to" an "end-of-life plan" make any sense from the perspective of the person who made the plan? I mean, I can create a legal document that will take effect when I am no longer capable of making my own decisions, but the only way I can fail to "adhere" to that document is to create a new document that does the same thing.* But in that case, I'm still adhering to my end-of-life plan, it's just not the one I created earlier. If I'm for some reason incapable of making decisions about my own medical care, the only way I could fail to "adhere" to my "end-of-life plan" would be to spontaneously become well. I don't understand what I, as a potential patient, could do to "change my mind". I really feel like I must just be missing something - the only way I can find to interpret the "adherence

[tongodeon]

The health care document says:

For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life- sustaining treatment.Basically there's an incentive for coming up with a plan, and there's an incentive for sticking with the plan

[cdk]

I don't know how to make sense of the phrase "orders for life-sustaining treatment" except in the context of a living will. Why would I make a document that says, "In the event that I require life-sustaining treatment, and am perfectly aware, communicative, and able to participate meaningfully in health care decisions, please terminate me regardless of my wishes"?

[tongodeon]

Why would I make a document that says, "In the event that I require life-sustaining treatment, and am perfectly aware, communicative, and able to participate meaningfully in health care decisions, please terminate me regardless of my wishes"?

You wouldn't, and the doctor wouldn't, and that's not what would happen, and that's not what the document says to do. I have no idea where you're getting this from, but nobody except you is saying that.

[cdk]

I apologize for the frustration I'm causing. Please tell me what people are talking about. What type of "order for life-sustaining treatment" could I create and subsequently fail to adhere to?

[tongodeon]

Please tell me what people are talking about. What type of "order for life-sustaining treatment" could I create and subsequently fail to adhere to?

You've brought up some good points and it's got me thinking. I don't think the bill is saying that you wouldn't adhere to your own treatment. I think the bill is saying that doctor quality will be measured based on creation of and adherence to those orders, no further pronouns, period.

The doctor is one of your major advocates when you can no longer advocate for yourself. Perhaps they're trying to make sure that your plan gets followed after you're unable to make sure that it does. The words on the piece of paper that you and your doctor draw up only guarantee as much as your caretakers are willing to guarantee. High quality caretakers will make sure that your wishes get followed, low quality caretakers will just do what they normally do.

[tensegritydan]

The rating is of how well the doctor adheres to your plan, not how well you adhere to it.

It is possible for doctors/providers to carry out a plan of care in contravention to the wishes of the family where the patient's wishes were not made clear.

This happened to a relative's mother who passed away in a hospital hallway because the hospital would not admit her to hospice despite her husband's wishes (she was incapable of making the decision). This has been a source of bitterness for the family for over a decade.

So one of the bazillion things that a doctor should be measured on is how well they provide appropriate end of life counseling and then assist you in developing an end of life plan of care if you want one, and then how well they carry out your plan. If you want to change your plan, then they should help you change it and then carry out the new plan

[freeasinbeer]

This was my problem with her worries.

My stated desires about what I want are not written in stone. If I have a discussion with my doctor, and even write it down,
"Do everything you can to keep this body breathing", for example. Then, I get some terrifically painful condition, and CHANGE MY MIND.
It seems like I can. "You know that plan from last year? For get it. I changed my mind. here's the new plan"

Is seems like the health care plan would reward the doc for following the new, current plan.

He objection seems to be the unlikely scenario that
1) you have a plan and change your mind.
2) the doctor gets rewarded for ignoring your current wishes.

That does not seem to be in the document at all.
It would involve something like "you can only make a plan once" or something.

[tongodeon]

Is seems like the health care plan would reward the doc for following the new, current plan.

That's my understanding. At any time you can go back and rewrite your plan. Which is cool with me, and seems to eliminate the 'death panel' concerns.

Although - worst case - let's say that we're both wrong and whatever you decide is what the bill thinks ought to be carried out. That's where doctor quality comes in. In the pre-planning, pre-painful stages the good doctor is going to say "um, have you considered how totally painful this is?" He might even take a patient down the hall to meet a few unfortunates. A bad doctor won't and his patients will end up changing their mind when the chips are down, which will indicate that he didn't do the job right the first time.

[crisper]

The hysteria I occasionally hear around the death panel issue doesn't seem to revolve around "they're going to come kill me". It's always, "they're going to kill Grandpa" or "they're going to kill Mentally Handicapped Cousin". I have inferred from this that the objection, whether clearly stated or not, is the scenario:

1. Grandpa makes a plan with his doctors ("is forced to plan his own DEATH!!!")
2. Grandpa becomes incapacitated and can no longer change his plan
3. You don't want Grandpa's plan to be carried out after all but you don't have power to change it
4. Doctor kills Grandpa

[lexica510]

The important part of #3 that's not included there is "but you don't have power to change it because Grandpa didn't want you to, or he would have done a durable power of attorney for healthcare naming you as the person to make decisions, instead of a DNR/living will the way he did."

Tangentially, I was delighted to discover, upon renewing my driver's license, that in California it's no longer possible for one's relatives to override one's wishes to donate one's organs:Prior to the registry, the responsibility for giving consent for donation fell solely to the donor’s family. Unfortunately, family members are not always aware of their loved one’s wish to donate. Registering with Donate Life California eliminates any doubt about your wish to be a donor. Your family will be provided proof of your registration at the hospital so that your life-saving wishes can be fulfilled

[flwyd]

Things are complicated in many situations when (1) is likely to happen. People on heroin are not well known for making sound decisions, so lying in the hospital on painkillers is not a particularly good time to change your mind about fundamental values, but it's a time when you may have a new perspective on your old decisions.

But that's an issue with living will/do-not-resuscitate orders anyway. It sounds like this bill just rewards doctors for doing what they're already supposed to.