Comments

With overheated and misleading rhetoric coming from all sides, it would be helpful if CT could contribute to a thoughtful discussion of this important issue. Perhaps you will consider doing this with your next article.

When did Rupert Murdoch buy CT?

As a pastor, I have witnessed more than one patient that needed an honest assessment of his or her impending death instead of the false hope of treatment that only prolonged the suffering leading to death instead of adding meaningful life filled days. If nothing has changed in 14 years since the study cited in the opening paragraph in the ways that doctors have the difficult conversations about terminal illness, then legal encouragement to do so is needed.

This comment is going exactly in the wrong direction. This is not about cost-cutting or hastening the end of life. It's about humane end-of-life care. Too many doctors feel compelled to intervene to keep terminally ill patients alive for as long as possible, even when the treatment ruins any chance for quality of life in the patient's last days. Using every technical means available doesn't necessarily show greater respect for life. In fact, to me it crosses the line into "playing God" by extending life unnaturally and without benefit to the patient (or the patient's family, who must watch helplessly as suffering is prolonged). The provision objected to in this article is precisely what health care workers, chaplains, and others have been calling for now for at least a decade: an honest, compassionate conversation about end-of-life care, to ensure that a patient's last days are as pain-free and dignified as possible.

I greatly appreciate Rob Moll and/or CT editors decision to change the title of this post from "Section 1233, Mandating Euthanasia" to the more appropriate "Will Section 1233 Hasten Patient Deaths." I wonder if only those who have endured the reality of having to make end of life decisions with or for a loved one can really appreciate the true gravity of the subject.

Because I have been there twice, with my 72 year old mother-in-law with end stage, metastatic lung cancer and with my 49 year old sister with a terminal glioblastoma multiforme brain tumor, I am doubly sickened by this issue being perverted into a fear mongering, political football. We have buried both of these loved ones. But because of what we endured as we made our way through issues of medical and legal power of attorney, living wills, palliative care decisions, DNR's and more, I am glad that 1233 would reimburse the wonderful physician who counseled us as my mother-in-law's cancer reached the stage when there was less and less that could be done medically to retard its growth.

Also, I apologize for the snarky comment I posted above about Rupert Murdoch and CT. I posted it LATE last night when I first linked to the article from my Twitter feed. Because of my life experience, the original title enraged me and I was sorely disappointed in CT. That, however, is no excuse. I hope you'll forgive me.

What a shame that CT has stooped to parroting the rhetoric of the reactive right, which has all but crushed civility in public conversation under its heal. What's curious to me is that it was a proposal from Senator Johnny Isakson, a Republican, that led to language in the bill to help Medicare patients learn about options for care at the end of their lives. If a Republican in Congress can transcend base political motives for the betterment of the quality of life, surely CT can maintain at least as a high a level of discourse.

I'm coming up on 30 years in parish ministry, and I assure you that one thing people desperately need is to have open, informative and enlightening conversations with their doctors about end of life care. The doctors themselves will also benefit, because many of them might learn for the first time what really matters to the patients they're treating. Rob Moll's cheep shots at what is already a difficult public policy perspective just makes everything worse.

Just wanted to let everyone here know that CT is censoring comments on this piece. Several critical comments from last night, including mine, have been deleted from the comment stream--so much for free and open discussion. The title change is a step toward truth, but the entire piece is still misleading by giving credence to fringe views such as Sekulow's without strong critique. And it conflates palliative care with hastening death for financial reasons. I'm hoping the editors will retract this ill-conceived and misleading piece.

This article should be retracted and the information it is passing as truth needs to be vetted. I'm surprized at a long-standing Christian publication allowing such mis-information to be printed unter their banner without checking accuracy first. Has everyone in the publishing world knelt down to the internet's demand for sensationalism and lust for immediate news??? Remember what professional journalism is all about and do it right or retract it.

It's pieces like this that cause many to believe that many of CT's writers should simply put a disclaimer at the top of their "articles" that they will simply repeat Republican talking points no matter how invalid they are.

