On Friday, a state congresswoman in Illinois introduced a new bill that would require Illinois nursing homes both to have policies about and to inform residents of their rights concerning advance directives. While I agree with the objectives of the bill, it seems that the bill is superfluous. The Patient Self Determination Act, CMS regulations, CMS guidance, and Joint Commission accreditation standards all already require nursing homes to do that.
On the other hand, much health law is redundant and overlapping. It increass the chances that at least one regulator/auditor/plaintiff will incentivize quality care.
Excellent point about the redundancy. What it will really need are funds for people to actually take the time to explore these issues with patients and families since the health care system treats advance care planning as a checkbox inquiry.
ReplyDeleteDo you have them? If not do you want them?
These are usually checked "no" and "no" in most of my observations, even on patients who make it very clear within 5 minutes of talking to them they say, "Oh yeah, I don't ever want to be on machines."
If most patients would want to opt out of aggressive end-of-life treatment, then perhaps we should just switch the presumption. For patients who reach a specificed terminal condition: no CPR, no ventilator unless specifically requested.
ReplyDeleteBasically, palliative care would be an opt-out instead of an opt-in system. This has widely discussed with respect to organ donation.
This is also consontant with the increasingly-popular libertarian paternalism of Sunstein and Thaler.