What are we Scared of?

Listen carefully-I have an important secret to reveal (we as physicians often hold our medical wizardly very close to the chest so this may be a rare opportunity).  One inescapable fact of life is that ultimately we all die.  It is the final outcome for us and for all our patients.  Of course, neither I nor other physicians need be fatalistic-there is much we can do to help our patients live long, happy and healthy lives BUT we do always have to keep this basic tenet in mind.  It is as basic a medical principle as those of circulation, respiration, and digestion which most second graders have mastered.
So why have we, as Americans in 2010-2011 decided there is some crazy taboo about discussing end of life issues with our patients?  During the recent Health Reform Debate, this topic became politicized as "death panels" (bipartisan debunked by PolitiFact).  Then just last week, the subject was again stirred up by inflammatory headlines such as The Hill's:

Medicare chief: Keep gov't out of end-of-life care planning

By Jason Millman - 02/09/11 12:55 PM ET

I can honestly say that in my many years as a neurosurgeon, I have done more good for my patients through such end of life discussions that I have done with my scalpel. That doesn't mean I have spent my career rationing or withholding care, it doesn't mean I have easily given up on difficult cases, and it certainly doesn't mean I have been lazy (done well, these types of discussions are more time consuming and difficult that alternatives). But it does mean I am honest and realistic, I am willing to broach challenging subjects with my patients and their loved ones, and I have learned to carefully use words such as futile. In doing so, I know that I have helped these people begin the challenging process of grieving in a way that will help them emerge on the other side whole. In doing so, I have gained invaluable inner riches that provide me sustenance.

It is rare that someone feels it is a "right time to die" and no wants to be cheated (for themselves or their loved ones) of a treatment that could allow them to live for a day/week/year/decade. However, I also believe that no one wants to be kept ignorant of critical health decisions or to suffer needlessly because hopeless treatments are administered. On one level, the politicians got it right-we need to take politics out of death-but that doesn't mean we can ignore reality.