A 2009 provision of the Affordable Care Act to pay doctors for end-of-life counseling never found its way into the law. Partial credit goes to former Alaska Governor Sarah Palin and a simple pair of words, “death panels.”  Five years ago Palin called a system in which government bureaucrats determine healthcare based on an individual’s  level of productivity in society “downright evil.”

The term “death panels” is still going strong and now, according to Modern Healthcare, the refrain may have prompted a 507-page “repudiation of the controversy” by the Institute of Medicine (IOM).

Incredibly, the IOM’s study titled “Dying in America” not only fails to repudiate Palin’s original analysis, the lengthy report supports her assertion.

“Dying in America” recommends end-of-life conversations between patient and physician beginning in childhood.

From the report:

All individuals, including children with the capacity to do so, to have the opportunity to participate active in their health care decision making throughout their lives as they approach death, and receive medical and related social services consistent with their values, goals and informed preferences.

The experts want professional societies to establish  quality standards for death and dying discussions that are “measurable, actionable, and evidence based.” Payers should then tie these standards to reimbursement, licensing and credentialing.

The report suggests patient-doctor conferences should occur at significant times in one’s life, such as getting a driver's license, turning 18, leaving home or marrying.

Palliative care would most likely enter into the conversation. In cases of those youngsters with serious illnesses or chronic conditions the IOM finds that a palliative approach affords patients and families the highest quality of life.

The committee defines palliative care  as that which provides relief from pain and other symptoms, supports quality of life, and is focused on patients with serious advanced illness and their families. Palliative care may begin early in the course of treatment for a serious condition.

What does palliative care mean to clinicians who often use aggressive treatments and cutting edge drugs to treat early onset diseases like sickle cell anemia? The life expectancy for a sickle cell patient used to be around 14 years of age,  but now many afflicted with the disease are living much longer. Will palliative care as defined by IOM lead to a decrease of medical research breakthroughs in treating serious illnesses? Most likely.

The 21-member IOM committee of experts also implies “poorer, minority and less-educated individuals” are especially vulnerable to the “perverse incentives” inherent in America’s fee-for-service medical system. The study maintains these groups lack adequate information and are reluctant to plan end-of-life treatment. Are these experts targeting “undesirables?”

Besides children, poor people, minorities and the uneducated, Dr. VJ Periyakoil of Palliative Care Education and Training at Stanford’s School of Medicine thinks “Dying in America” is not only “relevant to persons who are seriously ill”  and their families but will help address end-of-life concerns for ethnically diverse seniors.

The timing of the report is exquisite, especially as the population of multiethnic older Americans is now exploding into a 'silver-brown tsunami.’

The experts  concluded the high cost of end-of-life care  and an aging population should lead to a restructuring  of Medicare and Medicaid.  They determined that most chronically ill and elderly Americans prefer to be put out to pasture rather than fight to the end with feeding tubes.

Not true. A lot of God-fearing Americans do not want a bunch of right-to-die doctors deciding when life should end or engaging in death conversations with their children.

In the end if providers’ reimbursements are tied to complying with government regulations regarding their patients’ end-of-life decisions then doctors, insurers and hospital administrators will have little incentive to keep the sick and “silver-brown tsunami” of old people alive. Talk about “perverse.”

It should also be mentioned that this elite panel of representatives was convened by an  Institute which lists universal health coverage as one of its five principles and whose President stated, “The time is now for our nation to develop a modernized end-of-life system.”