[Congressional Record (Bound Edition), Volume 154 (2008), Part 16]
[Extensions of Remarks]
[Page 22964]
[From the U.S. Government Publishing Office, www.gpo.gov]




 INTRODUCTON OF THE LIFE SUSTAINING TREATMENT PREFERENCES ACT OF 2008, 
WHICH WOULD PROVIDE COVERAGE UNDER MEDICARE FOR CONSULTATIONS REGARDING 
 ORDERS FOR LIFE SUSTAINING TREATMENT AND PROVIDE GRANTS TO DEVELOP OR 
         ENHANCE ORDERS FOR LIFE SUSTAINING TREATMENT PROGRAMS

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                          HON. EARL BLUMENAUER

                               of oregon

                    in the house of representatives

                      Saturday, September 27, 2008

  Mr. BLUMENAUER. Madam Speaker, today I am proud to introduce the Life 
Sustaining Treatment Preferences Act of 2008. Advances in health care 
have led to an aging population facing increasingly complex end-of-life 
health care decisions. 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.
  In response to this, health organizations in Oregon came together in 
the early 1990s to develop what became known as the POLST form, or 
Physicians Orders for Life Sustaining Treatment, 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 
regarding intensity of medical intervention, transfers to the hospital, 
use of antibiotics, artificially administered nutrition, and 
resuscitation.
  National interest in Oregon's POLST program has blossomed and Oregon 
has become the national resource for states and communities interested 
in developing similar programs. Recently California and New York 
enacted orders for life sustaining treatment programs and 23 other 
states have adopted or are developing programs.
  While Medicare currently pays for acute care services provided to 
beneficiaries, it does not 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 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.
  Programs for orders for life-sustaining treatment 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. The Life Sustaining 
Treatment Preferences Act creates a grant program to support the 
development and expansion of these programs, providing necessary 
resources to states and local communities.
  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, which will lay the groundwork so all 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 respected 
by health care personnel.

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