Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Learn to earn end-of-life respect

Kevin Haselhorst, MD
Physician
January 6, 2023
62 Shares
Share
Tweet
Share

Pele, the famous Brazilian soccer star, reportedly stopped medical treatment for colon cancer. Media outlets stated he was receiving various iterations of comfort, hospice, and palliative care which were perceived as criminal and disrespectful. His daughter denied these allegations on Instagram.

How often are those with serious illnesses treated like criminals for wrongdoing?

When medical treatment is withdrawn or withheld, it seems the person has lost the battle or chose not to fight. “Ain’t it a shame” reverberates around the airwaves and within the person, especially after declaring to beat the odds. Self-esteem and others’ respect is difficult to realize.

We might learn to earn end-of-life respect by adopting a new language beyond medical terminology while speaking about the “stages” of a serious illness in the context of an advance directive. How would Pele like to be respected at this stage of life? Is his medical condition treatable, incurable, or terminal? What does he value? What are his wishes?

If Pele’s colon cancer is incurable, it’s reasonable to stop treatment. He mostly values self-determination. And he wishes for person-centered care if taken to the emergency department. This means he prefers to not hold out hope and refuse hospitalization, maintaining control of his situation and medical decisions.

Medicare can bridge the communication gap between physicians and patients with serious illnesses by explaining palliative care in lay terms as “outpatient person-centered care for serious illness” (Medicare Plan C). Medical treatment upholds patient-centered care (Medicare Directive A), and hospice provides home-centered care (Medicare Directive B).

If Pele were eligible for Medicare, he would choose “Medicare Advance Directive C” during enrollment. Pele is not a U.S. citizen, and U.S. seniors are not given an opportunity to choose an advance directive at enrollment. Congress needs to enact end-of-life respect through legislation requiring seniors to be informed of self-determination with critical medical decisions each year.

If I were treating Pele in the ER, I would immediately know that his “Medicare Advance Directive C” means his goals of therapy align with outpatient palliative services. We might treat an infection with a single dose of IV antibiotics followed by pills or infuse a bag of IV fluids if dehydrated. Admitting him to the ICU for sepsis would go against his wishes. And cardiac resuscitation is out of the question.

Taking the mystery out of what patients want at any crisis moment is the goal of advance care planning and advance directives. Removing the fear of life-and-death situations necessitates people making their wishes known.

When 70 percent of people wish to die at home, and 70 percent of patients die in medical facilities, fear gets the best of 40 percent of those who experience a medicalized death. Some 30 percent prefer to fight to the end, while the remaining 30 percent receive comfort care. Ideally, Medicare would support the 40 percent of seniors who desire end-of-life respect given by palliative services.

Palliative care is often linked with hospice, but this doesn’t serve those who want nothing to do with hospice. “They’re not there yet,” nor are they actually dying. People receiving palliative care are disrespected when misinformed medical providers and the media link it to hospice.

Like emergency medicine, palliative care is ill-defined. As an emergency physician, I’m often asked what I do. Am I a surgeon or a general doctor? Am I a trauma physician? Oddly, I’m like a palliative physician who manages serious illnesses with comprehensive outpatient services from the beginning to the end of life. My task is to triage patients as sick or not sick, hospitalization or no hospitalization, specialist or no specialist.

Palliative services, like EMS, triage patients before arriving in the emergency department. If patients with a serious illness appear to need hospitalization, then admitting them to hospice would be the next course of action as per their wishes. Fear prompts people to call 911 before palliative services, lessening the chance of dying at home.

Gandhi says, “Your values become your destiny.” Honoring your values earns self-respect.

Joe Biden famously said, “Don’t tell me what you value; show me your budget (advance care plan with advance directive), and I’ll tell you what you value.”

  • Medicare Advance Directive A values medical protocols.
  • Medicare Advance Directive B values uncompromising compassion.
  • Medicare Advance Directive C values self-determination.

While values are vague, wishes need to be specific and matched with certain goals of therapy:

  • Wish to fight to the end: Medicare Advance Directive A
  • Wish to end life at home: Medicare Advance Directives B & C

Every incurable illness progresses to death. Every senior citizen faces mortality. The goal is to earn self-respect along the way. Most people don’t value hospice or palliative care until the end. Medicare can empower seniors by simplifying the terminology of medical, hospice, and palliative care respective to hospital, home, and outpatient care.

We might be clear about how we label advance care plans with this outline:

Hospital-centered care: Treating a curable illness (objective) – Patient

Outpatient-centered care: Living with an incurable illness (subjective) – Person

Home-centered care: Dying of a terminal illness (precious) – Loved one

Hospital-centered care permits physicians to think, say, and do for the patient.

Home-centered allows families to think, say, and do for their loved ones.

Person-centered care allows persons to think, say, and do for themselves.

We earn respect by being informed of the consequences. We lose respect when suffering the consequences of illness. The best practice for being informed is being open-minded with a balanced perspective between treating and not treating, which results in a clear decision and forthright directive.

As Pele’s currently being treated for COVID in a Brazilian hospital, his end-of-life respect, like many seniors, seems to be guided by fear-based happenstance rather than an advanced care plan. We might honor his passing legacy with the goal of making our wishes known at the time of Medicare enrollment, beginning each New Year with the end in mind.