For example, wouldn't it be worthwhile to mention that it was Georgia Republican Senator Isakson's suggestion to include reimbursement for the consultations in the first place???

There is NO mandate for a consultation. But, if you are going to pay a doctor for having the discussion (no more than every FIVE years, by the way), then you need to define what you are willing to pay for.

Sekulow may not "know" the truth, but it is highly likely he does. He continues to show that he learned well from Pat Robertson who famously blamed 9/11 on gays and feminism.

I am a physician (gastroenterologist) who has been in practice since 1982. I have many "end of life" discussions with patients and their families every year.

I am astounded that with the thoughtful quality that CT usually has in their reports that input was sought from lawyers and writers with clear agendas but no one was consulted who has been at the bedside innumerable times.

The "end of life" discussions are almost always entirely of having the patient and family discuss the issues. Very rarely does this occur until the physician forces them to. As physicians, we help identify the issues that need to be addressed, answer the questions and make very sure that all have opportunity for input. Unfortunately, too many of these occur in the ICU setting when too much has already been done that does not prolong life but does greatly enlarge the suffering for the patient and family. These discussions have always gone on-and will continue to do so. If we can get the patient and family to start the discussion sooner, we can help them make better decisions in a less emotional and fearful time.

Those who use the terms referring to euthanasia or death squads are showing their ignorance and/or maliciousness. This is already a difficult area that causes great emotional distress to each of us in the discussion. Please do not do the work of satan in sowing needless fear and anguish.

I'm glad that you changed your headline for "clarity's sake." I think I and your readers (especially those who had earlier left comments) would also greatly appreciate your changing the article for "clarity's sake."

This is an article -- articles need to be "clear" (and, I believe the word that you were looking for, "factual").

As a lawyer, I too find this post shameful. Mr. Sekulow sounds like an insurance/pharmaceutical company lobbyist, or Gov. Palin, or one of those people who argues that Medicare will be ruined "if it taken over by government", or that Stephen Hawking would have been left to die in a country with government run health care (For those who don't know, he was born and raised in England). Re Gov. Palin, more than 300 Alaska citizens died last year because the state bureaucracy acted too slow in processing payments form funds already allocated. Her talk of "death panels" was apparently a projection of her own issues.

P.S. Many people believe that talking to a lawyer about estate planning will hasten their death. As a result, too many die without a will or any arrangements at all. This anti-counseling position adds to the grief and loss, both emotional and financial, suffered by the survivors.

End-of-life discussions are nothing new and, as Dr. Gifford posted, they are part of conversations most healthcare professionals have with patients who are facing death. That Section 1233 reimburses for these decision is a good thing - -regardless of what you think of the reform legislation.

I'm astounded that CT is twisting this into something evil, something targeting the elderly and the obese. Even worse is the attempt to turn hospice care -- which has been a blessing to more than one friend-- into something sinister.

There are so very many issues that need to be discussed regarding efforts at health reform. If this is representative of what CT does, perhaps it should consider dropping the "C" part.

For shame.

jordan

It is a tragedy that this important subject doesn't get more attention paid to it. Radical right wing christians have made this a political football charged with extreme emotion and provocative intent. Sarah Palin's comment yesterday was highly inflammatory..the death squad will be coming for my mentally challenged child. This comment is not worthy of a Christian who knows that this is not the truth. I am completely discouraged by the rhetoric of many Christians on this subject. The mind of the Klan has not been expunged from our Churches. Viciousness has replaced love and uncontrolled anger abounds. The Church is failing in this critical hour. I am praying that the rhetoric of professing Christians does not inspire some unstable follower from assasinating the present President. Fox news seems to delight in goading believers to extreme positions. No apology was forthcoming when one of their stars told the audience he would like to poison Nancy Pelosi. The Church is silent and brings no civility or wisdom in this contentious season

Glad to see the title changed, but the updated version still feels like its inserted a slant into the discussion. As its been said, there is no MANDATE for hospice consultations. Its an optional program.

