The Good Daughter Syndrome

This week's topic, how the proposed overhaul will impact senior citizens, is very dear to my heart. I am a family physician with substantial experience in geriatric medical practice; I have always tried to be an advocate for my elderly patients. I wish to focus my comments on the issue that seems to have hijacked the reform debate from the senior perspective: advanced directives and end-of-life care.

What I refer to as "Good Daughter Syndrome" is a scenario that I have seen play out innumerable times in my career, and it breaks my heart every time I see it. Too many elderly have little or no family support. But oftentimes, there is one attentive family member, most often the good daughter (or son, or niece -- you catch my drift) who has stayed close to Mom and has heard many times from her, "I don't want to die in pain / un-dignified / a burden." There may or may not be an advanced directive. Regardless, as the terminal stage clearly develops, the less-attentive family members seem to come out of the woodwork, their guilt at having ignored their loved one kicking in and now everybody adds their voice to the cacophonous din. The good daughter's voice is drowned out by a chorus of, "But you gotta keep Mom alive at all costs." Then, despite Mom's well-known prior wishes to the contrary, all the stops come out and two weeks of painful, expensive and ultimately futile hospital care ensues.

Let me be clear: I am no proponent of euthanasia, which I find to be morally repugnant. And that is not what the advanced directive provision in HR 3200 proposes. There is a huge difference between euthanasia and compassionate palliative care. At some point in every chronic, terminal condition, it becomes clear that effecting a cure is not possible. However, attempting to relieve pain and anxiety at the end of life is always possible. You have to know when to say when. Regardless of whether this activity is mandated by legislation, it is critical that we embrace the spirit of advanced directives and keep faith with our loved ones by supporting all the good daughters out there: enforcing Mom's wishes when the time comes. It is not merely an economic imperative, it is a moral imperative.

As I view the heated debate over health-care reform legislation taking place at various town hall meetings across the country, it feels to me that the frustration spilling over is a lot like the angst I see family members grappling with at the time of the impending demise of their loved one. Emotions strained. Statements curt. Manners often in short supply. And then the end comes... And the family dynamic re-casts itself. Some folks reconcile; others retreat to their respective corners.

I suspect that health-care reform legislation is ultimately going to play out in much the same fashion. As the heat of August burns away, we'll all become resigned to the fact that a dramatic transition is coming. Hopefully, cooler, more moderate voices will hold sway in September. And we'll pass meaningful, fiscally responsible, morally upright health-care reform legislation.

It's what Mom would've wanted us to do.

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Raymond J. Zastrow

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The Good Daughter Syndrome