My old Canadian friend toxicologist Cliff Walberg was right when he famously said, “there is absolutely no limit to how revolting things can be.”

Remember that. It comes in handy, in addition to strong swear words, when stuff happens.

Case in point: I believe that every American deserves the right to choose to have a death with dignity and as pain-free as medical science and practice can provide.

To achieve that, patients and physicians must discuss the options for managing an upcoming death.

Some patients may wish to involve family members and/or a religious representative as well.

Many patients and physicians now have this timely discussion, but despite many years of medical journals publishing and medical organizations teaching about “advance directives,” “durable powers of attorney,” and the like, actually having the conversation, and acting effectively on the results, remains a minority event.

Most Americans who die are old, and thus Medicare beneficiaries.

Physicians who provide an important medical service deserve to be paid for such. Okay.

But what happens when that was proposed? In roared opportunistic politicians using highly effective metaphorical rhetoric. Death panels, pulling the plug on Granny, and the like.

Demagoguery ran rampant, exciting paranoia about government amongst not only the public but some physicians. The administration and Congress caved.

Then, glory be, the regulators put back the language, so physicians treating Medicare patients could get paid for such essential, humane, voluntary, end-of-life counseling beginning Jan 1, 2011.

At writing time, 79% of more than 1,800 MedPage Today survey participants responded in favor of Medicare reimbursing physicians for voluntary end-of-life counseling.

Then, in the first week of 2011, the uproar started again. Only days later, the administration caved again to ill-advised political pressure, rather than doing the obviously right thing.

When will we as a country be mature enough to have this conversation openly, even as adults?

Maybe soon?

HHS confirmed that the proposed regulation had not gone through the customary comment period. Oh. Now it can.

Let’s us continue having that discussion, on these pages.

Maybe the country will grow up, little by little, participate and follow.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.com for more health policy news.