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Globe Editorial

At end of life — more planning, more counseling, more dignity

March 23, 2011

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MOST PEOPLE can’t control how or when death comes, but can prepare for certain scenarios — hospital, nursing home, or hospice — and pass their wishes along to doctors and loved ones.

But most people don’t want to think about end-of-life care. Bay State health officials hope to change that with a common-sense series of recommendations that all sides of the end-of-life debate can support.

Massachusetts led the nation by embracing the principle that every citizen deserves full access to affordable health care. Now, public health officials hope to lead the way on a related principle: that when it comes to end-of-life medical decisions, every citizen has the right to understand all available options, and the right to a health care system that respects the balance they choose to strike between prolonging life and maintaining its quality.

That principle, plus assorted recommendations to implement it, were presented in a report by a Massachusetts panel of end-of-life experts, and embraced last week by the administration of Governor Deval Patrick.

The panel — which included health care professionals, service providers, policy makers, health care advocates, and legislators — identified several essential steps necessary to achieve the highest-quality end-of-life care. They boil down to informing and empowering citizens about their choices; promoting and supporting a knowledgeable, competent, and compassionate medical workforce; and employing quality indicators and performance management tools to measure results.

Understanding patient preferences can end up saving money. But the panel deliberately stayed away from any cost analysis, because that is where the polarizing politics of health care reform derails sensible discussion. However, some practical measures will have to be taken if state officials are really serious about giving people true choice. State Senator Patricia Jehlen, who participated in the panel report, said she plans to introduce legislation that will extend Medicaid benefits to hospice care.

That’s clearly necessary because, while nearly 70 percent of Americans say they want to die at home, surrounded by family, the panel found that, in Massachusetts, the reality is exactly reversed. “More than 70 percent die in hospitals or nursing homes, often spending their last days or weeks attached to high-tech life-support machines. Despite many efforts to improve care near the end of life, since 1991, the percentage of patients dying in the home has not increase significantly.’’

The “death panel’’ demogoguery that thrives with the Sarah Palin crowd makes a difficult topic even more difficult — even in Massachusetts. The panel’s final report was issued in October 2010, but state public health officials did not release it until this month, a delay linked to the desire to keep a sensitive topic out of last fall’s gubernatorial race.

Now that the election season is over, the report should be used for what it is, a thoughtful compass for patient-centered end-of-life care.