SHE WAS PROBABLY taller than she appeared, this old woman in the baby blue sweater set and careful white curls. But she'd slipped into a slouch in her wheelchair.

Behind her stood two much younger women, daughters perhaps, or granddaughters. One held the wheelchair's handles as they finished their discussion with the volunteer about the form they had just helped her fill out.

It was a Power of Attorney for Health Care that specified the elder woman's explicit desires for the very end of her life.

The younger women were talking, but she was smiling. She laughed and nodded when one of the pair remarked, "It's good to have this mumbo-jumbo done, isn't it?" and gently touched her curls. She was laughing, though what she'd just faced was what Sarah Palin famously labeled a death panel.

This was the first Thursday of the month, the day that end-of-life directives are displayed and discussed in the lobby of Vernon Memorial Hospital, on the clinic side. Vernon Memorial is an outlier of Gunderson Lutheran Hospital, the place where the incorrectly named idea originated, according to a New York Times story that ran shortly after Palin sprang the term on the world.

Several years ago, a new administrator arrived at the La Crosse hospital. He’d seen more than one too many battles between family members over the fate of someone who hadn’t made end-of-life wishes clear. To remedy this, he decreed that every hospital and clinic in the system would offer counseling. Offer, not impose.

The problem was that Medicare did not reimburse doctors and other staff members for these sessions, which sometimes lasted most of an hour. He informed his Congressman, Ron Kind, and other members of Congress, who took the ball and ran with it.

No less a conservative than Newt Gingrich saw the economic benefits. In March 2009, Gingrich was interviewed on Frontline. He said, “Let me give you an example that I find fascinating. In La Crosse, Wis., the Gunderson Lutheran Hospital system is, according to the Dartmouth [Atlas of Health Care], the least expensive place in America for the last two years of life. They have an advanced directive program, and over 90 percent of their patients have an advanced directive.”

In August of that year, Times blogger Uwe Reinhardt wrote, “It would be very helpful, indeed, if Mr. Gingrich, having offered these observations, now felt duty-bound to explain—to former Gov. Sarah Palin of Alaska, to former Lt. Gov. Betsy McCaughey of New York, to the radio and cable pundits they incite, and to the public at large—that end-of-life directives issued by patients, with or without the advice of their physicians, are quite far removed from the ‘death panels’ or the persuasion to cut life short that these two commentators have ascribed to end-of-live directives.”

So: Vernon Memorial Hospital; Thursday, July 1; Thursday, ¬August 5. It’s not a death panel.

And it’s not a bad idea.

—Marilyn Leys