As described in a NY Times article Tuesday, Governor Paterson of New York last week signed into law a bill requiring physicians treating patients with terminal illnesses to offer to share information with them or their representatives about end-of-life care options, including palliative and hospice care and other options for life-sustaining treatment. You may remember that something similar was included in drafts of national health reform bills until the provision (to reimburse doctors for taking the time to have these discussions with patients) was described as creating “death panels” and legislators then retreated from any support for it in fear of the response. The New York law requires doctors to provide the information only if the patients want to know the options. As is described later in the article, it is one thing to require doctors to have these conversations and another to train them so they feel prepared to have the conversations. More training needs to be done in nursing and medical schools in how to have these discussion with patients families.
In Massachusetts, the Expert Panel on End of Life Care presented its draft recommendations to the Quality and Cost Council last spring (see the presentation (ppt)). We are awaiting the final report and then next steps on implementation of the recommendations. One project that is already under way in MA is the MOLST demonstration project. A MOLST (Medical Orders for Life-Sustaining Treatment) form is completed by a patient or health care agent and a health care provider and it describes the treatments a patient wants or does not want at the end of life. The demonstration project, mandated by the MA legislature, is currently taking place in the Worcester area. Lessons learned from the project will be applied toward expanding the MOLST program statewide.
-Deborah W. Wachenheim