Thursday, March 24, 2011


I was glad to see the Boston’s Globe editorial endorsement for the “common-sense series of recommendations that all sides of the end-of-life debate can support” from Massachusetts health officials. I was inspired to improve my own understanding of

the end-of-life dialogue, and read online about the Quinlan and Cruzan cases, and the Patient Self-Determination Act of 1991. I won’t revisit those here, but was struck by two things:

In both Quinlan and Cruzan, the physicians and hospitals opposed removal of life support, and the parents had to fight in court to allow death to occur. This is a reversal of how such extreme cases are playing out today, and I’m not sure what that says.

The second is not a reversal, but more of the same. The PSDA of 1991 took an important step in encouraging the education of patients regarding advance directives, but notably left out one significant player -- the physician. Twenty years later, the physician’s role in this conversation remains too controversial to include in Medicare policy.

This seems to underscore the importance of Massachusetts’ effort to encourage the doctor-patient dialogue, and to increase the role played by palliative care specialists.

Here’s where to find the Globe editorial:

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