Mass. Senate Skirts End-Of-Life Counseling Controversy

BOSTON — With no debate, and a quick call of the ayes and nays, the Massachusetts Senate approved a requirement last week that all doctors and nurses talk to dying patients about their end-of-life options.

In passing the amendment, legislators avoided a minefield that exploded repeatedly during the national health care debate.

Senate aides who knew what was coming held their breath as Senate President Therese Murray asked the clerk to read amendment No. 121 known as “Palliative Care Awareness.”

“The question comes on adoption of the amendment,” Murray said in the rapid-fire speech she adopts to move Senate business along quickly. “All those in favor say aye, opposed no, the ayes have it, the amendment is adopted.”

In the absence of objections, Murray barely glanced up as members approved the requirement that physicians and nurses in Massachusetts talk to terminally ill patients about their end-of-life options, their risks and benefits, and how best to manage their symptoms and pain.

Almost three years ago, Sarah Palin claimed that such counseling could turn into death panels.

“I picture it as a panel of bureaucrats deciding who will receive that care based on someone’s subjective judgement of their years left of productive life,” Palin told radio host Sean Hannity. “That’s a cruel and evil way of allowing Americans to receive the health care coverage that they want.”

But now, in Massachusetts, end-of-life counseling advocates say they won’t let Palin’s interpretation derail their mission.

“The national controversy about death panels — what AARP called lies about death panels — is completely misguided,” said Dr. Lachlan Forrow, who directs ethics and palliative care programs at Beth Israel Deaconess Medical Center. “In Massachusetts we can unite and show how to do it right.”

Dr. Lachlan Forrow directs ethics and palliative care programs at Beth Israel Deaconess Medical Center. (Martha Bebinger/WBUR)

Dr. Lachlan Forrow directs ethics and palliative care programs at Beth Israel Deaconess Medical Center. (Martha Bebinger/WBUR)

Forrow chaired an expert panel on end-of-life care that wrapped up last year. The Senate amendment is a first step toward filling the panel’s recommendations. Forrow says there’s widespread agreement in Massachusetts that to make sure patients get the care they want they must be informed about their options.

“Life prolonging as long as it might work in the ICU might be a choice,” Forrow said. “[Some patients may say], ‘I want to be at home with my family, as comfortable as possible.’ People need to know the full range of choices. That needs to be documented if they have preferences and it has to be respected absolutely all the time.”

The next step, Forrow says, must be to train hospital and home care staff about how to follow a patient’s wishes.

Senate Republican leaders confirm that they have no objections to this amendment and it also has the support of one of the state’s leading right-to-life groups, the Massachusetts Family Institute. But the group’s president, Kris Mineau, has one caveat.

“We do have concerns down the road that, God forbid, should the physician-assisted suicide referendum pass on the ballot in November, this could open up a Pandora’s box,” Mineau said. He would oppose requiring that doctors counsel patients about the option of physician-assisted suicide.

Such broad support for end-of-life discussions with doctors begs the question: Why is reception for this issue so different in the Bay State?

“People in Massachusetts are smarter than everywhere else,” said Sen. Richard Moore, laughing. Moore sponsored the the end-of-life counseling amendment. “No, seriously, we approached this in the right way, bringing in people who had experience with it.”

The point, Moore said, was “not to demonize anybody in the process, and I think that’s a big part of it.”

Moore stresses that the state would not require that patients make end-of-life plans or even have the conversation if they don’t want to. Under the Senate plan, the state would consult with the Hospice and Palliative Care Federation of Massachusetts on information and guidelines for counseling patients.

This issue is only in the Senate health care costs bill right now. House leaders declined to say if they would support such an amendment when the House takes up its version of the health care cost legislation.

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  • J__o__h__n

    This state lacks utter morons like Sarah Palin. 

  • vito33

    This is great, and it should be adopted in the full health care bill. This shows how thinking adults can prevail over politically fueled hysterical paranoia.

  • Alice in NYC

    Everyone should read “A Life Worth Ending” the cover story for this weeks New York Magazine.  Here’s the link:  

  • Susan Steeves

    I am a great advocate for palliative care and end of life issues.  Worked in the field for many years.  Everyone at some time in their lives should be given the right to start a communication of their end of life wishes.  Saying that, I do not believe this is something  that the government should make laws over.  This is a doctor/nurse conversation not the government.  Being involved with hospice I see the compassion & dedication that doctors and nurses give to end of life decisions.  If the government has a say, some idiot will come along and take it further so they think that patient assisted suicide comes under this bill.  Only God has the right to know when a life is over.  The medical field can treat end of life pain and give dignity to death.   I am against the politicians thinking they know best.  They don’t unless they have a medical background and have worked in this field.

    • J__o__h__n

      People should be able to decide when their own lives end without people making that decision for them based on myths. 

    • GM

      Hi Susan,

      Sounds like you might have misunderstood the bill. It only requires that doctors/nurses offer to have a conversation about end-of-life plans. It doesn’t say anything about what that conversation should be, and patients don’t even have to talk about it if they don’t want to.

  • doctor

    Death panels was one of the few good things in Obama’s health care plan.

  • Art_As_Social_Inquiry

    Rational talk from Mass.! Doctors will not discuss end of life options lest they be accused of trying to kill the patient. But drs can do a million procedures to keep a body alive when all a person really wants is to go home and be with family.

    And now caregivers can really connect with patients and listen.

    This feels really good and compassionate.

  • Witchcat

    Palliative care ROCKS!!   Three cheers for my  state senate.

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