The years-long conversation about end-of-life care continues to rage on with the release of a report this week that calls for an overhaul of the nation’s current system.
The report, titled “Dying in America,” examined the quality of care for elderly and terminally ill patients in their final days and offered a host of suggestions for insurers and health care providers, some of which can be fulfilled without legislative action.
The recommendations — drawn up by a 21-person panel of doctors, nurses, insurers, religious leaders, lawyers, and aging experts — include giving health care providers financial incentives to initiate end-of-life planning conversations and using Medicare reimbursements to cover home health services.
Members of the panel, appointed by the Institute of Medicine, said they hope the 507-page document will compel lawmakers and members of the health care industry to provide elderly patients and their families with the most desired care and reign in growing end-of-life healthcare costs.
“The bottom line is the health care system is poorly designed to meet the needs of patients near the end of life,” David M. Walker, a former United States comptroller general and chairman of the panel, told the New York Times. “The current system is geared towards doing more, more, more, and that system by definition is not necessarily consistent with what patients want, and is also more costly.”
In recent years, some lawmakers have blamed political opponents for blocking the expansion of end-of-life health care options for the elderly and terminally ill.
Last year, Rep. Earl Blumenauer (D-OE) authored a bill known as the Personalize Your Care Act. If enacted, the legislation would cover voluntary end-of-life consultations between doctors and patients. However, it hasn’t moved beyond introduction on the House floor due in part to conservative messages that have likened end-of-life medical discussions to death panels.
But many Americans feel that end-of-life health care needs a facelift. A poll conducted in July found that one out of four elderly Americans — the equivalent of nearly 25 million people — said they receive excessive end-of-life care. They may have good reason to hold those beliefs. Previous research has counted 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 among some of the most overused medical procedures. Excessive medical care accounts for more than $2 trillion of domestic health care costs.
Advance directives — also known as living wills — often allow elderly and terminally ill patients to have more of a say in what kind of care they receive. While the panel touted the importance of advanced directives, it stressed that the host of choices currently available don’t reflect the diversity of America’s population.
Other hurdles elderly people may face in mapping out their health care during their last days include complicated legal jargon in end-of-life legal documents, requirements that documents have witnesses’ signatures, and struggles to schedule hour-long conversations with doctors. That often discourages the elderly and their families from tailoring their end-of-life care.
In recent months, attitudes have also been shifted toward what’s been dubbed as “assisted suicide” — a process during which patients and their families consult with physicians about ending their lives as painlessly as possible. Experts credit that change to a rephrasing of the procedure: Gallup pollsters reported a 20 percentage point increase when “end patient’s life by some painless means” replaced “assist the patient to commit suicide” in the questioning.
Today, a handful of states — including Montana, Oregon, Vermont, and Washington — allow the practice. Despite fears that more terminally ill patients would be killed off as a result, relatively few assisted suicides have taken place. Washington, for example, reported fewer than 300 procedures — 40 percent of whom happened at the request of terminally ill cancer patients — since its law went into effect three years ago.