END-OF-LIFE CARE: The Next Big Area For Reform

      Scripps Howard newspapers this week are featuring articles on end-of-life care issues. In one widely reprinted article, reporter Mary Powers looks at the state of end-of-life care in the U.S., reporting: "Despite nearly 30 years of legal, ethical and legislative effort, 'good' deaths remain elusive. Death in American often still means miscommunication, missed opportunities, unwanted or unneeded medical intervention and pain." Dr. Joanne Lynn, director of The Center to Improve the Care of the Dying at George Washington University, said, "I cannot imagine we will continue to do this badly. Gradually, families aren't going to take this." The article notes that as the Baby Boom generation nears retirement, "the quality-of-death issue ... has burgeoning economic implications." Some studies estimate that the government "spends some $100 billion a year for health care of people who die within 12 months, with the bulk of spending concentrated in the last two months." According to the article, advocates for better end-of-life care urge "honest discussions about the medical dilemmas a particular person will likely face." Marliyn Webb, author of The Good Death -- The New American Search to Reshape the End of Life, "envisions a movement in which people reclaim death much as the natural childbirth movement helped women reclaim birth" (Minneapolis Star Tribune, 9/20).

Out Front In Colorado
      The Rocky Mountain News reports that the nonprofit Colorado Collective for Medical Decisions is working to get hospitals and long-term care facilities "to establish policies on the care they offer dying patients." The group has drafted "11 guidelines establishing limits on medical intervention dying patients should receive," which are being tested "with about 6,000 Colorado doctors and nurses." Executive Director Susan Fox Buchanan said, "These are not commandments; they are not rules; they simply start the conversation and give patients and physicians a basis for knowing what is generally accepted in the community" (Griego, 9/21). In a separate article, the Rocky Mountain News looks at the Hemlock Society's "right-to-die crusade," as well as groups opposed to the society, such as the Catholic Church and Not Dead Yet (Griego, 9/21).

Other Scripps-Howard Stories

• Today's Knoxville News-Sentinel features a report on the use of living wills in Tennessee and an article on hospice care.
• The Memphis Commercial Appeal features an article by Scripps-Howard reporter Lee Bowman on taking a "proactive role" in planning end-of-life care. A separate article by reporter Paula Wade explores the long-term care landscape in Tennessee.
• Today's Rocky Mountain News reports on how physicians and other health care professionals are reexamining their approach to end-of-life care.
• Scripps-Howard has set up a special website on end-of-life care -- www.last-rights.com.
• Don't forget National Public Radio's ongoing series on end-of-life issues. Explore the special NPR website on the series -- www.npr.org/programs/death/

Geographic Variations
      The Minneapolis Star Tribune, a McClatchy paper, reports on the geographic variations in the kind of facilities people are likely to spend their final days. Oregonians have a wide variety of options when it comes to end-of-life care, with the state spending "50.4% of its money for long-term medical care to treat patients at home and home-like settings." But in Mississippi, people "are more likely to experience their last days in a hospital or nursing home," since the state "spends only 4.2% of its long-term health care budget to assist patients in a home environment." The 1998 Dartmouth Atlas of Health Care noted that "[s]tates with an oversupply of hospital beds and nursing homes tend to send dying patients to those facilities first and more often." Dr. John Wennberg, one of the Atlas' authors, said, "Where dying patients end up is a factor of physician preferences, availability of hospital beds and intensive care units." He added, "I don't believe Americans would prefer to die in a hospital ICU, but in many cities in the United States, they do" (Koehler, 9/20).

Pocket-Sized DNRO
      In Florida, state Rep. John Rayson (D) "said he may propose a law creating miniature versions of the state's prehospital 'do not resuscitate' order." The Ft. Lauderdale Sun-Sentinel notes that the DNRO "is the only advance medical directive that can keep paramedics from trying to save a life if someone's heart stops or the person ceases breathing." Rayson said, "This could be a portable thing that you could carry around with you. I envision a strictly controlled card that someone would apply for, maybe with their picture on it to help identify them" (Lade, 9/21).

Virginia Protest
      Yesterday's Washington Post reported that "about 400 protesters picketed [Sunday] in front of a Manassas [VA] nursing home against" a woman's plan to remove the feeding tube that has kept her husband "alive since a car crash more than three years ago." The wife, Michele Finn, received permission from a court three weeks ago to remove the tube. The Post reported that Virginia officials may intervene in the matter. Del. Robert Marshall (R), "who helped organize the protest, has been pressing state officials to intervene." He said Sunday, "This is as monstrous as the steps taken in pre-Nazi Germany to get rid of the handicapped and people in mental hospitals" (Sipress, 9/21).