Former Colorado Gov. Richard Lamm stirred a hornet's nest 25 years ago when he suggested that we all have "a duty to die." What Lamm said was obvious, and sane, and the stuff of Shakespeare and other poets. Death is guaranteed. We should face it wisely. "If it be not now, yet it will come," said Hamlet. "The readiness is all."
Yet Lamm was skewered, and his message distorted, by critics who claimed he was promoting euthanasia. And given the hysterical reaction of Sarah Palin and other right-wingers to an innocuous provision about medical counseling in President Obama's healthcare plan, it seems that we have not progressed very far in the ensuing quarter century. "The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide . . . whether they are worthy of health care," said Palin, in a note on her Facebook page. "Such a system is downright evil."
"You're asking us to believe that government can be trusted," said Newt Gingrich, in defense of Palin.
The Democratic healthcare bill will "put seniors in a position of being put to death by their government," claimed Rep. Virginia Foxx, a North Carolina Republican.
Section 1233 of the House healthcare bill would allow Medicare to reimburse our doctors when they take the time to talk with us about how we would prefer to meet our end. Nobody has to do anything. These consultations would be voluntary, as they are today, and not mandated. But those of us who shudder at the thought of wasting away in an institution; being fed goop through tubes; catheterized; with a colostomy bag, agonizing bedsores, a groaning roommate, and a ventilator thrust down our throats; may decide that we want something else instead. There are different paths to choose. A living will? An advance directive? A do-not-resuscitate order? Hospice care at home? Durable powers of attorney? Healthcare proxies?
Yup, these are scary topics. As the members of the "greatest generation" pass from the scene, many of us—their children and grandchildren—have sadly had to learn what the legalese means. But if you're not yet familiar with these phrases, who better to explain them to you than your family doctor, in the privacy of his or her office? Would you rather have a frantic ER doc or a stressed-out hospital administrator explain them to you as you writhe in pain or to your terrified spouse or kids amid the chaos of a crisis? Or are we so selfish, and fearful of even discussing death, as to duck such questions—dooming ourselves to "life" on machines, as medical bills consume our savings and consign our spouses to poverty?
Section 1233 is not merely a defendable provision of the proposed legislation; it is one of the bill's best. It offers a promise of dignity and choice. Nobody is pushing Grandma off the train. "The level of treatment," the House bill says, "may range from an indication for full treatment to an indication to limit some or all or specified interventions." If you want to rage, rage against the dying of the light with machinery and tubing. Go for it. But if you would rather die in your loved one's arms, at home, you can choose that, too.
Palin may be scoring points with right-wing Republicans by attacking Obama. But I suspect that she and her ilk are out of touch with mainstream American families grappling with these end-of-life issues and increasingly choosing new alternatives. A case in point: The choice of hospice care has tripled in the past decade. And living wills and healthcare proxies are commonplace, if far from universal, these days.
Some of Obama's critics say that our cash-strapped government, by encouraging these counseling sessions, is trying to nudge Americans toward a cheaper way of death. Could be. But only if you believe that, given a choice between hospice care at home and the indignities of costly, machine-assisted "life" in an institution, most of us will prefer the hospice care anyway. If so, what's the harm? Nor do I understand why conservatives, who so vehemently oppose federal inheritance taxes, object to farmers, small-business owners, and wage earners making educated choices that may preserve family savings for succeeding generations.