When my mother was in her late 80s, I took her to a lawyer's
office one sunny day to sign her "living will." We read over the questions
and her answers, and she signed on the dotted line. She was pleased with the
decisions that she had made weeks before.
We went shopping afterward, and she bought an antique watch that
caught my eye in a shop window. This was an appropriate gift, she joked,
because she had named me to be in charge of her "lifetime." If the time
should come that a doctor asks whether to prolong her life when all hope is
gone, I need to produce her living will.
Such discussions and "signings" with older parents had become
commonplace among my friends of a certain age. We were confronting
generational tasks that our grandparents never dreamed of. These were not
morbid tasks, merely the latest reality bequeathed by technology that can
keep a body physically alive, while those parts we think of as constituting
our humanity have flown away. Yet nothing puts terror in the hearts of old
folks as much as a discussion of end-of-life issues.
Can it be possible that faceless bureaucrats get the power to
decide how an aging person will be "counseled," regarding when and how to
give up the breath of life? This was the question asked of the president by
a woman named Mary at a town hall meeting for the American Association of
"I have been told there is a clause in there that everyone of
Medicare age will be visited and told to decide how they wish to die," Mary
said. "This bothers me greatly and I'd like for you to promise me that this
is not in this bill."
The president looked greatly bothered by the question, too. He
told her that the question was about getting information, not determining
when and how someone's life would end. His grandmother, who died only months
ago, the first lady and the president, himself, had signed living wills.
This, he said, gave his grandmother "some control ahead of time." Nobody
would be required to take such counseling, but one such medical consultation
within a five-year period would be paid by government insurance.
That sounds harmless enough. The consultation would be
voluntary, not mandatory; you could specify a family member to take charge
if you can't. The legislation would simply guarantee your ability to learn
about such choices and Medicare would pay for it. So, why are so many people
still upset by the end-of-life clause in the House health care legislation?
The health care debate this time is focused on numbers, but a
subtle psychological fear is pervasive: If the government in its "goodness"
decides it can pay for end-of-life counseling, it can later on determine the
content of the counseling. If the government in its "goodness" is concerned
with the enormous cost of health care, looking everywhere for places to cut
those costs, the elderly become an attractive budget item. Nevertheless, the
insurance companies, imperfect and fallible though they are, depend on us to
pay the freight. That leaves us in control of our choices, limited though
they may be.
Trying to allay Mary's fears, the president offered a flippant
answer: "We just don't have enough government workers to send to talk to
everybody to find out how they want to die." But what if it did? What kind
of Big Brother government have we created that makes us feel so small?
Collecting information about how the elderly want to die is not the problem;
who manages that information is the crucial part.
The health care debate is valuable as part of the search for ways
to cover the uninsured, but it gives a lot of us the creepy feeling that
we're losing the argument with the politicians, who are more concerned with
creating a salable "product" than with thinking through the complexities.
Health care hasn't been in the hands of the kindly family doctor,
sitting by the side of a sick child in that famous Norman Rockwell cover for
the Saturday Evening Post, for a long, long time. The specialist and the
technician with their mighty machines have replaced the reassuring touch of
a healing human hand. The health care schemes, for all the good intentions
of the schemers, sound ever more like schemes for a big government casino.
That's not the place we want to be when our numbers come up.