Mass. Moves to Require End-of-Life Talks

[Judi Lynn]

Source: Forbes

5/25/2012 @ 2:44PM |20 views
Mass. Moves to Require End-of-Life Talks

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.


Read more: http://www.forbes.com/sites/howardgleckman/2012/05/25/mass-moves-to-require-end-of-life-talks/

[Capt. Obvious]

1. This is going to tear Palin up

states rights v death panels

[secondwind]

14. My mother contracted a lung cancer that was

so unusual, in the sense that she never suffered, never had pain. She was in the hospital for another medical condition, when they discovered this.

We were told she had about six months.... she had been visiting us in Saratoga Springs, NY, and I transferred her to the Jewish Home & Hospital for the Aged, so she could recover from her hip surgery, and be closer to me.

She was dead in 3 days. It was the strangest thing. I spent every day with her, and the 3rd day, decided to take the afternoon off (her lady friends from the senior center were coming to visit her for the afternoon).

Before heading home after a wonder afternoon with an old friend, I decided to pop in and see how she was doing.. it was about 7:30 p.m. I found her in total distress, laying completely flat, (she was not supposed to lie like that because of the fluid in her lungs), and a very slow caretaker was s-l-o-w-l-y bathing her, while my mom was gasping. I was so ANGRY!

In any event, after I left her comfortable, though looking a bit frightened, a nurse whispered to me "come early tomorrow......."

Which I did, I was there a little 9 o'clock. My sister had flown in from LA overnight, so I had waited for her to arrive so we could go together.

We were with her for about an hour, she was fine, sipping some juice, happy to see us both together, when a doctor I had never seen , an Indian fellow, said he neded to speak to us 'in private'.. we were ushered off down the hall to a room, and he closed the door.

We sat waiting for him to say something, and waited . He finally spoke up and told us your mother has lung cancer (we knew that), her time is short (we knew that) ... he dragged a painfully slow conversation out that did not add anything to what we already knew..... next thing we know, a nurse is flying in, and whispered something to him.... he looked at us and said 'it's your mother'.

We flew down the hall, and my sister and I rushed to her side, while they closed the door behind us. Her head was flopped over to one side, tongue sticking out... I looked at her oxygen machine and noticed that it was DOWN to 7 from the 10 that it had been before. We struggled to hold her and talked with her (she could not talk to us) while she quietly passed.

Less than 20 minutes prior, she had been talking, smiling and sipping her juice.

I have always felt that they did something to her.

[wordpix]

18. I have a friend whose father had advanced Alzheimer's, similar story

Father was doing fine at home, with my friend and paid helpers taking shifts around the clock to care for him. At one point, the father had to leave home and go to a facility, I think a nursing home, due to something that came up---he needed some special care. Within a few days, he had died. My friend said his father had been fine the day before he died---he was shocked to go to facility and learn father had died so suddenly.

I have another friend who went to hosp for routine small operation (removal of benign cyst), but it was botched and his intestine was punctured. He then re-entered hosp. for second operation, where the doc almost killed him---he went home and almost died of septic shock. He needed a third operation to fix the second. He survived but will never be the same---the operations left him a shadow of his former self. Yet the hosp. is protecting the doctors who nearly killed him.

[99th_Monkey]

2. Maybe I'm being obtuse here

but I don't get it. Isn't this what Doctors and Nurses DO anyway?
"...discuss end of life options with patients who have a terminal illness."

WTF else would doctors and nurses do under such circumstances?

and why are we making a law to make people do what they already do?

What am I missing?

[kas125]

3. My dad, who is 83, has cancer and congestive heart failure. None of his doctors have ever

talked to him about palliative care, but he plans to ask about it when he goes back on Tuesday. All they talk about is more pills, more chemo, more treatment when there's no cure and all they're doing is prolonging the inevitable while sending him bills that are about three times as much money as he gets from his pension and social security every month. He doesn't want to give every penny he has to doctors and hospitals and he wants to stop treatment. But when he mentions it, his doctors argue and talk him into continuing. If they do it again Tuesday, that will be the third time.

Doctors don't talk to patients about end of life palliative care/hospice until they're very close to death, but they should.

[wordpix]

7. totally agree about the docs; they gave my father operation after operation until

they killed him after 7 wks. in the hospital. It would have been better to let him go home and have hospice care in the first place, and never enter Johns Hopkins.

Unfortunately, the major decisions were in the hands of my stepmother instead of my bros and me. She wanted to keep him alive at all costs, even though these operations were torture to him.

Frankly, I thought Johns Hopkins did a terrible disservice, giving her hope that he could recover. It was clear to me after the first operation he wasn't recovering from that one (and it was clear to me from the beginning he should never have had that first one), and yet the docs presented two more operations as "possible cures." Total BS.

My father was 82 and I am against major operations and chemo for people that age unless they are in excellent health, which my father was not. I am sorry for your situation. If you can get control, take it.

[99th_Monkey]

12. I have a friend

who is very passionate about how freaky-invisibly way more people
are killed by the MEDICAL profession, through neglect, incompetence,
etc. you name it. than are killed by police.

