New proposed policy encourages the process of advanced-care planning
END-OF-LIFE DECISIONS are complicated and fraught with emotion, but a recent announcement by Medicare will hopefully offer some clarity to those facing such tough decisions. In early July, Medicare announced plans to pay doctors, nurse practitioners, and physician’s assistants for conversations with patients concerning end-of-life care. It’s a new chapter in the conversation about how much “say” a person should have concerning how they die.
While nothing is set in stone yet — the final decision on the policy is slated for November 1 with a January 1, 2016, start date — lines are already being drawn in the sand. Most healthcare providers support the measure. Ronald Schonwetter, MD, the Chief Medical Officer for Chapters Health Systems, parent company of Central Florida’s Good Shepherd Hospice Centers, among many others, maintains that the policy will benefit patients the most. “It will allow patients to consider well in advance important healthcare decisions should they become very ill and not have the ability to participate in decisions at that time.”
Such discussions can be difficult to have once an emergency situation occurs, and relatives can be left trying to make end-of-life choices in their loved one’s place. The new proposal would allow patients to discuss options and make decisions in advance with the help of a physician. End-of-life consultations between doctors and patients can include relatives and caregivers as desired, and no one is limited to a set number of conversations. “The process of advance-care planning is exactly that — a process — and may not be completed in one visit,” Dr. Schonwetter continues, “and it should be revisited periodically over time with the patient and their healthcare provider.”
Discussions can range from emergency measures like resuscitation to long-term care like artificial breathing machines and intravenous nutrition. “Patients should expect to discuss completion of advance directives, such as living wills or healthcare surrogates,” Dr. Schonwetter explains. “A living will is a legally recognized document that describes what types of care a patient may want or not want should they develop a terminal illness. It would allow them to refuse resuscitation efforts should their heart or breathing stop when they have a terminal or end-stage condition.”
Patients could also use the conversation to discuss their wishes with loved ones. “It would allow them to appoint another person to make healthcare decisions for them if and when they became unable to make those decisions on their own. They would then have the opportunity to discuss their wishes regarding their treatment prior to them needing a healthcare surrogate, who could then act on their wishes when they no longer could participate in their decision making,” Dr. Schonwetter adds.
Critics of the proposal believe that patients will be pressured to reject life-saving measures or long-term care in an effort to save money. However, Dr. Schonwetter points out that advance care involves many different facets. “It is very important that they understand that patients can and should continue to receive supportive care and all attempts at maximizing comfort and independence even when facing an end-stage disease, and that completing a living will will not prohibit that ongoing comfort care.”
After all, knowledge is power, and — as Dr. Schonwetter asserts — patients “should know of services such as hospice and palliative care that will honor their preferences and provide care that is consistent with their values.”
article by ERIKA ALDRICH