Whoever coined the phrase “end-of-life counseling”, the term used in current healthcare reform legislation, made a terrible mistake both from a marketing perspective, and far more importantly, from an ethical/spiritual one. By ceding values-based language to their opposition, and failing to approach this issue from a values-driven perspective, they opened themselves, and all those who support this much-needed aspect of health care reform, to the death panel crowd and their charge that such counseling is about nothing more than cost-cutting. Nothing could be further from the truth.
While we may not all agree about the circumstances under which medical care should move from therapeutic to palliative, or from palliative to passive, it is always a dignity and compassion issue and we would have been better served had it been called dignity and compassion counseling, for that reason.
Such counseling, which would be offered, not imposed, under the proposed reform legislation would be a godsend for many people who find themselves in need of such expertise and unable to access it when they need it most. And let’s be clear about the fact that such conversations are happening anyway as more and more people have to make actual decisions about the end of their own lives an the end of those they love.
Death doesn’t just “happen” as much as it used to, especially for those who have access to the latest medical technologies and interventions. And so, much as we may hate it, choices must be made.
That’s not a rationing issue, that’s a taking charge of your own life issue. Until relatively recently, such choices were few and far between. Now however, we often have the technological capacity which demands that we make such choices, and simply knowing that we can do something doesn’t necessary mean we should do it.
We need to distinguish the difference between having the knowledge/capacity to do something and possessing the wisdom to determine whether or not we should. Compassion counseling, end-of-life counseling –call it what you will, simply invites us to be better informed about that kind of complex question.
If people find that threatening, it is either because they have never faced those painful questions personally, or can not rest until all people are forced to make the same decision they would under similar circumstances. Where is the dignity of life in that kind of thinking?