One of the tactics used by opponents of the recent federal health law was to claim that a provision regarding counseling for end-of-life care or general advance directives amounted to creation of “death panels”. While we were no fans of the law, it was very unfortunate that this provision ended up being removed, primarily because it would have improved the care of patients with terminal or very serious illnesses. Research reported in the New England Journal of Medicine on the use of palliative care for lung cancer patients further supports this view. (NEJM Article)
In a randomized trial, the researchers assigned some patients to early palliative care as well as usual oncology care, while the control group just received usual care. Consistent with other studies, this one found that patients with palliative care had a better quality of life and used fewer health resources, particularly in the form of less aggressive care near the end of life. The notable finding, however, was that the intervention group survived an average of 2.7 months longer than the usual care group.
So much for the “death panel” idea. Almost every piece of credible research has shown that patients prefer less aggressive treatment when faced with a potentially terminal illness. They don’t want to suffer and they don’t want to die in the hospital. Palliative care is about minimizing suffering, making sure patients fully understand the consequences of certain kinds of treatment and respecting their wishes, including very aggressive treatment if they want it. Counseling patients to help them understand the value of palliative care, and what their lives will almost certainly be like if they allow extreme measures, is the humane approach. It should be mandated and physicians and other health professionals should be trained to use palliative care effectively and to encourage patients to chose it.