[Congressional Record (Bound Edition), Volume 155 (2009), Part 15]
[Extensions of Remarks]
[Pages 20075-20076]
[From the U.S. Government Publishing Office, www.gpo.gov]




                        IN SUPPORT OF H.R. 3200

                                 ______
                                 

                          HON. EARL BLUMENAUER

                               of oregon

                    in the house of representatives

                        Wednesday, July 29, 2009

  Mr. BLUMENAUER. Madam Speaker, I submit the following regarding H.R. 
3200:


                               Physicians

       ``As a geriatrician who specializes in care of older 
     adults, the more power and choice we can put in the hands of 
     patients the better! My patients are afraid of being over-
     taken by the health care system. Advance care planning 
     restores the focus to where it belongs--on the patient's 
     goals, the patient's wishes, and putting the patient--not the 
     system--in the drivers seat.''--Diane. E. Meier, MD, Gaisman 
     Professor of Medical Ethics, Director, Center to Advance 
     Palliative Care, Mount Sinai School of Medicine.
       ``Patients and families have suffered too much and for too 
     long and needlessly. Adjusting the system so that providers 
     know what the patient's goals for care are allows us what we 
     all want: the chance for every person to live by our values--
     including when sick. With palliative care we can live life to 
     its fullest till the very last drop--including while curative 
     treatment continues. People make the best decisions when the 
     decisions are their own. When that happens, as individuals 
     and as a nation, we will be paying for what is right, not for 
     what is wrong. This bill gives us the right to do what is 
     right.''--Linda L Emanuel, MD, PhD, Buehler Professor of 
     Medicine, Director, Buehler Center on Aging, Health & Society 
     at Feinberg School of Medicine.
       ``As a physician, I strongly believe in advance planning 
     for life threatening illness and end of life care. Patients 
     deserve the opportunity to have voluntary yet candid 
     conversations with their physicians about who they want 
     involved and how they want their care managed during a 
     serious illness. A provision in H.R. 3200 encourages and 
     supports physicians to open the door for these important 
     discussions as their patients deal with unexpected illness 
     and anticipate natural life cycles. Thoughtful planning can 
     only help bring peace, comfort and healing to patients and 
     their families during a difficult time.''--Glenn Rodriguez, 
     M.D., Chief medical officer, Providence Health & Services--
     Oregon.
       ``Understanding patient preferences for care at the end of 
     life is a key component of patient centered care. Substantial 
     literature indicates that discussing care preferences 
     improves quality of life for patients and reduces caregiver 
     grief. These conversations require skill and time. The 
     Advanced Planning provisions in H.R. 3200 provide training 
     and reimbursement to deliver these essential care 
     components.''--Robert A. Gluckman, MD, FACP.
       ``As a palliative medicine physician and geriatrician who 
     cares for healthy older adults and those living with serious 
     illness and their families, I wanted to express my 
     unqualified support for efforts to promote advance care 
     planning and palliative care in the House health reform bill 
     [H.R. 3200]. These provisions will help ensure that older 
     adults get the care that they want and need by supporting 
     physicians' efforts to identify their patients' goals for 
     medical care and by allowing them to help their patients to 
     select treatments that meet those goals. Too often, my 
     patients are not aware of their options, receive treatments 
     that will not meet their goals, or do not receive treatments 
     that they want and need. The result is unnecessary patient 
     and family suffering. These provisions will make a real 
     difference in addressing this problem.''--R. Sean Morrison, 
     MD, Mount Sinai--School of Medicine.
       ``. . . Conversations with patients and their loved ones 
     that clarify goals of care, surrogate medical decision 
     makers, and resuscitation preferences help physicians develop 
     plans of care that offer only therapies that will be 
     beneficial and consistent with a patient's wishes. These help 
     tremendously in ``focusing'' therapies on what the patient 
     would want, reassuring loved ones that care is consistent 
     with that desired, and limiting inadvertent application of 
     unwanted precious medical resources. They are win-win 
     experiences for patients, providers, and payers.''--Jeanne 
     Lewandowski, MD, Director of Palliative Medicine, St. John 
     Hospital and Medical Center.
       ``We cannot change that people for whom we care will die, 
     but we can give them the choice of how they wish to live at 
     the end of their life. Some prefer the support of a hospital, 
     some prefer the comfort of the familiar in their home. Some 
     tolerate extreme discomfort in order to be alert while others 
     will compromise their alertness for relief of pain. We cannot 
     know what people will choose without having the discussion 
     about their choices. Further support for these discussions 
     only improves the care we can tailor

