Governor Mitch Daniels Advocates New Approach to End-of-Life Care

Indiana Governor Mitch Daniels (Republican) recently made headlines and provoked heated discussion when he discussed the fiscal, medical, and moral need to reevaluate end-of-life care. Daniels supports a stronger emphasis on palliative care for the terminally ill. He is also taking the lead within his party to engender a serious, mature, and balanced conversation on very difficult, painful, and uncomfotable issues relating to death, grief, and medical treatment. Politico reports:

“We all want to live forever, we want everything done for us to live forever,” the Indiana governor told a small group of health reporters. “We cannot afford, no one can, to do absolutely everything that modern technology makes possible to absolutely the very last day of the very last resort." 

“There will be limitations” on medical care, he said. “The question is whether the government will impose them or will people make choices for themselves? There will never be enough money.”

Daniels advocated for a more patient-centered approach, where families tackle the tough decisions of limiting care. “Someone will have to be making the decisions. I prefer it not to be the government,” he said.

“Look at it this way. It’s the most human thing in the world, when a loved one is in a desperately ill state and the question is, we can try this thing that has almost no chance of working, and it’s going to cost an incredible amount? Any person of course says, ‘Try it.’….It’s the hardest of all the questions. I don’t think there’s a more humane way than the re-involvement of patients and loved ones, to a greater extent.”

Regardless of whether or not one agress Daniels' position on end-of-life-care, he deserves recognition and respect for attempting create public space for an often muted, but always important conversation.

New Report Confirms Earlier Suspicions and Findings Regarding For-Profit Hospice

A new study adds to the already convincing evidence that for-profit business motivations and hospice are incompatible. Financial incentives defeat compassionate care under such an arrangement:

CHICAGO (AP) — For-profit hospices may be cherry-picking the least costly, most lucrative patients, potentially putting the nonprofit industry at a financial disadvantage, a study suggests.
The researchers found hospice care provided by for-profit agencies averaged 20 days versus 16 days for nonprofit agencies. Care lasting more than one year was most common among for-profit hospice patients.
Also, compared with nonprofits, for-profits had about twice as many patients with dementia and fewer cancer patients. End-of-life cancer care is typically much more intensive and costly than dementia care.
Patients with more days under hospice care and lower skilled needs may be more profitable under the Medicare reimbursement system for hospices, said lead author Dr. Melissa Wachterman, a palliative care physician at the Harvard-affiliated Beth Israel Deaconess Medical Center in Boston.

Read the rest of the report at Google News.