Wednesday, June 17, 2009
Editorial: Comfort the dying
Sen. Mark Warner's bill to expand end-of-life care should become part of health care reform.
From the RoundTable blog
Read the latest entries
Improving end-of-life care is not about ending life early by means of physician-assisted suicide. It is not about hurrying a natural death at all.
It is about allowing people to die well when they are in the last stages of life, something many physicians and hospitals -- focused on extending life -- do not do well.
Virginia Sen. Mark Warner seeks to change that dynamic by means of the Senior Navigation and Planning Act of 2009, legislation he introduced last week that he hopes will become part of this year's long-overdue attempt to reform the health care system.
It needs to be part of the debate.
Warner's bill seeks to make sure people understand their option to choose palliative care over aggressive medical intervention and treatment when chronic illness reaches the terminal stage.
Palliative care can be the more humane course, as well as being less expensive than critical care. In introducing his bill in the Senate last week, Warner cited research that found 27 percent of Medicare costs are incurred in people's last year of life.
"Specifically," he said, "studies demonstrate that if an additional 2 percent of hospitalized Medicare beneficiaries received palliative care, direct cost savings to the Medicare program would be $1.57 billion."
Such savings would be an important part of a more rational, effective health care system that leaves no one out. Cost-effectiveness should never come at the expense of ethical treatment of any segment of the population, however, including the aged. Warner's bill protects against that outcome.
Patients still would be able to choose aggressive treatment or palliative care. The bill would provide better access to the latter by offering Medicare's hospice benefit to people diagnosed with a life expectancy of 18 months or less, rather than the current six-month maximum.
Also, according to details on Warner's Web site, Medicare would no longer require patients to give up curative treatments to get hospice care.
New requirements would fall on physicians and hospitals to educate patients with certain terminal diagnoses about the likely effect of treatment on how long they could expect to live and what options would be available to them.
One option that is not available in most states is physician-assisted suicide. That, too, ought to become part of the health care discussion in the country, but it is a separate debate.
Physician-assisted suicide is not part of the hospice model, which, properly understood, seeks simply to ease people's journey along the inevitable path when death is near.
