So what is the solution? New legislation is not likely to solve the problems. Legislation has already been passed affirming the government's recognition of the need for proper end-of-life documentation. Solutions to the current deficiencies will be found through better enforcement and execution under the existing legislation. The solutions may be simpler than we think. Here are four key elements:
Fortunately, there are resources and organizations available to help provide some of these components. For example, Caring Connections, a nonprofit program of the National Hospice and Palliative Care Organization, provides educational resources to patients about end-of-life care and helps patients and families better plan for this situation.
But it is not enough to simply print out an advance directive from the Internet and keep it in a file cabinet until needed in the future. What is needed is a system that covers all the gaps that exist today, which have traditionally prevented a patient from documenting and receiving the end-of-life care they would desire. This system must:
These solutions would provide significant benefits to patients, their families, and their healthcare providers. Patients can feel confident that wishes for their own healthcare will be respected when they cannot speak for themselves. Families can feel empowered that proper supporting documentation exists to carry out a patient's healthcare wishes. Caregivers can provide care that is truly aligned with the patient's wishes. Not only can unnecessary healthcare services be avoided, but a patient's choices can be respected and honored.
People 75 years and older are the fastest growing segment of the U.S. population; this group is projected to more than quadruple over the next 50 years. A large percentage of this elderly population has chronic diseases that will necessitate appropriate planning for end-of-life care. This fact, combined with the ongoing growth in more expensive technologies, will continue to fuel the increase in healthcare costs. Medicare reform will need to consider comprehensive advance care planning. The benefits of doing so will be seen not only in judicial use of the healthcare dollar, but most importantly in respecting patients' end-of-life care wishes. What could be more important?