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

Experts Lament Administration’s Reversal on Medicare Support for Advance Care Planningby Sonja


FOR IMMEDIATE RELEASE: Thursday, January 06, 2011
CONTACT: Steve Hopcraft, 916/457-5546; [email protected]

PORTLAND, OR – Compassion & Choices, the nation’s largest nonprofit organization advocating for end-of-life care and choices, expressed profound disappointment over reports the Obama administration will drop a regulation to reimburse doctors for helping their patients with end-of-life planning.

“This Medicare enhancement encouraged communication, promoted choice, compensated doctors for important care and empowered patients,” said Barbara Coombs Lee, president of Compassion & Choices. “We are profoundly disappointed it was withdrawn. It’s important that patients and families discuss end-of-life options before they become vulnerable in a crisis. Research reveals people want to discuss advance planning with their doctors. The modest Medicare change merely reimbursed doctors and created time to talk during yearly wellness evaluations.”

Under the rule, which went into effect on January 1, Medicare authorized payment, as part of an annual wellness visit, for elective discussions about end-of-life plans, which could, in turn, be used to prepare an advance directive. Patients could state what treatments they would and would not want as the end of life approached.

About half of terminally ill patients do not have conversations with their physicians regarding end-of-life treatment choices, according to a 2009 study in the Archives of Internal Medicine. A separate study published there in 2008 reported ninety-three percent of family members of critically ill hospital patients said that avoiding discussions about prognosis “was not an acceptable way to maintain hope.” Families said that “timely discussions about prognosis help families begin to prepare emotionally, existentially, and practically for the possibility that a patient will die.”

Patients communicating their desires to physicians is part of standard, excellent end-of-life care and planning. Solid research shows people who talk with their doctor about end-of-life wishes are more likely to have those wishes honored, and more likely to experience a peaceful, pain-free death when the time comes.
Experts considered the reimbursement provision important because many physicians, when asked why they do not regularly engage in advance care planning with their patients, report that they do not have time for such conversations.

“It’s now up to us as consumers,” said Coombs Lee, “to drive the discussion with our physicians about the end of life care we want, according to our own values and beliefs.”
Information, model letters to doctors and other planning documents are available at www.compassionandchoices.org/g2g.

Compassion & Choices is a nonprofit organization working to improve care and expand choice at the end of life. We support, educate and advocate.