Report Offers New Recommendations For End-Of-Life Care

By Sarah Birnbaum

Dr. Joel Policzer checks on Walter Norton in the hospice wing of a Fla. hospital in Oct. 2009. Most of Policzer's patients have made no end-of-life decisions. Some officials in Massachusetts want to encourage a more deliberate decision progress. (AP)

BOSTON — Massachusetts doctors and policy-makers are calling for new guidelines on end-of-life care.

A report released Monday by a panel convened by Massachusetts health officials says that all too often, doctors don’t discuss end of life care with their patients.  And as a result, patients are likely to receive costly and unwanted hospitalization and medical interventions.

The report makes a number of recommendations. It says doctors should be required to talk with terminally-ill patients about their wishes for their end of life care, and that doctors should be required to inform their patients about all their medical options – including palliative and hospice are. Health insurers, it recommends, need to compensate doctors for these conversations.  

Dr. Lachlan Forrow is the director of  palliative care at Harvard’s Beth Israel Deaconess Medical Center and the chairman of the
end of life panel. He says the panel was guided by three principles.

"Individuals should always be informed of the full range of the ways they should be cared for. Any preferences they have should be documented and always available when medical decisions are being made. And those preferences should always be respected," Forrow said.

But some patient advocates worry that patients might be pressured into accepting palliative or hospice care over more expensive, life-sustaining treatments. And others say that while its fine to have conversations about end of life preferences, many patients don’t have the resources to get the kind of care they want.

The panel’s recommendations are non-binding, and the report provided no analysis of costs or benefits to making easier for terminally-ill patients to choose home care or even to die at home.  

The report comes as Vermont lawmakers consider a bill, supported by that state's governor, that would allow some terminally ill pateints the option of a lethal perscription, obtained by their physician.  

Your comments: Have you supported a loved one through end-of-life care? Did you feel informed about your options? What can health professionals do to communicate better?

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