Hospitals Ordered To Follow End-Of-Life Care Wishes

President Obama's memo requiring hospitals that participate in Medicare and Medicaid to allow gay partners to visit patients also included a second, also controversial, provision. It requires the Department of Health and Human Services to ensure that those same hospitals obey all rules regarding patients' desires to be kept alive — or not — using artificial means.

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President Obama, last night, issued a memorandum that seeks to guarantee same-sex partners the right to visit each other in hospitals that participate in the federal Medicare and Medicaid programs. But there's another element to the directive thats gotten less attention.

NPR's Julie Rovner reports on the impact the memo could have on patients' wishes for their end-of-life care.

JULIE ROVNER: This year, marks the 20th anniversary of the year Congress first passed the law requiring that Medicare patients be told of their right to exercise so-called Advanced Directives, those express what kind of care a patient does or does not want in the event they become unable to speak for themselves.

Federal law and the law in all 50 states require such directives to be followed, but that doesnt always happen, says Barbara Coombs Lee.

Ms. BARBARA COOMBS LEE (President, Compassion and Choices): There's not only a continuing problem with providers not honoring Advanced Directives, there is an increasing problem with providers not honoring Advanced Directives.

ROVNER: Lee heads the consumer group Compassion and Choices. She's pleased the administration is taking steps to require hospitals to honor Advanced Directives, thats because many of the people she deals with are suffering from terminal diseases.

Ms. LEE: Their worst nightmare would be to be in a prolonged, unconscious debilitated, vegetative state, like Terri Schiavo. And they want to take steps now to document in writing that they are not to be kept alive artificially.

ROVNER: But she says more and more states are passing laws like the one recently approved by the Idaho legislature. It allows a wide array of health care providers who disagree with a patient's treatment choices, to simply decline to abide by them. And patients have no recourse, she says.

Ms. LEE: That trend is putting the balance of power about health care decision-making exactly where it does not belong, which is with providers and institutions.

ROVNER: Another case involving Advanced Directives thats gotten a lot of attention is a policy change made late last year by the Catholic Church. Made largely in response to the Terri Schiavo case, the policy change makes feeding tubes for many comatose patients much more common, even if that contradicts the patient's own written wishes.

Sister Mary Ann Walsh is a spokeswoman for the U.S. Conference of Catholic Bishops. She says the change doesnt really impact how Catholic health institutions handle patients with advanced medical directives.

Sister MARY ANN WALSH (Spokeswoman, Conference of Catholic Bishops): We've said that the institutions of the Catholic Church cannot honor Advanced Directives, as contrary to Catholic teaching. The care you get in a Catholic hospital has to be in accord with Catholic teaching.

ROVNER: But Sister Carol Keehan, president and CEO of the Catholic Health Association, says it's extremely rare that such situations even arise.

Sister CAROL KEEHAN (President/CEO, Catholic Health Association): I spent 40 years in hospitals and I spent a great deal of that dealing with the most critical cases. I try to remember any time we transferred a patient, because their personal wishes couldnt be accommodated, and I can't remember one.

ROVNER: Rare or not, President Obama is taking steps to ensure that hospitals that participate in Medicare and Medicaid do comply with patients' Advanced Directives. The memo issued last night instructs the Department of Health and Human Services to not only ensure full compliance with existing law, but to issue new guidelines and whatever other steps are required to beef-up enforcement.

Patient advocate Barbara Coombs Lee says it's a good start, but she's hoping for the day when hospitals that provide care in defiance of a patient's stated wishes simply won't get paid.

Ms. LEE: It's not right that those Advanced Directives get ignored. And it adds insult to injury that taxpayers end up paying for this care that would be refused by a competent patient.

ROVNER: That however would take a new act by Congress.

Julie Rovner, NPR News, Washington.

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