Conference deals with end-of-life care

by Lynne Kozarek

Thomas Mann once said, “A man’s dying is more the survivors’ affair than his own.” Families often face difficult choices when a loved one is dying of a terminal illness, but doctors also face ethical issues concerning end-of-life care.
Physicians and experts discussed patient care options Thursday, Friday and Saturday at a conference presented by the University’s Center for Biomedical Ethics. The forum offered a chance for physicians and experts to discuss and present papers on end-of-life health care.
Dr. Steven Miles, associate professor of medicine and faculty associate of the Center for Biomedical Ethics, said that 225 people from around the country attended the three-day conference.
Miles is also the director of Discussion Evolving Choices In Dying and Ethics, or Project DECIDE, which is sponsored by the Allina Foundation. The project was created more than a year ago to help physicians, patients and families of the terminally ill better understand the ethical issues surrounding end-of-life care.
“This project has done a couple of things,” Miles said. “It has provided access to knowledge on the subject, and it has successfully introduced a constructive way for the ethics center to become involved in managed care.”
He said the project has opened the lines of communication and people are now able to frankly talk about the issues surrounding end-of-life health care.
“Eighty-five percent to 90 percent of private insurance in the Twin Cities area is managed care,” Miles said, “100 percent of Medicaid is managed care and 10 percent of Medicare is managed care. There is very little research out there on managed care and end-of-life issues.”
Joanna Weinberg, assistant professor at the University of California at San Francisco, spoke on state laws and end-of-life care by managed care systems. She said too often the general public discounts or discredits the needs of a patient when that person becomes dependent.
“Managed care facilities need to address specific needs of high-risk groups,” Weinberg said. “They need to address home and community-based care, social service links and existing community agencies.”
Miles said much of the care patients receive is provided by managed care systems. Now that there is a nationwide trend toward managed care, he said, there are also many questions that must be dealt with by medical practitioners.
Miles also said that in keeping with the project’s mission to focus on research and discussion on what can be done to improve end-of-life care, the University has recently opened a hospice program. He also said the feedback from the Minnesota Hospice Organization has been good.
The project and the Minnesota Hospice Organization have put out a physician’s guide to hospice care.
Hospices are just one option in end-of-life care. They provide an environment in which pain control and supportive loved ones are taken into consideration.
The goal of the project is to make patients, their families, their friends and their physicians better understand how to deal with care at the end of life. Most physicians at the conference agreed that there is much more to the issue today than just a “do not resuscitate” order on a chart.