Editorial: The wrong answer for end-of-life counseling

For patients near the end of life, decisions about medical care become exponentially more difficult. At some point, it may be appropriate to shift thinking away from recovery and focus instead on how to be comfortable and make the most of the time remaining.

When is that point? Who should initiate the conversation?

How about a total stranger, financed by the patient’s insurance company, who knows little about the patient beyond a name, the insurer, and the fact that the patient is seriously ill?

It’s hard to imagine a worse answer, given the built-in bias for the insurance company to cut end-of-life care costs.

Yet it is happening.

Vital Decisions, a company financed by insurance companies, has stepped into the vacuum that now exists for getting such conversations started. According to a report in Kaiser Health News, the company hires social workers who call patients and offer what they describe as “nondirected” end-of-life counseling. They seek to establish a relationship and sometimes seek permission to talk directly with doctors and family members.

Vital Decision CEO Mitchell Daitz told Kaiser the company seeks to foster these end-of-life conversations, which he says aren’t happening enough.

That’s true enough. Daitz correctly defines a problem for which his company offers the wrong solution.

The right answer is for doctors to take the lead, and be properly reimbursed for doing so. But back during debates about what became the Affordable Care Act, accusations about “death panels” derailed the conversation about adding reimbursements for doctors to conduct advanced-planning and end-of-life consultations.

The goal is to get patients the medical care they want, which might not include aggressive treatment suitable for healthier patients. Anyone who has helped a loved-one near the end of life knows what a wrenching about-face it takes to think about these questions in light of the realities facing a failing patient. Launching that conversation is devilishly difficult. Handing it over to a biased stranger isn’t the answer.