Now that the hysteria that accompanied the health care reform debate has diminished, perhaps it is time for an adult discussion about how to handle the difficult end-of-life decisions that an increasing number of individuals and families face because of advances in medical technologies.

The issue, which in no way should be controversial but remains so, surfaced again this past week when The New York Times reported that starting this year Medicare will reimburse physicians who discuss with patients their options and preferences for end-of-life care. The discussions will be part of a patient's annual Medicare "wellness visit."

This has led to accusations in some political corners that the Obama administration is accomplishing through regulation a policy it could not obtain in the health care bill. Section 1233, adopted by the House but dropped from the final health bill, allowed Medicare to pay for consultations about end-of-life issues.

Some conservatives expressed fears such counseling would pressure elderly patients to forgo care and hasten death in the interest of reducing medical costs. Former Alaska governor, former Republican vice presidential candidate and current TV celebrity Sarah Palin notoriously referred to them as "death panels."

In reality, there were never any panels planned, never mind death panels. But the scare-mongering worked politically and it stuck. A recent poll by the nonpartisan Kaiser Family Foundation found 30 percent of Americans 65 and older said they believe the new health care law allows a government panel to make decisions about end-of-life care for people on Medicare.

Quite the contrary - the intent of the language stripped from the bill, and the goal of the new regulation is to provide patients greater empowerment. The rights of the individual to determine his or her destiny should be a core Republican value, but apparently not as important for some as politically undermining the president.

Thankfully, the protests are fewer and less zealous than during the health care debate.

The latest regulation actually flows from legislation signed by President George W. Bush in 2008 that allowed end-of-life planning to be part of a patient's "welcome to Medicare" exam. Health care reform transformed the welcome visit into an annual wellness visit, with discussions about how the patient would want to handle a future medical crisis as part of the continuum of care.

When faced with a potentially fatal disease, the goal is to cure it. But at some point, that option may end, and the issue becomes prolonging life. A patient's priorities may then shift to other goals, such as having quality time, minimizing pain and having the opportunity to die at home surrounded by loved ones. Utilizing every medical option to squeeze out a few extras days, only to die attached to machines in a hospital, is not the end many prefer.

As uncomfortable as it may be, the time to discuss these matters is earlier, not under the stress of a crisis and not leaving it to others to guess what the patient would want.

The National Catholic Bioethics Center, which would never be accused of having a liberal agenda and consults regularly with the Vatican on medical ethics, recommends individuals create an advance directive, also known as a living will, which states the patient's wishes with respect to aggressive medical treatment.

This is not about rationing care or hastening death or euthanasia. It's about letting individuals manage a fatal illness and control how their lives will end. It makes sense that Medicare facilitates that planning.

Stop the politics.