In the year 2009 the Obama Administration decided to insert a provision for medical funding of end-of-life choices in the U.S healthcare Act. This provision authorized doctors to provide the kind of care patients would like to have once the latter becomes ineffective to make medical decisions. However, stiff opposition from several quarters including bio-ethicists and intellectuals had forced the Administration to withdraw it. Later, the Centers for Medicare and Medicaid Services (CMS) proposed a similar mechanism through regulation but that too met with the same fate. Many had thought that end life planning was a code language for forcing people to die prematurely. Some of them had characterized these provisions as “death panels” and President Obama was accused of “attempting to regulate rather than legislate.”

This amidst various other legislative issues like medical transcription outsourcing has seen a huge uproar across all states. Subsequently, each State formulated its own mechanism to help physicians and other health care providers to deal with the situation. For example, the State ofNew Jersey has passed a legislation called Physician Orders for Life-Sustaining Treatment (POLST) with the objective of honoring patient’s end-of-life treatment preferences. State ofNew York has enacted another legislation called Medical Orders for Life-Sustaining Treatment (MOIST). It documents patient’s treatment preferences concerning the treatments towards prolonging life.  The concept is clear i.e. honor patient preferences which are critical to provide quality end-of-life care and allow patients to decide their own fate in serious medical conditions. However, it caused further debates and protests across the nation.

A Pragmatic Approach

There are patients who may be longing to live for a few more days by taking aggressive treatment and no one is against saving lives. But the contentious issue is the amount of money spent at the fag end of the life of a patient disproportionate to nation’s medical costs. Many experts believe that the cost of end-of-life treatments can be brought down if patients with terminal illness are encouraged to choose an end-of-life plan in consultation with their physicians and families. According to Dr. James A. Tulsky of the Center for Palliative Care atDukeUniversityMedicalCenter, “talking about treatment choices at the end of life does not necessarily rob patients of hope. Redirecting the patient’s goal towards realistic hopes and being present with compassion can serve as a powerful act in helping patients make decisions while maintaining a hopeful outlook.” Like him there are many who think that there should not be any prescription or compulsion on patients into choosing something like living wills and advanced directives which they do not want.

There are studies suggesting that patients who were to live for a very short period lived longer once they chose hospice over aggressive treatment. It is easily said than done as there are humanitarian issues involved. Also it calls for extensive education to the patients and their family members about the limited health benefits that can be derived from choosing an aggressive treatment method. The moot question is; should patients be deprived of making a choice that is right for them as they enter the last stage of life? By all means the most pragmatic approach seems to be allowing them to make that choice.