Oregon Leads the Way on End-of-Life Planning
Kaiser Health News is out with a terrific story today on Oregon’s progress with end-of-life planning for its seniors. The secret to its success has been a simpler-than-expected solution that a number of states have already adopted or are considering, and it’s one of the most encouraging signs of progress in the field since the dark days of “Death Panels” during the 2008 campaign.
Oregon has been in the forefront of trying to make sure a person has as much control over the end of his or her life as possible. The state pioneered a form known as a POLST, for Physician Orders for Life-Sustaining Treatment, that has been adopted by 14 states and is being considered in 20 more. The form offers many more detailed options than a simple “do not resuscitate” directive.
The Oregon legislature set up a database several years ago to deal with the problem of inaccessible POLST forms.Now EMTs and doctors can access the state database to see if someone wants to be resuscitated. That database is beginning to generate some interesting facts about the medical interventions people want as they die, according to Dr. Susan Tolle of the Oregon Center for Ethics in Health Care. “We have really learned that this is not a black and white process,” Tolle says. “Less than 10 percent of people wanted to refuse all treatment. A majority want some things and not other things.” Tolle avoids the topic of whether these detailed end-of-life instructions save money; she is wary of starting another “death panels” debate. But the database has allowed the state to quantify the policy by some measures.
“What we found was that if people marked ‘comfort measures only’ and ‘do not resuscitate’ and did not want to go back to the hospital…there was a 67 percent reduction in life sustaining treatments, primarily hospitalization and emergency room visits,” says Tolle.
As we’ve long said, there can be no hope of long-term Medicare solvency without more rational policy and assistance to seniors as they decide how they want to die — not when Medicare spends 1 in 4 dollars today on care in the last 6 months of life. The POLST solution — a standardized document with physician support and an accessible database — is cheap, effective, and should be encouraged by CMS and the Administration. And it’s heartening that Senator Ron Wyden is from Oregon and deeply enmeshed in these issues — Oregon’s approach should be embodied in his work with Rep. Paul Ryan on Medicare reform next year.