End-of-Life Choice, Death with Dignity, Palliative Care and Counseling

Sen. Rockefeller Repeats Call for Advance Care Planning Legislationby Blaine


Senator John D. Rockefeller IV repeated his call Monday to included advance care planning in health care legislation. Along with the bill or “mark” the Senate Finance Committee reported to the full Senate, Senator Rockefeller included a 13-page report of “Additional Views,” similar to a dissent in a court case.

“The Committee mark is silent on advance care planning,” Senator Rockefeller wrote,

As I have asserted throughout this debate, a critical component of a modernized health system is the ability to address the health care needs of patients across the life-span – especially at the end of life. Death is a serious, personal, and complicated part of the life cycle, and care at the end of life is eventually relevant to everyone. Americans deserve end-of-life care that is effective in providing information about diagnosis and prognosis, integrating appropriate support services, fulfilling individual wishes, and avoiding unnecessary disputes.

Most people want to discuss advanced directives when they are healthy and they want their families involved in the process. However, the vast majority of Americans have not completed an advance directive expressing their final wishes. In 2007, RAND conducted a comprehensive review of academic literature relating to end-of-life decision-making. This review found that only 18 to 30 percent of Americans have completed some type of advance directive expressing their end-of-life care wishes. Perhaps most alarmingly, between 65 and 76 percent of physicians whose patients had an advance directive were unaware of its existence. In its present form, end-of-life planning and care for most Americans is perplexing, disjointed, and lacking an active dialogue. In its 1997 report entitled Approaching Death: Improving Care at the End of Life, the Institute of Medicine found several barriers to effective advance planning and end-of-life care that still persist today. I am extremely concerned that the Committee mark does nothing to inform consumers of their treatment options at the end of life or help them document their individual wishes for care.