By Martha Bebinger, Kaiser Health News
It's been almost three years since Sarah Palin claimed that end-of-life care options could turn into death panels.
But last week, with no discussion, legislators avoided a minefield that exploded repeatedly during the national health care debate. With a quick call of the ayes and nays, the Massachusetts Senate approved Amendment no. 121, “Palliative Care Awareness." It requires that physicians and nurses in Massachusetts must talk to terminally ill patients about their end of life options, their risks and benefits and how best to manage their symptoms and pain.
In 2006, Massachusetts passed statewide health insurance reform which requires nearly every resident to carry health insurance. It's considered a model to the feds' Affordable Care Act.
Since then, Massachusetts has been implementing its plan. Counseling advocates say they won’t let Palin’s interpretation of end-of-life care derail their mission.
“The national controversy about death panels — what AARP called lies about death panels — is completely misguided,” said Dr. Lachlan Forrow, who directs ethics and palliative care programs at Beth Israel Deaconess Medical Center. “In Massachusetts we can unite and show how to do it right.”
Forrow chaired an expert panel on end-of-life care that wrapped up last year. The Senate amendment is a first step toward filling the panel’s recommendations. Forrow says there’s widespread agreement in Massachusetts that to make sure patients get the care they want they must be informed about their options.
To prolong life “as long it might work in the ICU might be a choice,” says Forrow. Other patients might say “I want to be at home with my family, as comfortable as possible. People need the full range of choices. That needs to be documented if they (the patients) have preferences, and it has to be respected absolutely all the time.”
The next step, Forrow says, must be to train hospital and home care staff about how to follow a patient’s wishes.
Senate Republican leaders confirm that they have no objections to this amendment and it's also supported by one of the state’s leading right-to-life groups, the Massachusetts Family Institute.
New York requires hospitals and physicians to offer information and counseling about palliative care to terminally ill patients. The National Hospice and Palliative Care Organization says several bills that would establish end-of-life counseling funded by Medicare or Social Security are pending on Capitol Hill but that state action is very unusual.
Such broad support for end-of-life discussions with doctors begs the question: Why is reception for this issue so different in the Bay State?
“People in Massachusetts are smarter than everywhere else,” said Sen. Richard Moore, laughing. Moore sponsored the end-of-life counseling amendment. “No, seriously, we approached this in the right way, bringing in people who had experience with it.”
The point, Moore said, was “not to demonize anybody in the process, and I think that’s a big part of it.”
Moore stresses that the state would not require that patients make end-of-life plans or even have the conversation if they don’t want to.
This issue is only in the Senate health care costs bill right now. House leaders declined to say if they would support such an amendment when the House takes up its version of the health care cost legislation.