The fact remains is that a massive GOP disinformation campaign is polluting thoughtful dialogue on the topic. It seems to this read, that CT has decided to play along.

If we take the scriptures' instruction on slander and false testimony, then CT might get back some of its integrity if it'll glean the courage to inform its readers of the facts and perhaps call out the lies being spread (e.g. Sarah Palin claiming that healthcare reform will include "death panels" that would kill her youngest child-- and audacious lie as any).

Seems like most of these posters missed the last paragraph of the article that speaks to the "art of dying--the Christian practice that did not teach the pursuit of extended life at any cost." I don't see anywhere that the author advocates "using every technical means available" or says that end of life counseling in not a good thing. The concern, and it is mine as well, comes in having the government involved in ecouraging or otherwise suggesting (use whatever verb you want) these discussions.

When my mother was in the hospital due to respiratory failure, we knew she wasn't going to get better. Maybe we were lucky to have such a good hopital nearby, but hospital personnel talked to us about hospice care and other choices she and our family had. They could not have been more concerned and informative. No government entity had to suggest it. No one had to pay them extra for this "service".

Came across a Facebook posting ripping into CT. Found and read the CT piece. Read all the comments. Re-read the piece. I don't get the big deal. The CT piece looks fairly even-handed to me. I think some people in favor of the health reform plan being pushed by the administration believe they have to vilify every argument raised against it. I think some people on the other side sometimes use similar tactics. Taken as a whole, this piece does not.

Sue & Wes,
Those who came to the article more recently missed the original title that inflamed these reactions.

this is astounding error in Doctrine. No one said anything about ETERNAL LIFE WITH JESUS. A gun in my stomack with a threat to kill should be answered "go ahead- my destination is HEAVEN"

I am NOT a radical right wing Christian, but am responding to a radical socialist democrat "health care initiative". The government has absolutely no business telling my doctor (or reimbursing him) what to do about my medical treatment and my end of life issues WHEN I REACH THAT POINT. Obama wants to start "end of life counseling at say 65 or so and do it every 5 years even though I might not have actual "end of life issues". He wants the government to have selective responsibility and rationed care to me and my elderly loved ones. I can't think of one effective government run program that has been run efficiently or effectively. We DO need health care reform but NOT the absolutely ridiculous way that Obama wants it. And WE THE PEOPLE are tired of hearing the lies from the administration about this government run public health care initiative.. It hasn't worked in Canada or Europe (where people have to wait unbelievably long periods of time to get their needed treatment), and they are not "end-of-life issues we are talking about here folks. Obama just wants EVERYONE to agree with EVERYTHING he says and if we don't, then we are "unpatriotic Americans" and members of the MOB, of which I am neither. I am an independent, unorganized (like ACORN does with its liberal democrat friends), freedom loving (like our founding Forefathers intended), US Army veteran who is also a proud patriotic American!! But it is a crying shame what Obama is trying to do to our country and to ruin the future of our grandchildren. I want my grandchildren to enjoy their grandparents instead of me having to face "end of life " counseling MANDATED by the government when I have NO end of life issues. It is indeed a sad state of affairs with which we find ourselves faced with in this ENTIRE administration. We don't need to throw out the baby with the bath water!!!! We need to do things to control costs and take other responsible measures and keep health care out of the hands of ineffective government hands.

