Clip files / Local news from the states
Clip files / Local news from the states
This column features selected short items about state health care policy.
Lawmakers reach an end-of-life bargain
CONCORD, NH — New Hampshire residents will likely have more tools to guide them in defining the type of medical care they receive at the end of their lives. A State House committee reached a last-minute compromise on a complex bill that reworked rules governing living wills and other end-of-life planning documents. The legislation also would create guidelines for do-not-resuscitate orders, which allow patients to forgo CPR and are not currently addressed in state law.
It's been more than two years since a group of lawmakers, lawyers, health care providers and clerics began rewriting the rules that govern end-of-life planning in New Hampshire. While they worked, their already-emotional debate became more heated during the much-publicized battle over the fate of Terri Schiavo, a brain-damaged Florida woman who relied on a feeding tube for fluid and nutrition. Doctors were eventually allowed to remove the tube, as Schiavo's husband said she had wished, and she died last spring.
This winter, the House and Senate debated the bill at length before passing slightly different versions by wide margins. The concepts in the legislation are not new. Since 1991, the state has allowed adults to use two documents to indicate the type of care they'd like at the end of their lives. One, called a living will, outlines the procedures a person wants when they're near death or permanently unconscious. The other, called a durable power of attorney for health care, designates someone to make medical decisions when the patient cannot.
Current law does not cover do-not-resuscitate orders, which bar medical personnel from using CPR if a patient has a heart attack or stops breathing. Instead, most hospitals and nursing homes have their own forms patients can choose to fill out. In most cases, orders issued at one institution do not apply at another.
Under the compromise, doctors could opt out of providing treatment if they're morally opposed to carrying out the patient's wishes. Hospitals, too, could decline to honor do-not-resuscitate orders for moral or religious reasons as long as their policy is clearly posted in waiting rooms.
Still, not everyone was pleased with the committee draft. Brad Cook, a lobbyist for the Roman Catholic Bishop of Manchester, said the bill defined "near-death" and "permanently unconscious" too broadly, and that the changes would only confuse people. "We like the present law better," he said. "We think it's tighter, we think it's more precise, we think it's understood."
—Concord Monitor 5/20/06
Oregon acts to curtail suicides by older adults
PORTLAND, OR — Every year for at least the past decade, about 100 Oregonians ages 65 and older have committed suicide — enough to place the state well above the nation's elder suicide rate and fourth among states, all in the West, with the highest rates.
In Oregon and across the nation, suicide rates are highest among older adults — especially older men — and escalate sharply after age 65. But Oregon, for reasons that are not altogether clear, follows only Nevada, Wyoming, and Alaska in 2003 for having high concentrations of suicide among its most senior citizens.
The suicide in question is not the doctor-assisted variety. Oregon officials, anticipating the wave of baby boomers approaching their vulnerable years, are responding with an effort to hold down the suicide rate. Their plan, two years in the making, outlines ways groups can work together to promote awareness of suicide's danger to older citizens.
Dr. Mel Kohn, Oregon state epidemiologist, said a key element of the plan is to educate doctors and nurses to recognize symptoms of depression and explore patients' risk for suicide.
Right now, for example, less than half of doctors polled say they ask their depressed and suicidal elderly patients whether they have access to a gun, the dominant means of suicide in Oregon, according to Mark Kaplan, professor of community health at Portland State University and an expert in late-life suicide.
The state's report shows that more than a third of suicide victims had visited a physician in the past 30 days of life. Of the victims, 76% of men and 72% of women had some physical problem. Appointments for ailments give doctors an entree to discuss their patients' emotional health. The Oregon Department of Human Services has received $100,000 in federal funding to help start the program.
—The Oregonian, 5/16/06
New Hampshire residents will have more tools to guide them in defining the type of medical care they receive at the end of their lives; and every year for the past decade, about 100 Oregonians ages 65 and older have committed suicide.Subscribe Now for Access
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