Health care reform may be on a respirator, but the practical effects of the debate are being felt in hospitals across the country, in particular by the very ill.
In an attempt to refute claims that medical centers are encouraging the withholding of care through so-called death panels, some hospitals have started to forbid doctors and nurses from even mentioning the possibility of death, even among the terminally ill.
Some GOP leaders have attacked Obama's health care plan by claiming that it would create "death panels" that would rule on whether the infirm, elderly or disabled would qualify for care. In fact, the proposal would merely provide funding for optional consultations with doctors about "end of life" care, such as hospice.
Nonetheless, some hospitals are sensitive to the claims raised by those railing against "death panels" and are concerned about possible litigation. The guidelines that have been disseminated at one Boston hospital forbid doctors from telling patients that they have a terminal illness; they also include a long list of words and phrases that they aren't allowed to say to their patients, such as "towards the light", "angels", "last rites", and "get your affairs in order."
Such avoidance of reality is a disservice to patients and their families, says one doctor who works at a hospital where talk of death is verboten. "We're not allowed to tell them about DNRs (do not resuscitate) orders -- which means that we're spending thousands of extra dollars for extraordinary measures that some of the patients probably don't want."
In order to get around the new guidelines, the doctor said, he had taken to speaking in tortured metaphors and euphemisms to patients who begged him for a prognosis. For example, for patients with serious heart disease, he speaks elliptically about artichokes and says if the center (heart) is rotten then that affects the health of the rest of the artichoke -- which will soon be doomed -- even if the leaves appear healthy.
"Most of them look at me like I'm crazy since they're worried about the looming possibility of a fatal heart attack and I'm talking produce," said the doctor. "But what can you do?"