"The Declaration of Independence" clearly states this:
THAT WHENEVER "ANY FORM OF GOVERNMENT" BECOMES DESTURCTIVE TO THESE ENDS, IT IS THE "RIGHT OF THE PEOPLE" TO ALTER OR TO ABOLISH IT, AND TO INSTITUTE NEW GOVERNMENT, LAYING IT'S FOUNDATION ON SUCH PRINCIPALS AND ORGANIZING IT'S POWERS IN SUCH FORM, AS TO THEM SHALL SEEM MOST LIKELY TO EFFECT THEY'RE SAFETY AND HAPPINESS. PRUDENCE INDEED, WILL DICTATE THAT GOVERNMENTS LONG ESTABLISHED SHOULD NOT BE CHANGED FOR LIGHT AND TRANSIENT CAUSES: AND ACCORDINGLY ALL EXPERIANCE HATH SHOWN THAT MANKIND ARE MORE DISPOSED TO "SUFFER," WHILE EVILS ARE SUFFERABLE, THAN TO RIGHT THEMSELVES BY "ABOLISHING" THE FORMS TO WHICH THEY ARE ACCUSTOMED.
BUT WHEN A LONG TRAIN OF ABUSES AND USURPATIONS, PURUSING INVARIABLY
THE SAME OBJECT EVINCES A DESIGN TO REDUCE THEM UNDER ABOSOLUTE DEPOTISM, "IT IS THEIR RIGHT, IT IS THEIR DUTY, TO "THROW OFF" SUCH GOVERNMENT, AND TO PROVIDE NEW GUARDS FOR THEIR FUTURE SECURITY.
-The Declarations of Independence. "So The Americans Have Awoken, but have you Christians? The United States Of America was founded upon the Biblical Principals of Jesus Christ, and such should be returned to. PEOPLE OF GOD, IF YOU HAVE A HEART AT ALL FOR THIS COUNTRY, YOU'D BE WILLING TO DIE FOR IT. FREEDOM ISN'T FREE, IT COMES WITH A PRICE PAID. AND CHRIST PROVED THAT WHEN HE SHED HIS BLOOD FOR US ALL. I AM NINETEEN, FOR A VERY LONG TIME I WAS HELD CAPTIVE BY MY ENEMY SATAN AND "I AM NOT ABOUT TO BE HELD PRISONER TO MERE MEN" STAND UP FIGHT!! AS THE GREAR SPY NATHAN HALE ONCE SAID: "I only regret, that I have but one life to lose for my country." CHOSEN PEOPLE OF JESUS CHRIST, IT'S TIME TO FIGHT THE GOOD FIGHT, SO THAT WE MAY FINISH THE RACE. I PLAN ON RECEEDING FROM THIS SATANIC GOVERMENT IF CALLED UPON. I DON'T WISH THAT ANYONE IS KILLED, BUT IF IT MEANS GETTING BACK OUR COUNRTY, THAN GOD LET IT BE SO.

So we've got "Jessie" here threatening violence (against the government or perhaps Obama? Better hope the secret service doesn't trace your IP address) if some additional health insurance regulation signed in to law, and "Charles" who doesn't seem to get that the consultations about hospice care are NOT MANDATORY.

So CT, as you can see from the comments on this page, the disinformation continues... and CT remains silent on the truth.

If anyone should be encouraging open and honest discussion about end of life issues it should be Christians. Christianity Today earlier this year had an article noting the fact that Christians seemed to spend more money prolonging life that was terminal that people that did not have faith and noting the irrationality of that. Now it has pretty much been determined because of dis-information and willful ignorance that these provisions should be taken out of any future bill. So now those doctors that think it is important to talk about end of life issues they will no longer be able to charge for them. So we have more dis-incentive built into the system to be clear, honest and upfront about our own wishes. Christianity Today need to be on the forefront talking about why this was a good idea, not quickly retreating from bad reporting.

And I have absolutely no idea what Jessie is talking about.

Setting up a Living Will and other estate planning documents is a responsible thing to do, as well as eating healthy foods, and exercising. But this is an area where the government should not be involved in. Do we want the government telling us what to do, what to eat, etc.? This is beyond the powers of the government that are stated in the U.S. Constitution.
There is so much confusion because the government and a lot of Americans don't read nor consult the U.S. Constitutuion, Bill of Rights, & The Declaration of Independence.
Do you play football, or baseball, or hockey without knowing or following the rules? At the Olympics, each athlete and the country they represent have to follow the rules of the Olympics and honoring the mission of the Olympics. Why then can't U.S. citizens and government seem to abide by the US Constitution, Bill of Rights & The Declaration of Independence?

