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Special Senate Committee Talks Advance Care Planning

Jennie Chin Hansen, C.E.O. of the American Geriatrics Society
Jennie Chin Hansen, C.E.O. of the American Geriatrics Society, moderated the roundtable meeting

During a roundtable meeting hosted by the U.S. Senate Special Committee on Aging, industry leaders called for an increased role among care providers to help more Americans complete their advance health care directives.

An advance directive may take many forms, such as a living will or power of attorney for health care. They help ensure one’s end of life wishes are carried out in the event a patient is unable to communicate. However, the vast majority of Americans have not planned for the end of life, according to recent findings published in The American Journal of Preventative Medicine.

“For frail elders, advance care planning for care preferences is particularly important and ensures that families, the physician, and other health care team members understand and act in accordance with a person’s wishes when it comes to the type of care that he or she would like to receive,” offered moderator Jennie Chin Hansen, C.E.O. of the American Geriatrics Society. “National and state policies should encourage patients and those who care for them to engage in advance care planning discussions.”

Paul D. Malley, president of advocacy group Aging with Dignity, said he urges both haste and caution as more providers help their patients plan in light of the Affordable Care Act.

“We must act with haste, because American families can’t wait. They need help navigating the system and navigating the expression of their wishes,” he said. “Caution, because I think as the best health care systems are working to improve care at end of life, there may be a focus on systems and processes that don’t make room for the individual preferences.”

Although the shift towards electronic medical records may help some physicians and care providers better learn their patients’ wishes, Malley said he believes there is still no replacement for the role of loved ones in end of life decision-making. “It is important to understand our roles, and our respective biases,” he said. Aging with Dignity distributes the popular Five Wishes collection.

Daniel OBrien, senior vice president of Ethics, Discernment and Church Relations with Ascension Health, offered a Roman Catholic perspective.

O’Brien said he believes comfort and care for the dying should be a primary goal of health care. “Palliative care, in particular, is one specific approach to care for patients with serious illness that we must support and grow, because it focuses on caring for the patient as person, regardless of diagnosis,” he said. “It focuses on identifying and addressing the goals of care that are meaningful to them.”

Ascension, the nation’s largest Catholic health system, has been working with the Florida Conference of Bishops’ Committee for End of Life Care on a POLST (Physicians Orders for Life Sustaining Treatment) form modified to address concerns under Church teachings.

“Bishops in some states have opposed POLST legislation outright, mostly due to specific problematic features of the POLST paradigms in those states,” O’Brien said. “After making recommendations to add a few additional protections to the form, the majority of the committee recommended to the Bishops’ Conference that we allow piloting of our edited POLST in our Catholic hospitals.”

POLST forms are medical orders, and are more detailed than conventional living wills or advance directives. They allow patients to indicate preferences regarding resuscitation, intubation, intravenous antibiotics and feeding tubes. The forms are intended for patients in their last year of life, and they can follow patients across care settings. More than a dozen states have officially endorsed versions of the POLST form.

The Senate Special Committee on Aging was first established in 1961 as a temporary committee, but was granted permanent status in 1977. Although the committee has no legislative authority, it studies issues and investigates reports of health fraud and abuse. Sen. Susan Collins, D-Maine, is a ranking member.