As the days fly by, the fate of the current federal health care legislation has come into focus. States banded together in opposition to a law that few want and fewer can afford. A federal judge in Florida agreed with the states. Regardless of what happens on the way to the Supreme Court, in the end ObamaCare will be a sapling that dies not from lack of attention but from lack of any soil to put down roots.

Our system of checks and balances works. Our founders, who risked their lives and fortunes, wrote a constitution to prevent the federal government from overstepping its authority. Much of the Constitution is devoted to what the government may not do. The colonists, for very good reason, were concerned about creating a federal government that would become as tyrannical as the one they had just driven off in the revolution.

This poorly conceived legislation, which was slipped through a lame duck session of Congress, should be allowed a quick and peaceful death. Why keep it on life support? Prolonging the dying process just adds to the pain and delays creation of legislation that will effectively address the problems before us without using the Constitution as birdcage liner.

Some parts of the bill, such as insurance reform, are worthwhile and should be included in the new legislation. Other parts, such as the bastardization of the commerce clause to force citizens to buy health insurance, must be eliminated. How anyone who has a rudimentary understanding of the problems at hand could have crafted the original legislation without addressing our absurd tort system is beyond comprehension. Congress has much work to do, and the sooner they get to it the better.

I’ve been puzzled by those on the right who demagogue the issue of end-of-life care. They claim that there will be death panels and the government will force people into talking about death. This hyperbole adds nothing to the debate. What many liberals and conservatives fail to acknowledge is that we are well past the day when we have enough cash sitting around to perform every conceivable intervention on people whose inevitable death is near or who lack self-awareness.

The federal government must get a grip on exploding entitlement costs. It is not unreasonable to encourage and enable doctors to have discussions with patients and family members about end-of-life care. This is a conversation that should be going on anyway. And it should be done on a routine visit to the doctor, not outside room 12 of the local ED when the patient is in respiratory failure.

If physicians don’t help patients and families make these tough decisions, soon enough the government will be doing it for them.

Too many times to count, I have had discussions with families about a moribund nursing home patient who has no designated code status. I try to present the situation to them objectively to help them understand prognosis and chance of success. Sometimes families choose to proceed with treatment and sometimes they decide to allow a peaceful death. This is the way it should be. These are decisions that should be made by patients and their families, not the government. We are less likely, however, to be providing futile care if these discussions are not held in the shadow of a pending crisis.

What I find most frustrating is when a DNR Comfort Care patient is sent by EMS from the nursing home for emergency care. According to the statute in Ohio, these patients are not to receive monitoring, resuscitative drugs, or an IV line. These are the expressed written wishes of patients and families, and yet nursing homes routinely send these patients for treatment that is not appropriate or desired.

I make these patients as comfortable as possible, talk to the family, and then return them to the extended care facility. The vacuum of common sense in these places could suck a satellite out of the sky.

Every day we see examples of futile and very expensive care. Ancient and demented patients receive dialysis, surgery, and positive pressure ventilation when there is no hope for any meaningful long-term success.

It is easy for doctors to say that we will “try everything” to prolong life. What takes courage and a sound moral compass is to sit down with a family and explain that sometimes the most loving thing you can do for a relative is to acknowledge that the end is nigh and to allow death to happen in a comfortable setting free of contraptions best used elsewhere.

On the day I write this, there is an AP article in the Toledo Blade about oncologists and end-of-life discussions. It reports that the American Society of Clinical Oncology says that fewer than 40% of patients with advanced cancer have a realistic discussion about what to expect and what choices they have in end-of-life care.

This is astonishing. If the oncologists are not getting this right, I expect that few other specialties are doing any better. Patients need our guidance in these important matters. Television and movies have conditioned the public to expect miraculous cures from interventions such as CPR for traumatic arrest and aggressive chemotherapy for late-stage cancer. Patients need us to put their condition into perspective and help them make sound decisions. Physicians must take the initiative in these difficult discussions.

This is good medicine and good economics simultaneously. We are in the middle of a gargantuan fiscal crisis. If physicians don’t help patients and families make these tough decisions, soon enough the government will be doing it for them.

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo (Ohio) Medical Center. Your feedback is welcome at David.Baehren@utoledo.edu.