To: US Department of Health and Human Services
From: Danielle Amar, Kevin Budway, Dona Danialzadeh, and Sylvia Dao
Date: Monday, March 9, 2015
3 thoughts on “POLICY OPTIONS BRIEF: Critical Public Health Concern Regarding End-of-Life Care Mismanagement”
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Your policy topic touches on something that many of us find too challenging to discuss. As a person in her 20s the difficulties with end-of-life care was fortunately not something I had to face, until a close family member was facing the end of his life. Even with an advanced directive and family discussion about what measures he did and did not want, it was still a very difficult conversation to have. Many times he did not want to discuss it and we were left hoping for the best, while fearing the worst. None of us wanted to be forced to make those tough decisions. Upon his death, I started to learn more and more about the statistics you mention and the overwhelming amount of resources expanded for the short additional time, often spent, as you also state, in a situation not at all to the wishes of the patient.
Many of us have health insurance with the hopes of not having to fully use it. The idea of death is not something we often wish to think about or discuss, but when faced with it ourselves, or a close relative, you can see how overwhelming the many decisions can be. I like the idea of having a directive before you are in a situation of having to decide in the moment. Additionally, making this a mandatory conversation during routine, or non-emergency medical treatments is strongly advised, as well as the suggestion to make this part of a portable and readily available electronic patient history.
I feel you made a very strong argument for what is a very sensitive issue. There is no “good” way to discuss death, but there is a way to assure a “good” death. Your recommendations would bring the conversation to the forefront and allow anyone, regardless of age or medical condition, to have the kind of death with dignity so many of us speak of, but do very little to make happen.
The issue of death with dignity is one that continues to pervade hospitals across America. At some point, everyone will have to come face to face with passing away, and the moral implications of doing so at ones own choice. Because of the scope of the issue (everyone), the case for a resolution is strong and pertinent. It is especially pressing, as more attention is being brought to the issue with changing standards, and laws both in US states and internationally.
The authors tackled the issue directly, and found different ways to approach a possible solution. The inclusion of Medicare and mandates related to the issue are solutions that are never mentioned in typical debates regarding the issue, and ones that I found most politically feasible as well as reasonable.
The only thing I wish the authors included more of was information on the cost of the solutions, and any economic advantages or disadvantages there are passing any of the solutions. I could foresee hospitals having lower cost as patients would theoretically be in the hospital for lesser time, but its not certain. There may be other costs associated with confirming an individuals decision.
End of life impact us all and we have a moral obligation to our family and society to consider our views on end of life and make our choices known. Families that plan cope better with crisis.
Medicare Choices Empowerment and Protection ACT is a Current Bill in Senate S.2240 was entered in April 2014. Under the Bill Certification Programs would encourage Beneficiaries to adopt and maintain advance directives, help to establish best practice for storage of Advance Directives and provide Beneficiaries with a $75 incentive for completing an Advance Directive.
We also should think about the fact that advances in healthcare, technology and therapeutics have been a double edged sword and the law of unintended consequences. So we must consider these two questions; Just because a life can be saved should it? Does quality of life matter?