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NBC News
updated 2/7/2011 2:34:42 PM ET 2011-02-07T19:34:42
Commentary

It is time for some frank talk with your doctor about dying.

So says the American Society of Clinical Oncology, the frontline troops in the war against cancer, whose board has just issued a policy statement imploring doctors to reach out to patients with incurable disease to discuss their end-of-life wishes and choices.

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Tossing aside irresponsible rhetoric about death panels, euthanasia, health-care rationing and throwing grannies on ice floes, the cancer experts say candid conversations are the key to ensuring comfort and dignity in the final days.

"Patients have a right to make informed choices about their care," said Dr. George W. Sledge Jr., president of ASCO. "Oncologists must lead the way in discussing the full range of curative and palliative therapies to ensure that patients’ choices are honored.”

Is there a need for end-of life talk regarding cancer?  Do ya think?

The American Cancer Society estimates that 299,200 men and 270,290 women died from the disease last year. After heart disease, cancer is the second biggest cause of death in America.  Roughly 1.5 million people in the U.S. were being treated for some form of cancer last year. One out of two men reading this and one out of three women will be stricken with cancer in the future.

Crucial questions
Even patients who have exhausted all proven treatments have decisions to make. Will you go home? Will you enter a hospice? Will you try to find a last-ditch experimental clinical trial?  Will you seek only palliative care if you are in the hospital? Who will speak for you if you cannot?

These are tough questions. Not everyone will answer them in the same way. More than a few people will change their minds about them. But when death looms, the best thing is to be prepared. Trying to make choices at the last minute often ends poorly for the patient, the family and those trying to care for them.

It seems like a given that end-of-life conversations should be encouraged. Sadly, in the hands of some conservative politicians trying to revoke the new health care law, it isn't.

The Obama plan originally contained a provision incentivizing all doctors to talk about end-of-life care planning with all of their patients by reimbursing then for the time involved. That idea was the one that got the eminent health care authority Sarah Palin tweeting away about "death panels." 

The White House dropped the provision, but tried to bring it back through regulations once the new law had passed. But conservatives, out to scuttle health reform, went back to the same poisoned well and hauled out a few more buckets of "death panel" talk. The administration finally gave up. Incentives to get conversation going between doctors and patients, while thankfully alive in oncology, are DOA in health reform, and, by some informed accounts, not coming back.

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If it is prudent to have doctors talk to their patients about end-of-life care — I, along with the those who really know best, the American Society of Clinical Oncologists, think it is — then any politicians or groups that oppose such conversations are irresponsible advocates of ignorance.

Oncologists better equipped than politicians
Those who raise the specter of "death panels" are doing their best to guarantee you a miserable death. By invoking the smear that conversation with your doctor about what to do if you cannot be cured is akin to euthanasia, they somehow managed to make a terrible topic much worse.

Thankfully, the oncology community has not yielded to the pressure. The oncologists fully understand the need for conversation early and often and are now insisting on it. 

When it comes to talking to your doctor, don’t listen to politicians who would have you pull the covers over your head and wish reality away. If your doctor fails to initiate a conversation with you at your next visit about your views about dying, don’t be afraid to start talking.

Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.

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