End-of-Life Choice, Palliative Care and Counseling

Posts Taggedend-of-life consultation

Sen. Rockefeller Repeats Call for Advance Care Planning Legislation

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.



News and Opinion Support End-of-Life Consultation Provision

Importance of End-of-Life Decisions
By Herbert Mathewson, Cape Cod Times, September 17, 2009

The twisted, cynical label of “death panels” being used against the proposed Health Care Reform bill (HR 3020) is apparently based on a single item in its 1,000-plus pages that proposes to reimburse physicians, through Medicare, for any time spent counseling their patients about end-of-life-decisions. Since the offering of such counseling has been mandated since 1990 by the Federal Patient Self-Determination Act, it hardly seems like a radical idea. That 1990 legislation explicitly recognized the patient’s right to refuse treatment and mandated hospitals to inform the patient about that right and to urge patients to create an Advance Directive, i.e., designate a Health Care Proxy in Massachusetts.

To read the full article, click here.

“Granny Squads” and “Death Councils” Don’t Exist
By Gloria and Al Boersch, Denver Post, September 18, 2009

Being afraid of “granny squads” or “death councils” is like being afraid of alien body snatchers hiding under the bed or in the closet. They don’t exist, nor has anyone proposed establishing such a thing. They are nothing but cartoon characters that appear in popular horror stories created by political opportunists and some radio celebrities. We know something about “end of life counseling” because long ago (1985?) we helped to establish the first hospital ethics committee in Ft Collins, and we have many times participated in counseling families who sought us out. We also put into place a policy that is now routine. At the time of admission the hospital asks the patient if they have a living will or a durable power of attorney. No one is required to have either; the hospital simply enters the answer in the patient’s medical record.

To read the full article, click here.

Editorials Support End-of-Life Consultation Provision

Health Care Reform and Death
Paul Gewirtz and Matthew S. Ellman, Huffington Post, September 15, 2009

Although President Obama gave new momentum to health care reform in his recent speech to Congress, he unfortunately ignored one key topic: end-of-life issues. Now there are rumors that the Senate Finance Committee will drop all provisions on end-of-life issues from the bill it unveils this week. But it’s not too late for the new legislation to address end-of-life issues appropriately. And no topic better tests our country’s maturity about health care reform.
The issues are much deeper than any particular legislative provision, such as Section 1233 of the House’s proposed legislation, which sensibly supports end-of-life medical counseling.
The basic issue is death itself. Death is essentially a taboo topic in public debates, and serious discussion about terminal illness and death has been almost completely lacking in the recent health care debates.

To read the full article, click here.

End-of-Life Choice
Lynn Mensch Anderson – Lawrence, Lawrence Journal-World, September 17, 2009

I am the 84-year-old person with congestive heart failure, for whom the plug will be pulled under the Democrats’ health care plan, according to Sarah Palin.
In my 50-some years of working with doctors in medical and mental health facilities, I have found that doctors view their professional duty as saving lives, and when they err, it is on the side of doing too much to maintain life.
End-of-life counseling is a wonderful thing. Giving thought to how one might want to end life should start when one is still young and the thought is not threatening.

To read the full article, click here.

End-of-Life Conversations With Dad
By Peg McEntee, Tribune Columnist, The Salt Lake Tribune, September 17, 2009

Here’s how I remember my dad: in a fishing boat, rods out for trolling, at a reservoir high in the Sierra Nevada. And driving through tule fog in the San Joaquin Valley at 4 in the morning during duck hunting season, the cracked window siphoning off his cigarette smoke.
Those days are long past, so here are more recent memories: he has a bad back and chronic obstructive pulmonary disease. He’s in a hospital bed, on oxygen, a feeding tube in his belly, his face betraying confusion and anger. He’s 84 years old. He was a combat veteran of World War II, serving on a little tub of a ship that dropped soldiers onto the beach at Normandy. In his final years, he relied on Veterans Administration hospitals for most of his care.

To read the full article, click here.

Sign the Petition Demanding End-of-Life Choice

Make sure Congress knows where you stand.

Sign our petition today. Help us deliver at least 50,000 signatures to Congress by September 15th.

Click here to sign our petition right now, and ask your friends and loved ones to do the same. We’ll make sure your Congress member and both Senators know that you expect them to lead, not follow or succumb to loud misrepresentations.

Jack Rice: The Truth about ’Death Panels’

In light of conspiracy theorists claiming that heath care ’death panels’ are coming, Jack Rice invited Barbara Coombs Lee, President of Compassion and Choices, on the show to dispel those rumors and set the record straight about end of life. Follow the “READ MORE” link below to listen to the interview.

That this kind of charge, this hysteria and hyperbole, was ginned up so quickly and caught people’s imagination is quite remarkable. It speaks to the fact that it’s hard to talk about death and hard to acknowledge that we’re all mortal. Tapping into these deep fears and telling scary stories is the height of political cynicism. None of it is true.

This is a bipartisan issue. Up until recently everyone was on board – Republicans, Democrats – with the idea that families shouldn’t be drawn in to Terri Schiavo – like disputes. We should take precautions against them by making our views clearly known to the people who love us and to the doctors who will be caring for us when we’re terminally ill and can’t speak for ourselves. The POLST (Physician Orders for Life Sustaining Treatment) legislation has very broad support among members of Congress and mainstream organizations like the AARP, unions and seniors’ groups. Then it was as though a need arose to discredit it and to stoke fear.

And it’s scary to think that someone else is making decisions for you. No one wants that. We want, everyone wants, people to make decisions for themselves. That’s what these consultations are about.

Click on the “Play” button (triangle) to hear Jack Rice speaking with Barbara Coombs Lee: