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Death with Dignity in 2013

Crystal Ball by Justin Glass on Flickr
Crystal Ball by Justin Glass on flickr

The pundits are out and about this time of year making various predictions about 2013, and the forecasting provides for fascinating reading. You'd think we'd have learned something after the Mayan apocalypse failed to occur. Right now, we're being told the price of gas will plummet in 2013; Nate Silver will become the model for all polling conducted for media outlets; Fidel Castro will die; Americans will pay more taxes and more for healthcare; and Lincoln will win best picture at the Oscars. We're gobbling up predictions faster than your uncle's attack on the pile of Christmas cookies.

So, here are my predictions for 2013:

POLST programs will be available in half of all states in this country by year's end. POLST (Physician Orders for Life Sustaining Treatment) programs represent an important step forward in advanced planning for end-of-life care. They go further than living wills because they use standardized forms, converting patient wishes about end-of-life care into physician orders for treatment to be used by emergency personnel, hospital staff, and other healthcare providers. They provide physicians with a vehicle through which to lead conversations with patients and family members about how aggressively a patient wants his/her illness to be treated. If a patient wants limited treatment or palliative care only, this becomes part of the POLST form. The form goes in the patient's chart as a medical order.

POLST programs have been made available in 15 states through legislation or regulation, and there is ongoing work in 28 other states. The Catholic Church has worked to oppose POLST programs in Wisconsin, suggesting the use of POLST forms would be a slippery slope to euthanasia. Regardless of the Church's opposition to written end-of-life care plans in medical charts, I believe POLST programs will expand to half of all states in 2013.

Speaking of the Church, I believe they will continue to quietly fund 70% or more of the opposition's work in states like Vermont, Montana, and Massachusetts. An analysis of the anti-Death with Dignity campaign spending in Massachusetts shows 71% of all money raised by opponent ballot question committees ($3.4M out of $4.8M) could be attributed to Catholic resources. An additional 15% came from sources traditionally associated with anti-gay activities ($730,000 out of $4.8M); nearly $500,000 came from major individual donors.

These patterns will continue in 2013 with most of the money supporting anti-Death with Dignity efforts coming from the Catholic Church. Furthermore, the Church will hide behind organized medicine, minimizing their role in the opposition. Nowhere will the public find evidence of the true motives behind the opposition—opposition based on Church-based teachings—but rather the public will continue to encounter slippery slope arguments which haven't proven to be valid in the 15 years of implementation in Oregon and Washington.

This spring will abound with Death with Dignity legislation throughout the New England area. We'll see activity in the Vermont legislature; and in Massachusetts, Connecticut, New Jersey, Maryland, and perhaps, even Maine. Vermont will continue to lead the nation in progress toward end-of-life care policy reform through legislative means, becoming the first state to enact Death with Dignity through the legislature.

My final prediction: BBC Three will experience mild success with its sitcom about three blokes who start an assisted-suicide business. Way To Go won't achieve the run-away success of Downton Abbey, but it will intrigue viewers, nonetheless.

POLST programs, the Catholic Church, success in Vermont, and an assisted-suicide comedy noir series on the BBC; it's going to be an exciting year.

Posted on January 9, 2013 in Massachusetts, New England, Vermont

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