In order to help cut medical costs, it has become popular to try to find financial savings in the last few months of life. President Barack Obama told "The New York Times," “The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill.”
In an attempt to attack that cost, the House wrote into its health care bill a section that would encourage physicians to have a consultation with their patients about end-of-life choices and advance directives. While the bill says nothing about the “death panels” that some politicians have used to work their base into a frenzy, the section does imply that Congress hopes to save money in the long run by reimbursing doctors for the consultations in which they’ll direct more patients away from aggressive end of life care.
The President acknowledges the difficulty in trying to convince elderly and chronically ill patients to not pursue medical treatment that could extend their lives. As he told "The Times," “Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. … That’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?”
For conservative Christians like myself, this positions the government on a slippery slope toward euthanasia. No, the bill doesn’t endorse the killing of terminally ill patients. Not even close. Euthanasia is still illegal throughout the U.S., and physician-assisted suicide is only legal in two states. However, within the context of a bill designed to reign in medical costs, many Christians are concerned that the government seems to be on the side of “pulling the plug.”
Instead of paying doctors to steer patients away from the hospital, Obama should use his Office of Faith-Based Initiatives to help seminaries provide adequate training to pastors and church workers on end of life care. By encouraging spiritual counselors to engage in these discussions with terminally ill patients, the government can avoid the complex moral issues associated and promote end of life care that is both realistic and holistic.
As a hospice volunteer, I’ve seen the beauty possible when family members, friends, and spiritual counselors come together around a dying person during their final months of life. This is a painful and difficult time, but the rewards are immense.
My last hospice patient was a 92-year-old man named Gene. He had cancer and heart disease, but every week I visited him and sometimes his wife. We talked and got to know one another. His great-grandson was my age, and we worked in the same field. So, Gene and I talked about the publishing industry; we prayed together; and I read him Scripture.
Gene’s body was falling apart. Literally, his tooth fell out one night before I visited. And cancer ravaged his organs. I began seeing Gene with the knowledge that he would soon die. Yet I was devastated that day I found out Gene had passed. I missed the message from hospice, and I showed up at Gene’s nursing home room. It was empty.
I would much prefer a death like Gene’s—faithful and surrounded by caring people—than one in a hospital with all of its advanced treatment. And I’m not alone. More than 70 percent of Americans say they would prefer to die peacefully, surrounded by friends and family, rather than hooked up to tubes and machines. Yet, only 20 percent to 30 percent of us actually do die at home. Something is wrong with our system that sends at least 40 percent of its patients to a kind of death they don’t want.
If President Obama and the Democrats in Congress hope to lower Medicaid costs by steering terminally ill patients toward palliative medical care, they’ll need to stop alienating those pastors and spiritual advisors who could be their greatest allies.
Rob Moll is editor at large for "Christianity Today" magazine and author of the forthcoming "The Art of Dying: Living Fully into the Life to Come."