End-of-Life Choice, Palliative Care and Counseling

Pain Management

Pa. Atty. Gen. Should Drop Case Against Woman Who Cared for Her Dying Father

Contact: Sean Crowley, 202-495-8520
scrowley@compassionandchoices.org

End-of-Life Legal Experts Say State’s Case Has No Legal Foundation

(Pottsville, Pa. – Aug. 1, 2013) Following a preliminary hearing today, legal experts from the nation’s leading end-of-life choice group urged the Pennsylvania Attorney General’s office to drop an assisted suicide charge against a woman who was present when her 93-year-old, terminally ill father ingested morphine to relieve his pain and later died because the case has no legal foundation. Authorities allege that Barbara Mancini, a registered nurse from Philadelphia, handed her father, Joe Yourshaw of Pottsville, a partially filled bottle of morphine at his request. They claim that this act constitutes “assisted suicide.”

Joe Yourshaw was dying. He suffered from multiple medical conditions that caused him extreme pain: end stage diabetes, extensive heart and cardiovascular disease, stroke, kidney disease, and arthritis. Dying patients have a constitutional right to adequate pain medication, even if it advances the time of death. The U.S. Supreme Court recognized this right in two landmark cases, Washington v. Glucksberg and Vacco v. Quill, both brought by Compassion & Choices’ predecessor organization, Compassion in Dying. More

Compassion Drives ‘Aid in Dying’ Movement

By Mary Steiner

Jun 02, 2013

Vermont recently approved historic legislation allowing aid in dying, sometimes referred to as “death with dignity.”

Its The Patient Choice at End of Life Act represents a tremendous advance for citizens of that state and the entire movement to expand end-of-life choice. Although widely covered in media on the East Coast, this important development received little attention in Hawaii.

Aid in dying allows terminally ill, mentally competent adult patients to request, and physicians to prescribe, life-ending medication when they their suffering unbearable to bring about a peaceful death.

Vermont is the first state to enact such a law legislatively. Oregon and Washington passed death-with-dig- nity acts by referendum, while the Montana Supreme Court ruled in 2009 that physicians there may provide aid in dying.

The new Vermont law, which the governor signed on May 20, contains provisions similar to Oregon’s Death with Dignity Act and policies in Hawaii. It follows Oregon’s model, but after three years, those requirements expire, at which time professional practice standards will prevail, as they do in Hawaii. More

Why Don’t Doctors Talk About Death With Their Patients?

by James C. Salwitz, MD
KevinMD
February 21, 2013

The failure of doctors to talk to their patients about end of life decisions perplexes me.  This gap in vital communication results in poor care, uncontrolled pain, futile treatment and death in hospital or nursing home, where no patient wants to be.  Certainly, for oncologists, every patient they see is concerned about dying and by not opening the topic it leaves each isolated.

I have generally taught my students that this failure results from a “culture of cure.”  Doctors and patients focus so hard on treatment, whether its fighting cancer, heart disease or even Alzheimer’s, that they ignore the reality that all life eventually ends.  Lost is the opportunity to plan for end-of-life needs, which can deny the patient and family a gentle passing.  Doctors falsely see death as the great enemy, instead of suffering and disease. Often the illogical emphasis on cure at any cost is key to poor end-of-life communication. More

Unwanted Medical Treatment at Life’s End Causes Needless Costly Suffering

February 20, 2013

Testimony of Mickey MacIntyre
Chief Program Officer, Compassion & Choices

Before the Institute of Medicine’s Committee on Transforming End-of-Life Care

Good afternoon. I am Mickey MacIntyre, Chief Program Officer for Compassion & Choices, a national nonprofit consumer organization dedicated to improving care and expanding choice at the end of life. I appreciate the opportunity to address the committee today.

Compassion & Choices’ central tenet is that Americans are free to choose how they live – so it follows that when the time comes, we are free to choose how we die. This private, personal decision belongs to all Americans – free from government interference. U.S. courts around the country, including the United States Supreme Court, have upheld this right.

Today, I want to address one specific problem: unwanted medical treatment. Patients have the right and the responsibility to guide their own health care throughout their lives, with their trusted health care professionals. Many Americans give thoughtful consideration to medical decisions that may need to be made if they are injured or debilitated, and they articulate their decisions in advance directives.

