The Burrill Report


Public outcry over so-called death panels led the Obama Administration to scrap provisions within its landmark healthcare reform legislation passed in 2010 concerning advanced care planning. But a new study finds that contrary to public fears about doctors discussing advance directives with patients—putting on paper instructions for their medical care should they become unable to communicate them—the plans have no impact on survival rates.

A new study of patients at three Colorado hospitals by researchers at the University of Colorado, School of Medicine found that, for patients considered at low or medium risk of death within one year, there was no significant difference in survival between those who had discussed or documented an advance directive and those who had not.

The study, published in the Journal of Hospital Medicine, also found no survival differences for those who had a living will in their medical record and those who did not. The study included 356 patients admitted at three different hospitals who had low or medium risks of dying within one year. Patients were followed from 2003 to 2009.

“The term ‘death panels’ has sparked considerable controversy recently. It has undermined the efforts of clinicians who provide end-of-life care by scaring patients into thinking that their lives may be cut short for their families’ or society’s best interest,” says Stacy Fischer, the lead author on the study. “We hope our study provides data to help inform the national debate about advance directives for key stakeholders; health care providers, policy makers, and patients and families.”

The researchers said it is possible that advance directives, when implemented properly, may dictate withdrawal or withholding of interventions that may extend the quantity of life of unacceptable quality. “A feeding tube delivering artificial nutrition and hydration may grant years to someone in a persistent vegetative state, but those years, without the ability to be aware or interact with surroundings and loved ones, may not be a life worth living for some individuals,” the authors write.

Though the Affordable Care Act did not include provisions for advance directives, payment regulations for the Centers for Medicare and Medicaid Services added a provision allowing compensation to physicians for advance directive discussions as part of the annual Medicare wellness exam.

“Our findings are reassuring. They support health care providers, who can initiate these discussions, and policy makers, who seek to reimburse these time consuming discussions,” says Fischer “Most importantly, our findings are reassuring for patients and families who desire these discussions with their health care providers."


September 30, 2011
http://www.burrillreport.com/article-death_panels_talk_radio_and_unplugging_grandma.html