COAXING PATIENTS OUT OF LIFE-SAVING TREATMENT ON THE BASIS OF QUALITY OF LIFE!

!!!!

Palliative Care Wants Electronic Health Records to Collect More Data (and re-direct patients into palliative care)

Here’s a bit of irony.

The Obama administration called for comments prior to launching the third phase of its plan to push everyone into electronic health records (EHRs).  The AMA and other medical societies responded with requests to postpone implementation.  CHIME (College of Healthcare Information Management Executives) warned:

We strongly caution policy makers not to expect that health professionals will be willing and able to capture significant amounts of structured data—unreasonable expectations in this regard are not only likely to compromise patient care (by unduly interfering with physician-patient interactions) but also lead to an anti-EHR response by the physician community.

It was a different story when it came to comments from the hospice and palliative care associations.  They rather liked the course the administration is taking.  In fact, they recommended that electronic records should collect even more data about patients and their families than was contained in the original plan.

Yes, these are the same hospice and palliative care professionals who are always moaning about the “technological imperative.”

Palliative care (i.e., the National Coalition for Hospice and Palliative Care (NCHPC))  submitted comments in January.  You can read the letter here.  (See also comments blogged by Joanne Lynn.)  NCHPC recommended that electronic health records collect data for research; compel patients to make decisions on future treatments; and automatically flag patients who are candidates for symptom treatment in lieu of more expensive and unnecessary aggressive curative treatments.

In one section, NCHPC suggests that the controversial POLST form might be used as a model to collect data, to coax “health systems who are not so forward-thinking.”  They write (emphasis is theirs):

Goals of care can and should be captured as structured data so that future measures can be developed related to goals of care that will not require laborious chart abstraction … To help imagine what this might look like, we cite the below example from an eMOLST1 form. MOLST forms [a version of POLST] are only appropriate for those very ill individuals with very poor prognoses, but [below is] illustrative of what is possible for goals of care generally. Indeed, forward-thinking health systems are … developing EHRs that can record goals of care. The meaningful use program should include objectives for health systems who are not so forward-thinking in leveraging EHRs in this way.

Generally speaking, advance care planning aids work in a two-step process.  Start by assessing the patient’s “values and beliefs” – i.e., how wretched is your quality of life now; how wretched will it be?  Are you now, or will you ever be, a burden to loved ones?  (multiple choice, the better to pigeon-hole patients):

[Click the image to enlarge it]

The next step is to set goals.  NCHPC’s sample:

[Click the image to enlarge it.]

So it appears that organized palliative care is in favor of the Technological Imperative when it aids and abets the Quality-of-Life Imperative.

Here is my question:  How often will we be subjected to these types of questions, and from whom?

A quick note on the people who signed the NCHPC letter speaking on behalf of the world of palliative care:   Three of the four signatories are Timothy Quill, Diane Meier, and Sean Morrison.  “Tim” Quill (as he is known by his friends in the palliative care world) is infamous for helping a patient to commit suicide, and then writing about it.  Meier, Quill and Morrison later co-authored a controversial study of (illegal) physician-assisted suicide practices.  Shortly thereafter Meier had second thoughts about advocating the legalization of physician-assisted suicide. Coaxing patients out of life-saving treatment on the basis of the quality of life imperative might be another matter.

Sunday, March 3rd, 2013, by admin, Filed under: Palliative care / palliative medicine,POLST,Uncategorized| , , , , | Comments off

About abyssum

I am a retired Roman Catholic Bishop, Bishop Emeritus of Corpus Christi, Texas
This entry was posted in EUTHANASIA, HEALTH CARE, LIBERALISM, LIFE ISSUES, MEDICAL-MORAL PROBLEMS, MORAL RELATIVISM, NUTRITION AND HYDRATION, ORGAN DONATION, RELATIVISM, SCIENCE AND ETHICS, THE RIGHT TO LIFE. Bookmark the permalink.

2 Responses to COAXING PATIENTS OUT OF LIFE-SAVING TREATMENT ON THE BASIS OF QUALITY OF LIFE!

  1. abyssum says:

    What data will be on your electronic health care records (EHRs) in the future? Your visits to the doctor? Diagnosis of your ailments? Your medications? Think again. Changes are coming to the “standard” content of EHRs, thanks to the “third path” euthanasia movement. Palliative care leaders want to digitalize family history, the actual content of your advance directive or POLST form, superfluous care transitions, your functional status, caregiving potential, identity of surrogate (if one) and when designated, etc, etc. Most importantly, they want to record your goals of care and discover your core values. They have developed a series of boxes to check during goals of care discussions which will allow your treatment to be centered around QUALITY measures individually tailored to each patient. Although this may sound benign it is actually pretty scary.

    The Health Information Technology Policy Committee (HITPC) is in the process of developing “meaningful use” standards for Electronic Health Records (EHRs). Bishop Gracida sent out this Belbury Review (www.belburyreview.com) blog below a few weeks ago suggesting that the changes coming to “standard” measures in electronic health records will help promote euthanasia.

    The article gives two very important links to palliative care input which is going into these EHR revisions.

    1) Comments made to the HITPC by Joanne Lynn of The Center for Elder Care and Advanced Illness at Altarum Institute (Go here). Lynn wants EHRs to become less backward-looking and more forward-looking. She goes on, “In short, the next phase of meaningful use needs to begin to build the future into the medical record.” What does she mean? Is this about hastening death?

    2) The Belbury Review post also links to a letter written by the National Coalition for Hospice and Palliative Care to the Committee (HITPC) on January 14, 2012 which was signed by the President of the American Academy of Hospice and Palliative Medicine, the Director of the Center to Advance Palliative Care, the Chief Executive Officer of Hospice and Palliative Nurses Association and the Director of National Palliative Care Research Center. You can read the letter here (or here). This letter explains in detail how goals of care discussions are to be utilized in Electronic Health Records and become important levers in the re-engineering of healthcare.

    Understand that palliative professionals are trained to steer the patient and patient’s family to choose goals that limit medical treatment. In their hands, Electronic Heath Records are destined to become just one more tool of the “third path” euthanasia movement.

    Prayers to the Holy Spirit, to St. Joseph and to Our Blessed Mother,

    Elizabeth (Betty) D. Wickham, PhD
    Executive Director, LifeTree
    http://www.lifetree.org
    PO Box 17301
    Raleigh, NC, 27619

  2. Elizabeth Wickham says:

    I’ll will also send to the LifeTree list when things calm down. B

Comments are closed.