WBUR radio and Kaiser Health News report that the Massachusetts Senate has quietly approved a measure requiring doctors and nurses to discuss end of life options with patients who have a terminal illness. The Palliative Care Awareness bill was included as part of a sweeping health reform measure and, remarkably, was not controversial. It was supported by both Republicans and Democrats and by a wide range of advocacy groups, including leading right-to-life organizations.
So far, at least, the fate of the Massachusetts bill is a far cry from what happened when Congress tried to include similar end-of-life discussions in the 2010 Affordable Care Act. There, a measure to pay doctors for having these conversations with all their Medicare patients was killed after Sarah Palin and other GOP critics blasted the law as a back-door way to create “death panels.” Later, the Obama Administration started but abandoned an effort to take a similar step administratively.
Few states have moved to require end of life discussions, although New York has a similar counseling law. However, many states have adopted MOLST (medical orders for life sustaining treatment) or POLST (physician orders for life sustaining treatment) forms that provide a mechanism for patients, their families, and their physicians to write down a patient’s choice of end of life care. In some states, providers such as nursing homes are required to complete such forms for their residents.
While the Massachusetts proposal is a good one, I preferred the 2010 health reform version because it would have encouraged doctors to initiate these important discussions at a patient’s first Medicare check-up. An early conversation, long before a patient has a serious medical crisis, is key first step that helps the patient think about these issues in a non-threatening environment. And while a patient can always amend her wishes as she ages or becomes ill, that initial discussion is an important tool for a doctor to understand her patient’s point of view.
It is not clear if the Massachusetts measure will be included in a House version of the bill, which is expected in about a month. Despite its shortcoming, this is an important initiative and I hope it survives.
This is excellent news Howard. Thank you for your post on this step forward in Massachusett’s regarding end-of-life discussions! My partner Hilary Cooke of SustainableAging(R) will I’m sure be writing to you about the project we have been working on and his proposal which is completely in accord with your perspective. Sincerely, Joanna Rueter