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David Kerr: Death in America

10 Jun, 14 | by BMJ

david_kerrIn the United States, even the grim reaper is not immune from political interference. Around two weeks ago, an episode of mass murder happened a few miles from where I live. On 23 May, 22 year old Elliot Rodger took his own life after killing six students, and wounding 13 others in the area known as Isla Vista—a campus for students attending the University of California, Santa Barbara.

Despite a diagnosis of Asperger’s syndrome, Rodger had managed to acquire three semi-automatic handguns, and 400 rounds of ammunition, when he shot himself to death. Richard Martinez, the father of one of the victims, blamed his son’s death on the US Congress’s failure to pass new gun legislation in the wake of other recent mass shootings, including the December 2012 massacre at Sandy Hook Elementary School in Connecticut, where 20 children and six adults were killed.

In a recent article in the Week magazine, the essayist Tim Kreider wrote that, as far as the US is concerned, “we’ve collectively decided, as a country, that the occasional massacre is okay with us. We’re content to forfeit the lives of a few dozen schoolkids a year as long as we get to keep our guns.” After the Sandy Hook tragedy, the comedian John Oliver had also remarked: “One failed attempt at a shoe bomb and we all take off our shoes at the airport. Thirty one school shootings since Columbine and no change in our regulation of guns.”

Also in May, Eric Shinseki resigned as secretary of Veterans Affairs, apologizing for a scandal in which employees throughout the VA’s massive hospital system conspired to hide waiting times, which were backlogged for months. This was perceived in some quarters as evidence of a “death panel.” Death panels first became big news when in 2009, as part of the Affordable Care Act, it was suggested that federal government would reimburse doctors for talking to patients and their families about advance care planning—including living wills and end of life treatment options. At that time, Sarah Palin, the former Republican vice-presidential candidate, took to Facebook to accuse President Barack Obama of proposing “death panels” to determine who deserved life sustaining medical care. Amid an outcry, the provision was stripped from the legislation.

However, just recently the American Medical Association issued recommendations on what doctors should be paid for advance care planning, therefore making it likely that it will become part of routine medical care after all. Although admitting to being unaware of the AMA’s proposal, Burke Balch, director of the Powell Center for Medical Ethics at the National Right to Life Committee, expressed concern that the measure would result in the “denial of life-saving medical treatment.”

In the US, there is a big disparity between what patients say they want and what they get—they want to avoid hospitalizations and high intensity care at the end of life, but their wishes are often overridden. The same is true for doctors as patients. It seems that the lack of compensation for advance care discussions is part of the problem with healthcare here: doctors who perform procedures are paid on average three times more than those who talk to patients.

David Kerr wears many hats, sometimes at the same time—diabetologist, editor of Diabetes Digest, researcher, and founder of VoyageMD.com, a free service for travellers with diabetes, and Excarbs.com, which focuses on exercise and insulin. He is now director of Research and Development at Sansum Diabetes Research Institute in Santa Barbara, California. You can follow him on Twitter (@GoDiabetesMD) and Linkedin.

Competing interests: The author has no relevant competing interests to declare. 

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