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.