More than 8,000 general practitioners in the United Kingdom will soon begin displaying in their offices seven “end-of-life” promises to their patients. It is a great idea. According to an article in The Independent, every GP (much like primary care physicians in the U.S.) will post this end-of-life pledge on the wall of their waiting room.
The Charter for End of Life was created by the Royal College of General Practitioners and the Royal College of Nursing. Its goal is to ensure that dying patients’ remaining days are as comfortable as possible, and that physicians do everything they can to preserve patients’ independence, dignity and, personal control. It includes a promise that the doctor will help patients “think ahead so as to identify the choices that you may face, assist you to record your decisions and do our best to ensure that your wishes are fulfilled.” GPs also promise to do “their utmost” to help keep a patient comfortable and make sure she gets appropriate specialist care, as well as emotional and spiritual support.
It is something like a Hippocratic Oath to the dying.
Of course, putting up a sign is not enough. But it is an important beginning. It is a critical reminder to both patients and physicians that end-of-life care is as important as, say, prescribing medications or ordering surgery. It signals that, while not every patient can be cured, every patient is owed the best possible care, and that sometimes that care may involve help with end-of-life decisions.
I especially like this idea because it creates on opportunity for patients and docs to discuss end-of-life long before there is a crisis. Imagine a 50-something patient who is in the midst of caring for a dying parent. Simply seeing that written pledge on the wall may be enough to open an important discussion.
In recent years, the National Health System in Britain has made a real effort to encourage doctors and patients to establish ongoing relationships. The goal is for patients to get to know their GPs and not see a different doctor every few months. This opening to discuss end-of-life is another way docs can build trust with their patients.
The U.S., sad to say, is miles behind the curve on this. During the debate over the 2010 health law, there was an effort to provide doctors with an additional Medicare payment for discussing end-of-life issues during routine annual check-ups. In one of the more shameful episodes in recent political history, Republicans charged these discussions were “death panels” and the Obama Administration abandoned the idea. Earlier this year, the Department of Health and Human Services tried to do this administratively but, once critics got wind of the plan, dropped the idea again.
A written pledge, or even additional compensation, is just a start. Physicians need to be trained to have candid end-of-life conversations with their patients. They need to learn that a dying patient is not a failure, and that–sometimes–things happen that are beyond their control. But posting a Charter for End of Life is an important start. We ought to try it.
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