Thank you for the explanation, Charles, but I pretty much had figured out what caused the initial anger. Howevr, I don't see any indication that the body of the article was changed. It is that upon which I based my comments.

Adam S. wrote, "If anyone should be encouraging open and honest discussion about end of life issues it should be Christians." I totally agree, which should leave the government out. Adam also wrote, "So now those doctors that think it is important to talk about end of life issues (they) will no longer be able to charge for them". As I mentioned, our Mother's doctors and hospital personnel spoke to us about "end of life" options although no one called it that. It was just options. She could do this, or she could do that. I never saw that on the bill. X-rays, medication, but no "counseling". Why should doctors, or pastors and ministers for that matter, expect to be paid for that? Isn't that all part of the service? We should expect honest, frank assessments from our bodily and spiritual doctors, without their expecting a payment...especially from the government.

Sue, our medical system is set up as a fee for service. So you have to be able to charge it to something in order for the doctor to get paid for his or her time. That is the way the system works. We could ask lawyers give away their time to write up living will as well because it is a good thing to do, but we have a system where we pay people for the work that they do.

Also, what this bill is doing is allowing medicare and medicaid to pay doctors, it is not requiring end of life discussions it is just allowing them to happen and then the government medical care to pay for this. This is what we want, it is not government intrusion, it is government paying for services that people need (when they request them.

!!!!

Rumor spreading was condemned by God in Ex. 23:1,2.

I read section 1233 of HR 3200 once. Maybe I miss something so I will read it again. But so far I don't see nothing that I have not experienced 4 times already in the last 15 years. Anyone who has been thru Surgery in any Hospital may have had this conversation with Administrative staff. They will ask about Advanced directives and living wills, and provide the legal documentation necessary for such. The VA actually helps with the preparation and the staff will sign as witnesses. So what seem to be the problem that Mrs. Palin et al have with it.

But here again we have the usual crowds doing what they are best at doing. Now they've become vociferous, intimidating, threatening and violent. Nothing new under the sun. I'm old enough to have seen this crowds before in person and on the History channel.

Rumor spreading was condemned by God in Ex. 23:1,2.

...

Dudy: "Setting up a Living Will and other estate planning documents is a responsible thing to do, as well as eating healthy foods, and exercising. But this is an area where the government should not be involved in. Do we want the government telling us what to do, what to eat, etc.? This is beyond the powers of the government that are stated in the U.S. Constitution.... Why then can't U.S. citizens and government seem to abide by the US Constitution, Bill of Rights & The Declaration of Independence?"

--First, it's amusing to see the Christian Right get all fired up about the government supposedly interfering in personal end-of-life planning. Isn't that exactly what they wanted the government to do in the Terry Schiavo case?

--Second, the government is not "telling us what to do." It is merely offering to pay for US to get advice from the medical advisors of OUR CHOICE. Please read the text of the proposal. It's not that complicated. Here's the link. Scroll down to p. 425. http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf

Rob Moll: "It asks doctors to report what was discussed and the decisions reached, which can be perceived as an intrusion into patient privacy but also makes sense if the government is interested in making sure the money is well spent."

--False. The reporting that's required is about aggregate data, not about individual decisions or personal decisions. The federal government will not know who made what decisions about hospice care or feeding tubes or ventilators. Read the actual proposal. Get a grip.

All people should have advanced directives and discuss end of life decisions with their physicians, with strong input from clergy. The government should have no role in that decision, other than to encourage and facilitate the process of having those discussions, while leaving the outcome of the decision-making to the involved parties. The legislation goes too far in trying to control the outcome. Whether to save money, or reduce the population, both supported by this administration in its abortion and end of life policy, expressed by its science czar, the government should not have this extensive a role. Feel free to clip and cut and paste my blog entry to the totalitarian fascists at flag@whitehouse.gov. Dietrich Bonhoeffer would have welcomed that opportunity in the 1930's had the internet been around.

