Ushered in by Senators Collins (R-ME) and Rockefeller (D-WV), the 1997 bill reinforces the original law by requiring that advance directives be placed prominently in a patient's chart. Further, the bill emphasizes the importance of portability of advance directives across state lines. These sections are included in an attempt to increase the usefulness of written documentation of patient preferences for end-of-life care.
However, the portability section may induce an immediate, knee-jerk response in legislators concerned about any imposition on states' rights-the language of the bill calls for the preemption of "any State law to the extent such law is inconsistent with such provisions." Some legislators may not look past the letter of the bill's language, to see the necessity of its purpose. Enforcing out-of-state forms, in an attempt to give validity to a now-incompetent person's wishes, is an important goal, one which the bill's sponsors hope other officials recognize.
Yet, the legislation does more than emphasize the significance of advance directives and push for adaptation of additional safeguards. It also encourages Medicare beneficiaries to discuss end-of-life issues with a trained professional, expands Medicare's drug benefit to include non-intravenous medications for relief of chronic pain for patients with a life-threatening disease, and calls for the establishment of a 24-hour hotline, providing information on end-of-life care.
"Patients and their families should be able to trust that the care they receive at the end of their lives is not only of high quality, but also that it respects their desires for peace, autonomy, and dignity," noted Senator Collins. "This legislation will give us some of the tools we need to improve care of the dying in this country."
"So much attention has been focused on physician-assisted suicide that this has taken attention away from efforts to provide good, compassionate care at the end of life," commented Senator Rockefeller. "We still have a lot to learn in this area, and our bill will provide more information about how to provide all Americans with high quality end-of-life care."
The bill's timing is good: much of the nation recognizes the need for more attention to issues surrounding death in America. Americans for Better Care of the Dying congratulates Senators Collins and Rockefeller for placing such an important topic on the Senate floor and for recognizing the need for real change in our health care systems.
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