The fearmongering on this subject is one that’s interesting to me. I don’t know exactly what a “death panel” is, but I’m pretty sure the American people wouldn’t stand for it one bit. What I can tell you, from my experience as an Executive Director of a hospice, is that too few people are granted the gift of end of life care and suffer painful and long-suffering deaths.

There are many reasons people die painful and slow deaths in this country. The advances in medical care that prolong life, the egotistical doctors that want to pump frail bodies ravaged by cancer full of chemotherapy to the very end, families that refuse to let go even when the patient begs to die. I know, I’ve seen all of these and more. I’ve helped families that received the bad news pick up the pieces and decide the right course of treatment for mom or grandpa. It’s never easy, and no one relishes accepting that death is imminent. I do take pride in the fact that I helped people in pain have a “good death” and to go from this earth without pain and with some bit of dignity and ability get their affairs in order.

Hospice care is provided and paid for in full by Medicare for six months (in some cases longer, if the patient survives and re-qualifies). [see benefit] Hospice benefits provide social worker services to navigate living wills, family arrangements and counsel with the patient and the family on the diagnosis, nursing care, medications, home health aide visits, spiritual counseling, volunteers and even provide for grief counseling for the survivors for up to a year. Yet still, nationally, nearly 32 percent of dying patients had hospice care during the same period, for an average of 11.6 days. (NYtimes)

When a patient is terminal and in pain, what is more sadistic…to provide comfort and emotional care at end of life or to continue aggressive treatment and false hopes while not treating the pain?

I’ve seen too many families that came to us at the last minute desperate for some help only to have their loved one die before we even got a nurse out to their home.

We will all die. Me, I’d prefer it to be pain free and in my home surrounded by my family rather than stuck in a nursing home reeking of urine.

I’ve held the hands of patients as they breathed their last breath and known that I’ve helped them and their family with the greatest gift, a good death. I have cried along with sons and daughters as they acknowledge a parent is terminal and seen their relief as I explained how hospice is going to help them during the most dramatic time of their life. I’ve learned great wisdom at the bedside of terminally ill patients and their bravery helped me confront my own mortality.

It is up to you to decide when enough treatment is enough, but the medical professionals treating you should tell you the truth about your condition and your options with care.

For example, if you are 90 years old with terminal cancer and fall and break your hip you probably shouldn’t have hip replacement surgery. I’m not a clinician, but I can tell you that a lot of patients don’t survive that surgery at that age and medical condition and if they do they usually only last a few days afterwards. Why put patients through that additional pain and families through the false hopes of recovery?

I’m no longer in hospice. It takes its toll on the living that live their lives dealing with death. I take many things from my time with patients and the deaths that were part of my job. None of what I take from my experience could ever be called “rationing” or a “death panel” and I’m deeply offended at the implication in the remarks from some of the most irresponsible people I’ve ever seen handed a microphone. Shame on them.

This is the first in a series of my personal opinions on the great health care debate. More to come.