Last week the Centers for Medicaid and Medicare announced a
proposal that would provide Medicare reimbursement for providers to spend time
with patients discussing advance care planning. Though some have argued that this process will carry an inherent bias
toward non-treatment, the purpose of such conversations is to seek direction
from patients about preferences, values, and expectations should they lose the
ability to express these things for themselves. While many persons who articulate their treatment preferences
indicate the desire to forego aggressive intervention, this is hardly
unanimous. There are plenty of folks who want all possible treatment offered to
sustain life. The point of having discussions with healthcare providers is to
determine what any given individual prefers.
Acute care providers have long been left with challenging
dilemmas when patients are unable to communicate their healthcare goals, and
the default is to treat and often treat aggressively. When a patient arrives to
an acute care setting with documentation of preferences for treatment,
interventions and goals can be set based on the individual’s prior wishes –
whether this is to sustain life using any possible technology, or to allow a
natural, uninterrupted dying process. The default of treating when there is any
doubt will not change, but the opportunities for patients to discuss and
document their own preferences will be enhanced with this legislative support. Providing
muscle in the form of funding for these important conversations will only
encourage more of a good thing.
The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation.
The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.