[[Page 20076]]

     for each individual. Thoughtful consideration of these issues 
     takes time. Patients deserve our full attention when we 
     address these issues.''--Elizabeth Weiss, MD, Bangor, Maine.
       ``Most Americans will live for some years with a serious 
     chronic condition such as heart failure or dementia before 
     dying, and most of that time will be covered by Medicare. The 
     responsibility falls to Medicare to ensure that this phase of 
     life is rewarding, comfortable, and meaningful by making sure 
     that citizens get the information to make choices that serve 
     us well--and making sure that the services we need then are 
     reliable and efficient. For far too long, Medicare has paid 
     attention mainly to the issues and treatments that matter 
     most earlier in life--Medicare has to take the lead in good 
     care for the last years of life. Only one American in five 
     dies before becoming eligible for Medicare. We have the 
     opportunity to build the care system we can trust to serve us 
     well in the last years of life, and we should seize it.''--
     Joanne Lynn, MD, Author of The Handbook for Mortals.
       The focus of health care should be what is the best care 
     for patients as related to their life values and personal 
     goals. As a physician, I often find that evidenced-based 
     clinical care falls short of the dignity and comfort when the 
     disease is non-curable and in time, result in death. 
     Empowering people to make the best decisions related to their 
     health care requires much discussion about their diseases. It 
     is, in fact, allowing people to make their own decisions, to 
     be heard, to be respected, and to be cared for to the best of 
     our abilities regardless of disease treatment and or symptom 
     management. I support the advance care planning provisions in 
     H.R. 3200 because health care decision-making is American. It 
     is the patient's right to make an informed decision and not 
     for the government to decide what choices to make.--Mark A. 
     Fox, MD, Florence, South Carolina.
       It takes a great deal time to discuss advanced directives 
     with patients. This time spent should be compensated through 
     the Medicare program. Euthanasia is never part of the 
     discussion. Most physicians are ethically opposed to 
     euthanasia, either active or passive. It is also illegal in 
     98% of the states.--Martin A. Grossman, MD, New York.


                                 Nurses

       ``As trusted patient advocates, the nursing members of the 
     Hospice and Palliative Nursing Association witness the 
     suffering experienced by patients and family members during 
     difficult times when advance care planning does not occur. We 
     are, therefore, very pleased to see the specific language of 
     this bill [H.R. 3200] assuring the patient's right to express 
     their wishes through open discussions and know this change 
     will indeed allow for improvement in patient care.''--Judy 
     Lentz, RN, MSN, NHA, CEO, Hospice and Palliative Nurses 
     Association.
       ``As an advanced practice nurse working in palliative care 
     I know we improve lives of patient and families daily. I can 
     not emphasized how critical advance care planning and 
     palliative care is to the American health care system and 
     fully support the provisions of H.R. 3200 that provide for 
     Medicare coverage of these important conversations between 
     patients and their health care providers.''--Patrick J. 
     Coyne, MSN, APRN Richmond, Virginia.
       ``What is important for health care reform and for the 
     ninety million Americans living with serious illness is that 
     care is focused on quality of life, management of the 
     symptoms that accompany chronic disease, and facilitation of 
     care that reflects patient goals and values. As a geriatric 
     nurse practitioner and palliative care program director, I 
     strongly support inclusion of advance care planning and 
     palliative care--the medical specialty that focuses on 
     preventing and treating the debilitating effects of serious 
     and chronic illness--as a solution to achieving quality 
     health care.''--Lyn Ceronsky, APRN, MS, Director, Palliative 
     Care Program at the Fairview Palliative Care Leadership 
     Center