The legislation doesn't go anywhere in controlling the outcome other than saying they will only pay for it once every 5 years!

I just went and read the whole section. It is only a few pages long. There is nothing there except for three basic points. 1) Encouragement to do end of life planning and the people that need to be involved. 2) Encouragements for states to standardize the end of life forms and directions so they can be read clearly by different doctors and hospitals so that there is less confusion and 3) reporting back to congress about whether end of life discussions are actually happening.

What exactly is wrong with any of that?

Rob Moll has done more to make dubious the credibility of CT than any anti-Christian could. My friend died of cancer recently, and his doctors ran up the bill with unnecessary procedures to the very, VERY end. Then they sent him to hospice. Section 1233 would have paid a lead doctor to counsel and follow the patient's wishes earlier. Thousands of dollars lined doctor pockets the last month--for nothing. No medical benefit.
Finally, I heard the Sekulow interview, and I was struck with the image of vulture lawyers wanting a last crack at the corpse vs. doctors performing one more unnecessary procedure. Sekulow, Schiavo, Dobson--is that where Rob Moll wants this debate to go--again?
BTW, Jay is currently trying to raise 450,000 USD in donations at his website; so web traffic is why he's making hullabaloo, IMHO.

I wasn't threatening no government. I'm a Christian. I don't believe in taking someonee's life. That's for God to decide. I'll I can do is pray that our leaders make the right desions in our congress. So Matt K, do you consider yourself a Christian? Or A Pharisee. Even Jesus Christ disobeyed his government. So yes, if our leaders force some law saying we don't have the right to free relgion in our country. Than I will be all means not abide by that rule. Another thing you all should know is this. GOD IS CONTROL.
JESUS IS OUR ULTIMATE HEALER!! SATAN AND HIS DEVIL GANG ARE BEHIND WHATEVER BAD THING THAT GOES ON. KILLING ANYBODY WOULDN'T SOLVE ANYTHING, THE DEVIL WOULD STILL BE AROUND ANYWAY. OH AND BY THE WAY. I DON'T HAVE A IP ADDRESS. I DON'T EVEN E-MAIL.

Christian Doctor: "The legislation goes too far in trying to control the outcome."

--This is just utterly incorrect. The legislation does absolutely nothing to even influence, let alone control, the outcome. Please read the provision.

The consultations are voluntary, and even then, all the provision would do is to require that ALL options be discussed. And while it allows the patient to sign a living will or health care directive during the consultation with the doctor, the government will pay for that consultation regardless of whether the patient decides to withhold all life-saving treatment or to have every last expensive, high-tech thing done. The government pays either way. There is NO incentive for a doctor to encourage "cost savings" or any other objectionable thing.

It's ridiculous to repeat the scurrilous lies here if anywhere on the web, helping those trying to intimidate seniors and bully politicians. Same on you. Hospice issues are the most important issues families have to make. Health insurance should cover the costs for families to plan end of life decisions, but some vitriolic special interest lobbyists are willing use dishonesty about this issue like anarchists yelling fire in a crowded theater. Its troubling for that these kind of uncivil lies get repeated here to perpetrate the immoral profiteering from the sick and needy.

I hate to be the one to break this to you, Jessie. But because you've been on a computer on the web, that computer has an IP address. Email or no email.