Congress passed the Patient Self-Determination Act (PSDA) in 1990 to reinforce an individual’s right to determine the course of his health care. This Act amended Medicare and Medicaid law to require providers to follow policies and establish procedures with regard to advance directives. The PSDA established that if these policies are not followed, the Secretary of Health and Human Services (HHS) may decide that the provider is ineligible for payment through Medicare and Medicaid.

President Obama reasserted the importance of respecting patients’ rights in a 2010 memorandum to HHS asking the agency to, “ensure that all hospitals participating in Medicare and Medicaid are in full compliance with [these regulations]…[t]hat all patients’ advance directives…are respected, and that patients’ representatives otherwise have the right to make informed decisions regarding patients’ care.”

Nevertheless, many patients’ decisions are overridden or ignored in the weeks and months before their deaths. This happens for a variety of reasons and can lead to invasive and fruitless testing, needless suffering, unrelenting pain and a prolonging of the period before death. Patients are tethered to monitors and machines despite their determination to reject unwanted treatment and desire to die at home in the embrace of loved ones.

A new study published in JAMA found that between 2000 and 2009, treatment in intensive care units in the last month of life increased from 24% to 29%. The accompanying editorial concluded, “The focus appears to be on providing curative care in the acute hospital regardless of likelihood of benefit or preferences of patients. If programs aimed at reducing unnecessary care are to be successful, patients’ goals of care must be elicited and treatment options such as palliative and hospice care offered earlier in the process than is the current norm.” Compassion & Choices could not agree more.

Policy makers can and should provide both the carrot and the stick to ensure that patients’ wishes are honored: financial incentives for honoring advance directives and financial DISincentives for disregarding patients’ expressed wishes.

The Centers for Medicare and Medicaid Services (CMS) should deny payment to providers where there is clear evidence that specific treatments were unwanted — similar to policies where unnecessary treatment is provided.
The Justice Department is investigating and taking legal action against hospitals and doctors groups when instances of unnecessary treatment are exposed. The same due diligence should be trained on unwanted medical treatment. It is always unnecessary and should be considered a never event.

The explosion of the aging population coupled with the nation’s financial and moral commitment to providing health care to an ever-increasing number of Americans reveals that the scourge of unwanted treatment should be an urgent priority for this committee. Among the next steps Compassion & Choices recommends are:

Initiate and improve the quality of conversations among health care professionals, patients and families about end-of-life decisions, including:
1. reimbursing medical providers for participation in advanced care planning with patients and their families well in advance of illness or before facing end of life;
2. providing financial incentives and training to encourage medical providers to offer all the information and counseling necessary for decision making when securing informed consent;
3. ensuring that the full range of medical care and treatment decisions, including curative care, palliative care and medical assistance in dying, are freely available to patients without institutional or reimbursement barriers.

Further CMS should:
1. exclude from covered services and reimbursement any treatment that contravenes an adult patient’s informed health care decision;
2. track complaints where patient wishes were ignored and ensure that the survey and certification processes for providers require attention to patient’s advance directives;
3. revise billing forms to have providers indicate that care was rendered in conformance with patient’s advance directive and informed consent.

I thank you for the opportunity to testify today, and I will be happy to answer questions or provide written follow-up information.
Thank you.

Submit Your Story of Unwanted Treatment

Have you had an experience involving unwanted or unnecessary medical treatment. If so, please take a moment and tell us your story in an effort to help ensure that all patients have the right to guide their own health care decisions throughout their lives. Please follow this link to our stories submission page.

 

Chorus of voices grows stronger for ‘death with dignity’

By Steve Lopez
Los Angeles Times
December 18, 2012

The bullet that Larry Robert Broman used to kill himself went clean through his head and into the wall.

No one had expected him to do it. Not his ex-wife, who had remained close to him. And not their two grown daughters.

It happened early on the morning of Oct. 21.

“I heard a noise and ran down the hall,” said his oldest daughter, Heather O’Hara, who forced her way into the back bedroom of her Riverside home, where she’d been caring for her terminally ill father. “His hands went limp. The gun was in front of the sofa and he was sideways.”

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