[Congressional Record Volume 155, Number 56 (Thursday, April 2, 2009)]
[Extensions of Remarks]
[Page E865]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 INTRODUCTION OF THE LIFE SUSTAINING TREATMENT PREFERENCES ACT OF 2009

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                          HON. EARL BLUMENAUER

                               of oregon

                    in the house of representatives

                        Thursday, April 2, 2009

  Mr. BLUMENAUER. Madam Speaker, today I am proud to introduce the Life 
Sustaining Treatment Preferences Act of 2009. As we approach health 
care reform, there is no other area more vital for honest discussion 
and careful analysis than what happens at a patient's end of life.
  For most of us, the majority of our lifetime health care will be 
administered in that last year of life. Indeed for many, it is just the 
last few months where we will use the most doctor care, the most 
medical procedures, and the most days in a hospital.
  Advances in healthcare have led to an aging population facing 
increasingly complex end of life health care decisions. These strains 
make complicated, critical decision making about medical care 
incredibly difficult. Too often, these decisions are avoided until a 
crisis occurs, resulting in inadequate planning, unknown patient 
preferences, and families left struggling with the burden of 
determining their loved ones' wishes. For both families and patients, 
this is a time of incredible stress, confusion, and pain.
  In response, health organizations in Oregon came together in the 
early 1990s to develop the Physicians Orders for Life Sustaining 
Treatment program to help seriously ill patients identify their 
treatment preferences using a clear, standardized template. Written as 
actionable medical orders and signed by a physician, these forms help 
communicate patient preference to health care personnel regarding 
intensity of medical intervention, transfers to the hospital, use of 
antibiotics, artificially administered nutrition, and resuscitation.
  National interest in Oregon's Physicians Orders for Life Sustaining 
Treatment program has spread and Oregon has become the national 
resource for states and communities interested in developing similar 
programs. Last year, California and New York enacted orders for life 
sustaining treatment programs and over thirty other states are 
developing programs.
  We can and should do more to support these efforts to enhance quality 
patient care at the end of life. The Life Sustaining Treatment 
Preferences Act provides coverage under Medicare for consultations 
regarding orders for life sustaining treatment. These discussions add 
quality and value to patient care, but they often require significant 
time, proper training, and great delicacy, which merit compensation 
through Medicare. Medicare currently pays for acute care services 
provided to beneficiaries, but it does not specifically recognize the 
important benefit of informed discussions between patients and their 
health provider about care preferences for their last months and years 
of life.
  The Life Sustaining Treatment Preferences Act also creates a grant 
program to support the development and expansion of these programs, 
providing necessary resources to states and local communities. These 
programs provide valuable services to patients, their families, and 
health care providers through educational materials; professional 
training on advance care planning; coordinating and collaborating with 
hospitals, skilled nursing facilities, hospice programs, home health 
agencies, and emergency medical services to implement such orders 
across the continuum of care; and monitoring the success of the 
program.
  To be effective, advance care plans must ensure that treatment 
preferences are elicited and presented in a way that is recognized and 
respected by the health care community--orders for life sustaining 
treatment programs do just that. These programs have a track record of 
promoting patient autonomy through documenting and coordinating a 
person's treatment preferences, enhancing the authorized transfer of 
patient records between facilities, clarifying treatment intentions and 
minimizing confusion, reducing repetitive activities in complying with 
the Patient Self Determination Act, and facilitating appropriate 
treatment by emergency personnel. Oregon is nationally recognized for 
our exemplary end of life care and orders for life sustaining treatment 
have played a critical role providing quality, patient-centered care 
for those in their final chapter of life.
  I am proud to introduce the Life Sustaining Treatment Preferences Act 
of 2009, which will lay the groundwork so all seriously ill Americans 
have the tools to make informed medical care decisions, convey their 
care plans as clearly as possible, and feel confident their wishes will 
be known and respected by health care personnel.

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