Nearly one out of four elderly Americans — the equivalent of 25 million people — said they received excessive or unwanted medical treatment, according to a poll released this week, bolstering the efforts of some medical associations and advocacy groups to curb what they consider costly medical procedures.
Purple Insights, the research division of well-known polling firm Purple Strategies, interviewed 1,007 adults older than the age of 50. An overwhelming majority said they would discuss or write down advance directives — legal documents that allow patients of sound mind to outline desired medical care in the event they become incapacitated. Two out of three respondents also said they support withholding payments to healthcare providers who do not follow through on their patients’ end-of-life medical wishes.
“Twenty-five million Americans receiving excessive or unwanted medical treatment is 25 million Americans too many,” said Daniel Wilson, national and federal programs director for Compassion & Choices, a national end-of-life advocacy organization that sponsored the poll. “This survey demonstrates that older Americans clearly trust their doctors, but they also expect them to honor their end-of-life medical wishes.”
Excessive medical care accounts for one-third of nearly $2 trillion in healthcare costs accumulated in the United States, according to PricewaterhouseCoopers, LLC. In 2012, nine medical groups, including the American College of Cardiology and the American Society of Clinical Oncology, compiled a list of treatments and procedures they believe doctors overuse, including repeat colonoscopies for patients with no family history of colon cancer and stress echocardiograms for patients who don’t have risk factors for heart disease.
Since the late 1960s, advance directives — also known as living wills — have allowed Americans to proactively determine their desired quality of care in their last days. The Patient Self-Determination Act of 1990 required health care providers — including hospitals, nursing homes, and home health agencies — to raise awareness among patients about their rights to make advance directives. A 2010 presidential memorandum to Kathleen Sebelius, then U.S. secretary of health and human services, later maintained patient self-determination.
While use of advance directives has increased by 30 percentage points within a 10-year span, according to University of Michigan researchers, elderly people still face hurdles in affirming their end-of-life medical wishes. A 2011 University of California, San Francisco study found that complicated legal jargon in end-of-life documents often discouraged patients from making advance directives. Other obstacles for elderly people, according to the study, include requirements that documents are notarized or have witnesses’ signatures.
A recent study published in the Annals of Internal Medicine also suggested that many decision aids — printed leaflets, videos, and interactive sites about advance directives — may not serve as adequate alternatives to conversations with doctors, which often take longer than one hour.
Last year, Rep. Earl Blumenauer (D-Ore.) authored legislation that would provide patients with more opportunities to discuss end-of-life decisions to their healthcare provider. The bill, touted as the Personalize Your Care Act, provides Medicare and Medicaid coverage for voluntary consultations between patients and their doctors. Although 57 House members on both sides of the aisle sponsored the bill, it hasn’t moved beyond introduction on the House floor, in part due to a barrage of messages from conservative groups that liken end-of-life medical discussions to death panels.
In a statement on his website, Blumenauer gave a rallying cry for end-of-life medical discussions, drawing parallels between individual choice and securing the financial solvency of America’s medical infrastructure.
“We should decide who makes decisions for us, so that our wishes are fulfilled whenever we are unable to decide for ourselves, whether at end of life or a temporary condition from an accident,” said Blumenauer. “Families need the tools and ability to work with health care providers to stop the insanity of healthcare on auto pilot, late-stage, extreme medical procedures, operations and interventions that not only can destroy the quality of life, but often shorten it.”