End-of-Life Choice, Palliative Care and Counseling

New Research Shows Wide Support for Patients’ End-of-Life Rightsby Sonja

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By Ashley Carson Cottingham

Recent news coverage about a poll from The Pew Research Center’s Religion & Public Life project missed the real news.

The poll showed that a majority or “two-thirds of Americans (66%) say there are at least some situations in which a patient should be allowed to die” and concluded “the share [of people] saying they would stop their treatments so they could die has remained about the same over the past 23 years.”

Yet, many subsequent headlines and stories about the poll focused on a slight increase in the percentage of Americans who say that doctors should do everything possible to keep patients alive.

This latter finding is not surprising given the growing chasm of access to healthcare between the wealthiest and poorest Americans over the last few decades. It is only natural that many Americans who are medically underserved or marginalized would want more medical care at the end of life when asked that question.  In addition, healthcare has seemed like a luxury to millions of Americans who cannot afford it. But thanks to implementation of the Affordable Care Act starting next month, they will expect to have access to more and better-quality healthcare.

Equally important is that everyone feels differently about how much medical treatment they want at the end of life, based on the specific circumstances they are facing.  These critical end-of-life decisions are complex and tightly connected to a variety of factors in a person’s life or situation.  For example, 57 percent of those polled say they would tell their doctors to stop treatment if they had a disease with no hope of improvement and were suffering. That figure is 52 percent when the same people were asked if they would want to stop receiving treatment if they had an incurable disease and were totally dependent on someone else for their care.

These numbers indicate that healthcare professionals providing realistic quality-of-life expectations to seriously ill patients about various treatment options are extremely influential in patients’ decisions about whether to pursue any treatment or not.  How often does a healthcare provider tell a patient that a particular treatment might result in the patient living in a nursing home, totally dependent on someone else for their care, even if the treatment is “successful”?

Also newsworthy is that a growing share of Americans (62%) say that a person suffering a great deal of pain with no hope of improvement has a moral right to “commit suicide,” up from 55 percent in 1990. Yet, why do only 47 percent of the same people approve of laws described as “physician-assisted suicide”?

The answer is simple: “physician-assisted suicide” is a grossly inaccurate way to describe the medical practice of aid in dying, both from a medical and legal perspective. For example, the Oregon and Washington death-with-dignity laws allow physicians to prescribe medication to terminally ill, mentally competent adults that they can ingest to achieve a peaceful death if their dying process becomes unbearable. However, they both specifically say that this practice does not constitute assisted suicide.  In fact, assisted suicide is still illegal in both states.

Lastly, a sizable majority (62%) of the Pew poll respondents say they have talked with someone about their end-of-life wishes. That is very encouraging. Unfortunately, only 35 percent of those polled have written down their wishes.

It’s very important that individuals document their wishes by using a variety of advance care planning tools.  Compassion & Choices provides many of these tools on our website: www.compassionandchoices.org.

Once individuals take this step to secure their own rights at the end of life, it’s up to policymakers and advocates to ensure patients’ wishes are followed in all scenarios.  Patients deserve the medical care they want: nothing less … and nothing more.

 

Ashley Carson Cottingham is the director of policy & advocacy for the nation’s leading end-of life choice advocacy organization, Compassion & Choices, and a former staff director for the Senate Health, Education, Labor and Pensions Subcommittee on Primary Health and Aging.