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Death in the Casino

The opinions expressed by columnists are their own and do not necessarily represent the views of

When my mother was in her late 80s, I took her to a lawyer's office one sunny day to sign her "living will." We read over the questions and her answers, and she signed on the dotted line. She was pleased with the decisions that she had made weeks before.


We went shopping afterward, and she bought an antique watch that caught my eye in a shop window. This was an appropriate gift, she joked, because she had named me to be in charge of her "lifetime." If the time should come that a doctor asks whether to prolong her life when all hope is gone, I need to produce her living will.

Such discussions and "signings" with older parents had become commonplace among my friends of a certain age. We were confronting generational tasks that our grandparents never dreamed of. These were not morbid tasks, merely the latest reality bequeathed by technology that can keep a body physically alive, while those parts we think of as constituting our humanity have flown away. Yet nothing puts terror in the hearts of old folks as much as a discussion of end-of-life issues.

Can it be possible that faceless bureaucrats get the power to decide how an aging person will be "counseled," regarding when and how to give up the breath of life? This was the question asked of the president by a woman named Mary at a town hall meeting for the American Association of Retired Persons.

"I have been told there is a clause in there that everyone of Medicare age will be visited and told to decide how they wish to die," Mary said. "This bothers me greatly and I'd like for you to promise me that this is not in this bill."

The president looked greatly bothered by the question, too. He told her that the question was about getting information, not determining when and how someone's life would end. His grandmother, who died only months ago, the first lady and the president, himself, had signed living wills. This, he said, gave his grandmother "some control ahead of time." Nobody would be required to take such counseling, but one such medical consultation within a five-year period would be paid by government insurance.


That sounds harmless enough. The consultation would be voluntary, not mandatory; you could specify a family member to take charge if you can't. The legislation would simply guarantee your ability to learn about such choices and Medicare would pay for it. So, why are so many people still upset by the end-of-life clause in the House health care legislation?

The health care debate this time is focused on numbers, but a subtle psychological fear is pervasive: If the government in its "goodness" decides it can pay for end-of-life counseling, it can later on determine the content of the counseling. If the government in its "goodness" is concerned with the enormous cost of health care, looking everywhere for places to cut those costs, the elderly become an attractive budget item. Nevertheless, the insurance companies, imperfect and fallible though they are, depend on us to pay the freight. That leaves us in control of our choices, limited though they may be.

Trying to allay Mary's fears, the president offered a flippant answer: "We just don't have enough government workers to send to talk to everybody to find out how they want to die." But what if it did? What kind of Big Brother government have we created that makes us feel so small? Collecting information about how the elderly want to die is not the problem; who manages that information is the crucial part.

The health care debate is valuable as part of the search for ways to cover the uninsured, but it gives a lot of us the creepy feeling that we're losing the argument with the politicians, who are more concerned with creating a salable "product" than with thinking through the complexities.


Health care hasn't been in the hands of the kindly family doctor, sitting by the side of a sick child in that famous Norman Rockwell cover for the Saturday Evening Post, for a long, long time. The specialist and the technician with their mighty machines have replaced the reassuring touch of a healing human hand. The health care schemes, for all the good intentions of the schemers, sound ever more like schemes for a big government casino. That's not the place we want to be when our numbers come up.


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