William S.E. “Doc” Coleman was a dynamic fixture. I did not know him particularly well, and leave the romantic remembrances of his long and illustrious life to others to mark and celebrate.
But I did know him a little. He did his best to direct me in my middling efforts as an actor at Drake University in the mid-1990s. His laugh and his knowing looks are easily remembered. But what strikes me most about his passing on July 8th is how different it was than it might have been even 10 or 15 years ago.
Doc died at home.
Doc died in the care of Linda, his loving partner.
Doc saw the end coming and connected once again with his many students and colleagues and friends. And he set forth a model for how I would want to go.
How do you want to go?
Are you a fighter? Will you struggle to the very end? Will you seek out the latest research, the clinical trials, and the compassionate uses of every possible medical intervention, in the hopes that you might successfully challenge the end?
Are you circumspect? Do you take your time and accept the vagaries of our mortal lives, knowing that you cannot change the outrageous fortune of our lives? Will you seek comfort and companionship as you draw ever nearer to shedding this mortal coil?
In a certain sense, these questions are ridiculous. When I say that Doc went out in a way that I would want to go, one of the key elements is that he was almost 90 years old. I cannot pretend to know what it will be like to be that age and to see the end coming. But, I am much more likely to accept it as a gentleman and a scholar if I am ripe and old. If I get a diagnosis tomorrow, however, or even in the next decade, I am likely to fight.
And so, it is with a modest amount of enthusiasm that I welcome the news that Medicare may begin reimbursing physicians for conversations about care at the end of life. This will likely lead private insurers to also reimburse for such conversations.
But two reasons keep me from getting too excited. First, I wonder if the reimbursement will be enough. I am unable to find numbers and so do not know how much this reimbursement will be, but given the bias of our current reimbursement schemes, I doubt it will be much. As I’ve discussed before, conversations about end of life care are long, complicated, and difficult. Will physicians be encouraged to take the time by a token payment?
Second (and related), it seems shortsighted to discuss the reimbursement in terms of physicians rather than medical practitioners in general. Physicians will be the best persons to have these conversations in some cases, but in other cases they will not be. Individuals as well suited to have these conversations (and likely better suited in many cases) are social workers and nurses and other members of the healthcare team.
It’s for these reasons that I’ll be trying to make comments on the proposed policy, and I hope you will too (you can find a pdf of it here, but the electronic commenting was not open at the time of this writing). And perhaps by the time the comment period ends and the reimbursement is officially put in place in January all of this will be accounted for.
If all goes well, the reimbursement schemes of Medicare still will not help me become the mentor, professor, author, and playwright that Doc Coleman was. But it might mean that when it’s my time to exit the stage I can do so as gracefully and as much on my own terms as he did.
Abraham Schwab is an associate professor of philosophy and a medical ethicist at IPFW.
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