Kevin Haselhorst is an emergency physician and author of Wishes To Die For: Expanding Upon Doing Less in Advance Care Directives. 

Prev

How a positive staff helped an uncertain hospital stay [PODCAST]

January 5, 2023 Kevin 0
…
Next

How to deal with challenging patients

January 6, 2023 Kevin 1
…

Tagged as: Oncology/Hematology, Palliative Care

Post navigation

< Previous Post
How a positive staff helped an uncertain hospital stay [PODCAST]
Next Post >
How to deal with challenging patients

More by Kevin Haselhorst, MD

  • April 16th is National Healthcare Decisions Day: Plan for your end-of-life care now

    Kevin Haselhorst, MD
  • The heartbreaking story of Jimmy Carter: a call for Medicare reform in end-of-life care

    Kevin Haselhorst, MD
  • Tom Brady’s legacy and the importance of personal integrity in end-of-life choices

    Kevin Haselhorst, MD

Related Posts

  • A real-life example of irrational health care spending

    Taylor J. Christensen, MD
  • End-of-life care talks begin at home: even for doctors

    Abdel Albakri
  • Can the dwindling numbers of primary care physicians explain decreased life expectancy?

    Niran S. Al-Agba, MD
  • Respect the duty to care for all patients equitably

    Anonymous
  • How social media can help or hurt your health care career

    Health eCareers
  • A letter to a cancer patient in palliative care

    Alison Vasa

More in Physician

  • Raw humanity on night float: inspiring patient encounters and overcoming challenges

    Johnathan Yao, MD, MPH
  • Revolutionizing emergency medicine: Overcoming long-term challenges with innovative solutions for physicians and patients

    Anonymous
  • The pediatric health care system tested to the limits: an inside look at the “at capacity” period during the tripledemic

    Jacqueline Bolt, MD
  • How chronic illness and disability are portrayed in media and the importance of daily choices for improved quality of life

    Juliet Morgan and Meghan Jobson
  • How biased language and stigmatizing labels affect patient care and treatment

    Joan Naidorf, DO
  • Emulating Michael Jordan’s winning mindset: a path to success for health care professionals and entrepreneurs

    Harvey Castro, MD, MBA
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • Unmasking wage disparity in health care: the truth behind the Elmhurst Hospital physician strike

      Kevin Pho, MD | KevinMD
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • How electronic health records preserve patients’ legacies in the words of oncologists

      Marc Braunstein, MD, PhD | Physician
    • Unmasking the brutal reality of gun violence in America: a call to action for unity and meaningful change

      Osmund Agbo, MD | Policy
    • Emulating Michael Jordan’s winning mindset: a path to success for health care professionals and entrepreneurs

      Harvey Castro, MD, MBA | Physician
  • Past 6 Months

    • The growing threat to transgender health care: implications for patients, providers, and trainees

      Carson Hartlage | Policy
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
  • Recent Posts

    • The surprising medical mystery of a “good” Hitler: How a rescued kitten revealed a rare movement disorder

      Teresella Gondolo, MD | Conditions
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • Raw humanity on night float: inspiring patient encounters and overcoming challenges

      Johnathan Yao, MD, MPH | Physician
    • Is AI the solution for the shortage of nephrologists? ChatGPT weighs in.

      Amol Shrikhande, MD | Tech
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • What Drug Did FDA Just Approve for COVID?
  • PET Scan for Alzheimer's Dx; Predicting Colon Cancer Survival
  • What Happens When We Classify Kids' Weight as a 'Disease'?
  • Sotagliflozin Gets FDA's Blessing for Heart Failure
  • Cardiorespiratory Monitoring Can Be Telling of Outcomes in Extremely Preterm Infants

Meeting Coverage

  • No Access to Routine Healthcare Biggest Barrier to HPV Vaccination
  • Trial Results Spark Talk of Curing More Metastatic Cervical Cancers
  • Cross-Border Collaboration Improves Survival in Pediatric Leukemia Patients
  • Monoclonal Antibody Reduced Need For Transfusions in Low-Risk MDS
  • Less-Invasive Surgery for Pancreatic Cancer Proves Safe, Effective
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • Unmasking wage disparity in health care: the truth behind the Elmhurst Hospital physician strike

      Kevin Pho, MD | KevinMD
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • How electronic health records preserve patients’ legacies in the words of oncologists

      Marc Braunstein, MD, PhD | Physician
    • Unmasking the brutal reality of gun violence in America: a call to action for unity and meaningful change

      Osmund Agbo, MD | Policy
    • Emulating Michael Jordan’s winning mindset: a path to success for health care professionals and entrepreneurs

      Harvey Castro, MD, MBA | Physician
  • Past 6 Months

    • The growing threat to transgender health care: implications for patients, providers, and trainees

      Carson Hartlage | Policy
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
  • Recent Posts

    • The surprising medical mystery of a “good” Hitler: How a rescued kitten revealed a rare movement disorder

      Teresella Gondolo, MD | Conditions
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • Raw humanity on night float: inspiring patient encounters and overcoming challenges

      Johnathan Yao, MD, MPH | Physician
    • Is AI the solution for the shortage of nephrologists? ChatGPT weighs in.

      Amol Shrikhande, MD | Tech
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Learn to earn end-of-life respect
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...