And she feels there should be more public outrage about the relatively
high numbers of "accidental or suicidal" patient deaths are due to medical
malpractice, in comparison to the number of people killed by our "LAW
ENFORCEMENT professionals".

We keep hearing about how innocent citizens, apparently due to the color of
their skin or their "incorrect" political views, or their "appearance", are being
randomly frisked, gagged, jailed, hunted down and murdered in cold blood,
discredited for allegedly engaging in some sexual "no-no", or blackmailed,
or bribed, or otherwise silenced i.e. are being bullied, intimidated, beaten, by
the US/CIA/Pentagon proxies on the ground, coming soon to a community near
you, also supported by all the wrong people for all the wrong reasons.

All that said, you have my prayers and creative vibrational visualization
of a better future for you, your family, and for us all.

[wordpix]

15. This, too, is unfortunately true ---every sick person needs a patient advocate

whether a family member or "other."

I am the advocate for my mother with advanced Alz. and so far I've been able to keep her at home with good helpers. But if I weren't with her every day, how would I know who is "good" and who is not? I have had to fire one person and in other cases, given training even though the helper is "very experienced" with Alz. disease.

If you care about a sick loved one, you must be in the hosp., assisted living facility or home where the person is cared for to know what is going on, or else hire someone such as a case manager or trusted caregiver, who knows what is happening and can assure bad things won't happen.

[99th_Monkey]

24. Please see

http://www.democraticunderground.com/?com=view_post&forum=1014&pid=129503

[99th_Monkey]

22. And every situation is different

for example, in one case it can be a doctor who doesn't want to "worry" or unduly "upset"
a patient, because they know that will only increase likelihood of a heart attack or whatever.

And in another case it can be a doctor who'$ just gaming with a patient'$ life to milk it for all
it'$ worth.

And everything in between.

[Autumn]

9. When my Brother was diagnosed with an aggressive cancer

the Doctor met with all of us and discussed end of life options. That was three years ago. I don't see why a law is needed for that either.

[magical thyme]

11. because your doctor had that discussion does not mean that all do

most do not. And some, as poster below writes, pressure you to get more chemo, more surgery, more radiation, without any regard for quality of life. I've witnessed the pressure and been forced to draw blood against someone's express wishes. It is not right.

If all doctors presented all options and were honest about quality of life issues, there would be a lot more people choosing differently.

Some are so ingrained in euphemisms, like "discomfort" instead of "pain," they start to believe them.

[Autumn]

13. It should be required everywhere .n/t

[99th_Monkey]

23. I admit to being very fortunate

with my doctors. Especially because I live on a very limited
and fixed income as a retiree & considering the context, in the
USA where the only thing "universal" about health care is pain
and needless suffering of patients. Thanks for reminding me to
count my blessings and yes I would totally support requiring this
to ALWAYS happen as needed, as appropriate to the situation.

[magical thyme]

10. no they do not.

and it should be mandatory. All options should be presented, accurately.

If people truly understood what awaited them in our glorious healthcare system they would not be seeking more healthcare, they'd be running for their lives.

[Posteritatis]

21. It's turning a "should" into a "must." (nt)

[rug]

4. This is not just for the old.

My daughter was born with schizencephaly and hydrocephalus. After nine months and seven operations the prognosis was pretty clear. Still, we had to go before the hospital's ethics committee before withholding treatment. It was like going before a grand jury and just as large. Ultimately, they agreed they were only treating sympoms, over and over again.

She was transferred to a palliative care unit of a children's hospital. Now, years later, I remember their care.

http://stmaryskids.org/programs-and-services/our-services/palliative-care/

[Auntie Bush]

5. What an awful experience to have to go through. Bless you. As Joe Biden

would say. I hope by now you can think of her and smile.

[rug]

6. I do, often.

Thanks.

[cbayer]

17. I am so sorry, Rug. That had to have been heartbreaking.

[rug]

20. Thank you.

[wordpix]

8. while discussing, bring up dementia/Alzheimer's

This is an epidemic and it's going to get worse as people live longer. My mom has advanced stage Alz. now at 87 but she can still get around (just barely) with someone holding her arm so she doesn't fall. Her brain is gone---last night I showed her how to break off the stem-tops of peas from my garden, and she tried but could not figure it out.

I had a scare with her the other night and had a dilemma about calling 911. She still had a strong pulse so I opted to make her as comfortable as possible at home, and she fell asleep and was fine in the morning. But if you don't know what your loved one wants ahead of time if he/she has Alzheimer's, when something happens you must make your own decision. I don't like having this responsibility but there's no directive about this.

[cbayer]

16. Good move.

Too often, both medical professionals and families avoid talking about this. While some physicians and other professionals are open to it and good at it, many are not.

[beac]

19. The Virginia State Bar has a free Advance Directive for Health Care form on their website

that you can download, fill out, have witnessed and distribute to your doctors and family: http://www.vsb.org/site/public/healthcare-decisions-day

You can also register your ADforHC online with the state of Virginia: https://www.virginiaregistry.org/



I wouldn't be surprised if other state bars offer a similar form.