A letter to Ellen Goodman, August 7, 2009

This is my response to Ellen Goodman's article(http://www.boston.com/bostonglobe/editorial_opinion/oped/articles/2009/08/07/in_a_wing_nut_world_granny_is_toast/) in the Boston Globe today.

Dear Ms. Goodman,

Everything you say in your article is true except there is a concern still lingering. As usual technocrats in Washington murder to dissect. Wouldn't any counseling between a patient and a physician be a valuable interchange? It should be coded as such for billing purposes. By having to label it "End of Life Discussion" it is an intrusion that is a ready opening to many outside sources among which are government and insurance companies. This is one of the sympathetic cords these off the beam fellow citizens react to. They do not want their most personal wishes telegraphed. They have zero trust in government authority. This feeds into it and continues the frenzy. The privacy of this moment must be well protected. If someone wishes to study or investigate such conversations then they should get the proper permissions on counseled patients. With identities protected, then do whatever investigation some review deems of value. It should not be an automatic that such data or, in fact, any data be available without safeguards. Of course, after this conversation between doctor and patient has occurred in private, the patient then becomes more comfortable in asserting their status when asked in the appropriate setting. They can even be asked if they talked this over with their physician. The problem described in your article is that these protesters may have had a point but it got lost in their destructive, disruptive undemocratic behavior. A doctor sitting with their patient hears many interesting notions people believe in, but in that setting it becomes a teachable, empathetic moment not a mob scene. It is proper to eschew their methods in certain forums but not their sentiments. They do have real fears that need to be assuaged. My biggest concern is preserving the doctor-patient realationship. Would it be a moment of comfort for you if a doctor suggests: "Next time we'lll schedule your end of life discussion." EDITED FROM ORIGINAL FOR CLARITY