Americans deserve to have end-of-life discussions with their doctors

Let's take a rational — rather than uninformed — look at the end-of-life planning provision in the U.S. House's health-care reform bill that has caused such an uproar during public forums and discussions. Let's make this clear — end-of-life planning is not euthanasia or assisted suicide. It's a way for people facing serious illness and approaching the end of their lives to discuss their needs and wants with their physicians.

We thank our elected officials for understanding the end-of-life needs of their constituents enough to include this important and necessary component in this version of the reform bill. Uninformed individuals have described this as a mandatory exercise that would dictate health-care choices for older Americans. This is inaccurate and has resulted in confusion surrounding the value of end-of-life planning.

The proposed provision would allow coverage for an "Advance Care Planning Consultation." This provision is intended to offer Medicare beneficiaries an opportunity to engage in an informed and focused conversation with their health-care practitioner about "advance care," or the care they want at the end of their lives.

This would be voluntary and would be reimbursable under Medicare once every five years, or whenever a patient undergoes a qualifying event such as a life-threatening, chronic disease or terminal diagnosis, admission to a nursing home or hospice program.

Topics that are covered during the consultation include:

• An explanation by a physician, nurse practitioner or physician assistant of advance-care planning, including key questions and considerations, important steps and suggested people to talk to;

• An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses;

• An explanation by the practitioner of the role and responsibilities of a health-care proxy;

• The provision, by the practitioner, of a list of national and state resources to assist consumers and their families with advance-care planning;

• An explanation of the end-of-life care, services and supports available, including palliative care and hospice, which means comfort care for the patient and family at the end of the patient's life.

These discussions already go on every day in physician offices, nursing homes and hospice settings. The proposed provision would simply allow specific payment for it. Regardless of whether this part of the legislation is ultimately approved, these conversations will not stop caring physicians from discussing these matters with their patients facing serious illness. This is simply part of being a good doctor.

Planning for this stage in life — like planning for any other life-cycle event — is extremely important. When serious illness strikes, someone other than the patient — usually the family — may be asked to make major health-care decisions. Research shows that loved ones might not know what kind of care the patient wants, which causes significant distress.

We see this all too often when caring for our patients. Creating a formal way for patients to have a voluntary discussion with their physician — and having that visit covered by Medicare — is an important step in improving this planning process.

Patients should have the care they actually want, loved ones should know about these choices, and physicians should be able to learn how their patients wish to live out the remainder of their lives. Such planning can only help bring peace, comfort and healing to patients and their families.

Peg Rutchik, RN, MN, CHPN, left, is executive director of Providence Hospice of Seattle. Dr. Wayne McCormick is medical director of Providence Hospice of Seattle.