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• W577158069 abstract "End-of-life planning promotes patient autonomy by allowing individual patients to inform and direct care givers and healthcare proxies on their desired level of end-of-life care, where the patient prefers to pass away (whether at home or in a hospital setting), and the methods and levels of pain management that the patient deems desirable. Given that, it is counter-intuitive that a significant majority of American's fail to execute, or fail to properly execute, advance directives. The author’s efforts focus on what can be done to improve, generally, end-of-life care. To that end, the authors conclude that improvements in end-of-life care must be achieved at three levels: the individual level, the healthcare provider level, and at the government level. On the individual level, patients must assume greater accountability for their own end-of-life care. That entails making one's wishes for end-of-life care known to family members and healthcare providers. On the healthcare provider level, improved patient communication and improved delivery of palliative-oriented care are first order initiatives. Finally, the government can play a significant role in improving end-of-life care by collecting better healthcare utilization and cost data on end-of-life experiences, expanding benefits for palliative care services, and promoting the use of advance directives through legislative efforts that include patient education measures. Florida Public Health Review, 2010; 7, 50-63. Background Perhaps at no point in this country’s recent history has a debate fueled emotions within the halls of Congress, and within the citizenry, more than healthcare reform. Much of the debate during the 2009 healthcare reform effort, arguably President Barack Obama's biggest domestic policy initiative during his first year in office, has been rife with hyperbole; politicians have charged that reform of the American healthcare system will result in the creation of “death panels” that will “pull the plug on grandma” or otherwise coerce people to “die quickly” (Palin, 2009; Grayson. 2009). Consequently, end-oflife considerations, mired with the complexities of patient autonomy, costs, and ethics, have been highly visible in the current healthcare reform debate. As a result of advancements in medicine and medical technology, individuals in the United States are living longer lives. Although these advances continue to increase life expectancy, attention to the quality of life and to the inevitable experience of dying, has not kept pace (Grady, 1999). With increasing life expectancies come increasing healthcare costs. To that end, there are three central concerns regarding end-of-life healthcare policy reform. Those are: (1) the use of advance directives and other measures that serve to increase patient autonomy; (2) the benefits of hospice care to improve the quality of care received at end-of life and avoid unnecessary costs associated with futile medical treatments at end-of-life; and, (3) the use of pain management at end-of-life and the delicate balance between patient autonomy and ethical medical treatment that must be achieved in connection therewith (Werth & Blevens, 2002). At the outset, it is important to establish the parameters of what constitutes end-of-life. For purposes hereof, the National Institutes of Health definition is adopted. The term end-of-life can take on various meanings, and none are definitive. According to The National Institutes of Health, there are two constituent parts to end-of-life. The first is the presence of one or more chronic diseases, symptoms, or functional impairments that may persist or fluctuate. The second is the presence of symptoms or impairments resulting from an underlying, irreversible disease, requiring formal (paid, professional) or informal (unpaid, unskilled) care, and can lead to death (Heitkemper, Bruner, et al., 2004). End-of-life can also be defined by advanced age. However, with advanced age there are generally indicia of “debility, dementia, and protracted chronic and terminal illnesses” (Hardwig, 2009). Individuals at end-of-life may face legal incapacity and rendering them incapable of expressing their wishes, with regard to end-of-life healthcare. This very point was evidenced in the Terri Schiavo case. Recall that Ms. Schiavo was in a persistent vegetative state and a fierce legal battle ensued between her parents and husband regarding who had the right, if anyone, to order her life support withdrawn. That legal battle played out in the" @default.
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• W577158069 date "2010-01-01" @default.
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• W577158069 title "Health care reform's proposed end-of-life provisions." @default.
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