Have We Reached a Tipping Point?

You know there have been a couple of events across our nation lately that make me wonder if we’ve reached a tipping point for real reform of end-of-life care in the United States.  Here’s what I’ve seen.

First, there was a number of states recently who passed assisted dying legislation, including Washington state in 2008, Montana in 2009, Vermont in 2013, and most recently one county in New Mexico in 2014.  Oregon was the first state to pass assistance in dying in 1994.  Then we had the highly publicized case of Brittney Maynard, a 29-year old woman with brain cancer who chose to die by assisted suicide in Oregon in November 2014.

In September 2014, the Institute of Medicine published, Dying in America:  Improving Quality and Honoring Individual Preferences Near the End of Life.  In it they clearly outline that it is time to make changes to how we care for people at the end of life, including earlier palliative care, better care coordination based on person-centered goals, attention to caregivers, and attention to physical, social, emotional, and spiritual needs of persons and their family members in the delivery of care (just to name some of the big recommendations).

Next came Atul Gawande and his book, Being Mortal:  Medicine and What Matters at the End (October 2014) and the Frontline special Being Mortal on PBS (February 10, 2015).  Dr. Gawande is a surgeon who figured out that doctors have very little training and therefore too often few skills in how to have productive end-of-life conversations with their patients.  They basically don’t know how to give news they themselves would not be comfortable receiving.  The book is excellent, however, the Frontline special left some things to be desired — like showcasing at least one end-of-life conversation as the example of how to do it well, when in fact it was a strong example of the opposite — of how NOT to have a clear and productive, while at the same time, compassionate discussion.  Regardless, what Gawande’s book and book tour has done is add another voice to the complaints many of us share around end-of-life care today.

Finally, I recently attended two conferences, the most recent one was the National Action Conference:  Policies and Payment Systems to Improve End-of-Life Care with Senators Susan Collins (R-ME) and Mark Warner (D-VA) held March 20, 2015 in Washington DC.  Atul Gawande was the key note speaker.  What I heard from Senators Collins and Warner is that perhaps the time is ripe now to realign our health care system with the wants and needs of our parents and our friends who are facing their last days.  Senators Warner and Collins agreed that the time of “death panels” and scared silence has passed and now is the time to bring end-of-life care back into the light of healthy, bipartisan debate.

Maybe we’ve reached a tipping point.