[Congressional Record Volume 150, Number 131 (Tuesday, November 16, 2004)]
[Senate]
[Pages S11381-S11382]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. WYDEN:
  S. 2984. A bill to amend the Public Health Service Act to increase 
the number of permanent faculty in palliative care medicine at 
accredited allopathic and osteopathic medical schools and to promote 
the development of faculty careers as academic palliative specialists 
who emphasize teaching; to the Committee on Health, Education, Labor, 
and Pensions.
  Mr. WYDEN. Mr. President, our health care system is structured to 
cure but often neglects how we die and how to make dying patients and 
their families more comfortable. Today, I am introducing two bills 
which I believe will provide better care options for dying patients in 
our country. The Medicare Hospice Demonstration Act seeks to test ways 
in which to improve the Medicare hospice benefit, and the Palliative 
Care Training Act recognizes that we need a larger cadre of health care 
professionals who know how to help those with terminal illnesses have a 
better quality of life.
  Although this Congress made improvements in the Medicare Hospice 
benefit last year, I believe we need to continue to test new modes of 
providing hospice care so that more seniors are not only aware of the 
benefit, but access it when needed. Medicare introduced the hospice 
program in 1983 as an optional benefit for achieving a ``good death''. 
This benefit is widely recognized as effective in improving quality of 
life for terminally ill patients. Hospice programs provide a range of 
services to control pain and provide comfort care, primarily to 
individuals in their own homes. In the past decade, the number of 
Medicare patients receiving hospice care has more than doubled. Today, 
about 20 percent of patients who die in the United States receive 
hospice care. However, average lengths of stay in hospice have been 
dropping. According to the GAO, twenty-eight percent of Medicare 
patients in the hospice program receive hospice care for one week or 
less. One reason for this shift in hospice use is patient unwillingness 
to forego curative care--or to abandon hope despite a terminal 
diagnosis. The Medicare hospice program pays for medical procedures 
necessary for pain control and other symptom management, but not those 
aimed at curing the patient. As a result, many seriously ill patients 
resist the program because it forces them to make a choice between the 
hope that there might be a cure and the acceptance that one's life is 
coming to an end.
  The Medicare Hospice Demonstration Act would remove this obstacle by 
permitting patients to seek hospice care as they continue curative 
treatment. I believe more people would use the hospice benefit and use 
it in a timely manner so they could get the full benefit of the range 
of services hospice offers if they did not have to give up hope. I also 
believe that this concept along with counseling assistance provided by 
this demonstration project would help the medical community be better 
able to help patients accept hospice care.
  The second bill I am introducing, ``The Palliative Care Training 
Act'', uses the model already in law for other specialities to create a 
Hospice and Palliative Care Academic Career Award. This award would 
foster the creation of faculty at our Nation's medical schools to teach 
palliative

[[Page S11382]]

care, once the specialty is recognized as a board certified specialty.
  For some the term ``palliative care'' may be new. Palliative care 
improves the quality of life of patients and their families facing the 
problem associated with life-threatening illness, through the 
prevention and relief of suffering by means of early identification, 
assessment, and treatment of pain and other problems, physical, 
psychosocial and spiritual. It neither hastens nor postpones death. 
This type of care offers a support system to help patients live as 
actively as possible until death and to help the family cope during 
their loved one's illness and in their own bereavement. In addition, 
palliative care is applicable early in the course of illness, in 
conjunction with other therapies that are intended to prolong life, 
such as chemotherapy or radiation therapy.
  No one likes to think about what it will be like at the end of our 
lives. We rarely have the discussions we need to have with our medical 
providers about how to help us have a ``good'' death. Much of the fault 
lies in the way we have structured our health care system. With all 
that the American health system has to offer, we need to make sure 
resources are put in place to assure patients and their families better 
care in their last days. I believe these two bills provide important 
components to do that.
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