Whether or not the government is trying to save money by adding the provision for doctors to have the "discussion", is not really the point. (but of course they are trying to save money) The whole idea of the health care bill is "supposed" to make health care more affordable and free for many, and cost must be cut somewhere to do so. If that was not the reason, why did our,caring left special interest groups not mandate this provision of a "discussion" before now? Why is it only now included in the biggest plan ever to take away our freedom of choice. (if you think small businesses will be able to continue to afford health care for their employees, think again. eventually those wanting to keep their current health care will not have it available to them) Government should not dictate what medical discussions a doctor and his patient share, whether that be long term health care or end of life care. Just as it is not good for a doctor to "play God" as Sarah mentions above, by using every possible means to extend a life unnaturally., also, insisting that a "conversation" be mandated and how often, is not a good thing or a role that our government needs to take. If the government would like to help, then pay for literature and education. There are websites in every state for folks to find out all the details they need about end of life decisions, from medical to legal and spiritual. Nursing homes could have literature for their residents. No need to wait until in a doctors office or the hospital. The government is trying to step in where it is not needed and that it the greater problem. People wise up., you don't have to wait for the government to tell you when to make personal discussions/decisions. This is another example of too big government and wasted funds. Let's spend the tax payers dollars more wisely on things that we need.

correction. the blog above refers to Sarah in one of the comments above and the reference should actually be from Kate's blog above. sorry for any confusion.

WHEREAS, Healthcare Decisions Day is designed to raise public awareness of the need to plan ahead for healthcare decisions, related to end of life care and medical decision-making whenever patients are unable to speak for themselves and to encourage the specific use of advance directives to communicate these important healthcare decisions. WHEREAS, in Alaska, Alaska Statute 13.52 provides the specifics of the advance directives law and offers a model form for patient use.

WHEREAS, it is estimated that only about 20 percent of people in Alaska have executed an advance directive. Moreover, it is estimated that less than 50 percent of severely or terminally ill patients have an advance directive.

WHEREAS, it is likely that a significant reason for these low percentages is that there is both a lack of knowledge and considerable confusion in the public about Advance Directives.

WHEREAS, one of the principal goals of Healthcare Decisions Day is to encourage hospitals, nursing homes, assisted living facilities, continuing care retirement communities, and hospices to participate in a statewide effort to provide clear and consistent information to the public about advance directives, as well as to encourage medical professionals and lawyers to volunteer their time and efforts to improve public knowledge and increase the number of Alaska’s citizens with advance directives.

WHEREAS, the Foundation for End of Life Care in Juneau, Alaska, and other organizations throughout the United States have endorsed this event and are committed to educating the public about the importance of discussing healthcare choices and executing advance directives.

WHEREAS, as a result of April 16, 2008, being recognized as Healthcare Decisions Day in Alaska, more citizens will have conversations about their healthcare decisions; more citizens will execute advance directives to make their wishes known; and fewer families and healthcare providers will have to struggle with making difficult healthcare decisions in the absence of guidance from the patient.

NOW, THEREFORE, I, Sarah Palin, Governor of the state of Alaska, do hereby proclaim April 16, 2008, as:

Healthcare Decisions Day in Alaska, and I call this observance to the attention of all our citizens.

As a retired Baptist Hospital Chaplain, I have relied on data, such as this piece below, to prayerfully assist me in walking the terminal ill in their environment to the experience of death.

Bill Simpson, San Antonio, Texas

Principles of a good death
by Richard Smith, Editor
British Medical Journal

To know when death is coming, and to understand what can be expected
To be able to retain control of what happens
To be afforded dignity and privacy
To have control over pain relief and other symptom control
To have choice and control over where death occurs (at home or elsewhere)
To have access to information and expertise of whatever kind is necessary
To have access to any spiritual or emotional support required
To have access to hospice care in any location, not only in hospital
To have control over who is present and who shares the end
To be able to issue advance directives which ensure wishes are respected
To have time to say goodbye, and control over other aspects of timing
To be able to leave when it is time to go, and not to have life prolonged pointlessly

While the physician is encouraged to raise the subject, the physician is rated positively merely for having done so. If the patient wishes not to have such a discussion, the physician's quality rating is exactly the same as if the patient had chosen otherwise. The physician gets no plaudits for pressing for an outcome, only for raising the issue.

Those patients who ignore such advice, however, dodge an important health care issue that may have impact on the ability to witness to their loved ones that palliative care could give them in their dying days.

Staying alive isn't the point; serving is.