End-of-Life Choice, Palliative Care and Counseling

Posts TaggedCarolyn Lamm

Resuscitate End-of-Life Counseling

ABA President Carolyn Lamm
ABA President Carolyn Lamm

Carolyn B. Lamm, president of the American Bar Association, makes a compelling argument for the health care reform bill provisions to make advance care planning consultations available to Medicare beneficiaries.

The reality of health care today is that seniors do not know all of their options when faced with serious, chronic medical conditions. Few family members or friends have the expertise and knowledge to advise them and almost no experts will provide advice and counsel without compensation.

Doctors often have no idea about their patients’ care goals. As a result, care is often dictated by those who have not spoken directly with the patient.

That’s the problem addressed by the advance care planning consultations provision. The opportunity for such consultations — which are voluntary, not mandatory — ensures that elderly patients facing difficult decisions are well-advised of all options and the individual’s well-informed wishes, goals of care, and values are known and honored by their health care providers. This is a patients ’ rights issue.

Health care providers benefit, too. They need to know who to contact when a patient loses the capacity to make health care decisions. When a patient chooses and authorizes a spokesperson, through a health care power of attorney, physicians can provide health care consistent with the patient’s goals and wishes. Patients can include any specific wishes or guidance for health care in this kind of advance directive.

Not surprisingly, research tells us that patients prefer to have their doctors initiate these talks. When physicians do so, patients are more satisfied with their care. The failure of physicians to initiate discussions in connection with serious chronic illnesses is often associated with poorer patient quality of life. For Medicare patients with serious, life-limiting conditions, these consultations are a win-win situation. They enhance patients’ rights, comfort and quality of care.

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