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A Piece of My Mind |

One Vote for Death Panels

Paul Kettl, MD, MHA
JAMA. 2010;303(13):1234-1235. doi:10.1001/jama.2010.376.
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I wish we had death panels.

I don't mean that I’m in favor of some appointed group of erudite experts gathering to decide who lives or dies in a process controlled by the government, but rather the death panels that were originally proposed. I’m in favor of periodic discussions about advance directives that Medicare would pay for as medical visits.

As a geriatric psychiatrist, I have a fair amount of experience with this type of death panel. Approximately two-thirds of the patients admitted to our geriatric psychiatry inpatient unit have dementia, with a wide array of behavioral disturbances. These problems in behavior made it difficult for these elderly patients to receive care at home. They would then seek care from our unit or, too often, would be admitted to nursing homes that would continue to have problems managing the behaviors and then refer these folks to us. As part of the care delivered, we would meet with the patient, and then with the family, to explain the type of dementia, the typical course that could be expected, as well as ideas about how the behavioral component of the disease manifests and how it can be managed. Finally, we talked about what the future would bring, usually giving the already-burdened patient and family an explanation of the inexorable downhill course of progressive dementia leading to death. We tried to explain the course of the illness to the family, opened the discussion about what care was available, and asked the patient and the family about what care they may want both now and in the days ahead.

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