I don't want to wade into the waters of political debate too deeply here, but Medicare already has end-of-life planning. This might be news to some, but end-of-life planning was added to the "Welcome to Medicare" visit - yes, the preventive care service welcoming patients to the Medicare program - this year (we started writing about it last summer).
Here's how the service was defined in the Medicare Improvements for Patients and Providers Act (MIPPA) in 2008: "Verbal or written information regarding -
- (A) an individual's ability to prepare an advance directive in the case that an injury or illness causes the individual to be unable to make health care decisions; and
- (B) whether or not the physician is willing to follow the individual's wishes as expressed in an advance directive."
NOTE: A physician or non-physician practitioner needs the patient's permission to discuss end-of-life issues. The service is not required when the patient does not give consent.
This entry is long, but here's how end-of-life planning is defined in the House-version of the health system reform bill under "Advance Care Planning Consultation" (I can't find anything resembling a "death panel," or a plan to euthanize seniors. If I'm wrong, let me know):
The term 'advance care planning consultation' means a consultation between the individual and a practitioner described in paragraph regarding advance care planning, if, the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:
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An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.
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An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
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An explanation by the practitioner of the role and responsibilities of a health care proxy.
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The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).
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An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.
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... an explanation of orders regarding life sustaining treatment or similar orders, which shall include:
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the reasons why the development of such an order is beneficial to the individual and the individual's family and the reasons why such an order should be updated periodically as the health of the individual change.
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the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and
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the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy)
Also:
"The Secretary shall limit the requirement for explanations under clause to consultations furnished in a State-- in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and that has in effect a program for orders for life sustaining treatment described in clause ... A program for orders for life sustaining treatment for a States described in this clause is a program that-
- ensures such orders are standardized and uniquely identifiable throughout the State;
- distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional's authority under State law) may sign orders for life sustaining treatment;
- provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and
- is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association."