[Congressional Record Volume 155, Number 53 (Monday, March 30, 2009)]
[House]
[Pages H4065-H4066]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               LIFE SUSTAINING TREATMENT PREFERENCES ACT

  The SPEAKER pro tempore. The Chair recognizes the gentleman from 
Oregon (Mr. Blumenauer) for 5 minutes.
  Mr. BLUMENAUER. Madam Speaker, as we approach health care reform, 
there is no area that is more vital for honest discussion and careful 
analysis than what happens at end of a patient's life. For most of us, 
we will get the majority of our lifetime health care in that last year. 
Indeed, for many it is just the last few months of life, we use the 
most doctor care, the most intervention in terms of medical procedures, 
the most days in a hospital. This is clearly the time of greatest 
stress both for the patient and the family as they watch their loved 
one enter what is often a struggle in these last few months.
  The evidence is that this is the hardest period to be able to make 
those critical decisions. We don't want to force spur-of-the-moment 
action for families when they are talking about things that have great 
consequence for the quality of life for not just a ``patient'' but a 
family member, the ability to extend the quality of life, and perhaps 
deal with recovery. This is also the worst time for people to go on 
autopilot check out, to have a default option where they just turn 
decisions over to whatever the local medical activity may be on that 
site without a thought and consequence to what the individual wishes of 
the patient and their family may be.
  There is strong evidence that in many cases the very intensive 
activities--the tubes, the procedures, the operations, the 
ventilators--actually don't prolong life, and they certainly impact in 
a negative sense the quality of life, the way that the patient may be 
able to interact with their family and friends in those last few days 
and their mind-set and their pain level.
  This research has sparked action from coast to coast. Many States 
have developed a new end-of-life care directive called Orders For Life 
Sustaining Treatment. They are being developed in over 30 States. They 
help the seriously ill patient identify their treatment preferences 
using clear, standardized language. It is written as actionable medical 
orders signed by a physician, and they help communicate patient 
preferences regarding the intensity of medical intervention, transfers 
to hospitals, use of antibiotics, artificially administered nutrition 
and resuscitation.
  Members of my family and I have concluded that we don't want those 
extraordinary measures as our default, and have signed instructions 
accordingly.
  What we find, however, is that too many people don't have access to 
the counseling and activities for them to be able to make an informed 
decision. The irony is that the Medicare system will spend thousands 
and thousands of dollars on intense medical intervention, intense 
medical activities, but they won't spend a few dollars to pay a doctor 
to have a conversation with a patient and the family about what they 
can expect, what their choices are, and to be able to engage with the 
patient and the family to decide what they want to have happen.
  I guess that we don't do it to save money; but the evidence suggests 
that when people actually have a choice, they choose things that not 
only improve their quality of life, but actually save money. Why don't 
we give individual patients and their families that choice under 
Medicare?
  That's why I will be introducing the Life Sustaining Treatment 
Preferences Act which will provide coverage under Medicare for 
consultations regarding end-of-life treatment options. It is time for 
Medicare to be able to address the needs that will truly reflect the 
preferences, the wishes, and the quality-of-life choices for Medicare 
patients and their families. It is the humane, compassionate thing to 
do. It will help us allocate our health care resources more 
appropriately to treat what people want, and it will relieve the 
pressure on the health care system so the default isn't always the most 
intensive, expensive interventions that often deteriorate the quality 
of life in those final days.
  I would urge my colleagues to look at this option and join me in 
making sure that we modernize Medicare to meet the needs of patients 
and their families in their final hours.

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