                           patient advocates

       ``This measure would not only help people make the best 
     decisions for themselves, but also better ensure that their 
     wishes are followed. To suggest otherwise is a gross, and 
     even cruel, distortion--especially for any family that has 
     been forced to make the difficult decisions on care for loved 
     ones approaching the end of their lives. AARP is committed to 
     improving the quality, effectiveness, and affordability of 
     health care for our 40 million members and their families. We 
     will fight any measure that would prevent individuals and 
     their doctors from making their own health care decisions. We 
     will also fight the campaign of misinformation that vested 
     interests are using to try to scare older Americans in order 
     to protect the status quo.''--John Rother, Executive Vice 
     President, AARP.
       ``The goal of this measure is to honor an individual's 
     choice to have or to limit life-sustaining treatments. By 
     developing tools to help people with Medicare and their 
     families make educated decisions about treatments, we can 
     assure that an individual's preferences for care are 
     respected.''--Paul Precht, Director of Policy and 
     Communications, Medicare Rights Center.
       ``In La Crosse, health professionals taking time to fully 
     inform their patients and their patient's family about future 
     choices better assures that the patient receives the best 
     care possible in light of that patient's health condition, 
     religious and cultural values and that these decisions are 
     really known by the family. Such a process benefits everyone 
     involved and better assures that our utilization of health 
     resources are actually matched with patient goals. This is a 
     far better method of distribution of resources than the 
     society deciding what is best for the patient.''--Bud Hammes, 
     Ph.D., Director of Medical Humanities, Gundersen Lutheran 
     Medical Foundation.
       ``The National Coalition for Cancer Survivorship supports 
     the advance care planning provisions of H.R. 3200, which will 
     help patients make well-informed decisions about the care 
     they want and need at the end of life. A first step toward 
     patient-centered care is productive dialogue between patients 
     and their caregivers, communication that is not adequately 
     valued in the current health care system. The practice of 
     advance care planning gives patients more control over their 
     health care than currently exists.''--Ellen L. Stovall, 37-
     Year Cancer Survivor and Acting President & CEO, National 
     Coalition for Cancer Survivorship.
       ``Make no mistake. Living wills and proxies (advance 
     directives) ensure that we--as opposed to just the doctors--
     have a clear voice and a choice in our care should we reach 
     that most vulnerable stage where we can't advocate for 
     ourselves. This is why I've chosen to have a health care 
     proxy, and I applaud [Representatives] Levin and Blumenauer's 
     efforts on this matter.''--Joseph Rickards, Patient Advocate, 
     New York City.


                            faith community

       ``The Supportive Care Coalition is a nationwide 
     collaborative of 20 Catholic health care organizations that 
     assists Catholic health ministries in addressing the 
     physical, emotional, psychosocial and spiritual needs of 
     those suffering from life-threatening and chronic illness, as 
     well as those approaching the end of life. We have long 
     supported measures that improve palliative care and end-of-
     life services, eliminate barriers and build a more connected 
     health care experience across the continuum of care. Central 
     to achieving patient-centered, quality care is strong 
     communication between patients and their health care 
     providers and for these reasons, we strongly support the 
     advance care planning provisions in H.R. 3200.''--Sister 
     Karin Dufault, SP, PhD, RN, Executive Director, Supportive 
     Care Coalition: Pursuing Excellence in Palliative Care.
       ``Reflection about the end of life, including elements in 
     medical care, is important for all of us. Such discernment 
     and discussion with loved ones can be enhanced by 
     conversations with thoughtful and caring physicians. Actual 
     decisions are always our own informed by our values and moral 
     perspectives.''--Msgr. Charles J. Fahey.

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