A Key Aging Issue Shows Gains in Recent Election

By Kim Callinan

This election year Americans learned there is much that divides us, across political, cultural and generational lines. However, on one issue there has been marked agreement: people’s desire for greater personal choice and control in their end-of-life care. This desire is taking the form of an increasingly successful consumer movement to authorize medical aid in dying for terminally ill adults who want the option to end unbearable suffering. And all of us who care about quality of life at the end of life should take notice because this movement offers insights into other policy solutions with the potential to transform end-of-life care.

The year was marked by major wins on this issue. In June, California’s new End of Life Option Act took effect. On Nov. 8, a similar ballot initiative in Colorado passed in a landslide. On Nov. 15, the District of Columbia Council approved the Death with Dignity Act by a supermajority vote of 11-2.

Recently, Compassion & Choices President Barbara Coombs Lee and I wrote an op-ed for the Washington, D.C. Hill newspaper that points out some of the striking figures underlying these victories. We noted Colorado voters across a broad demographic range supported Prop. 106, according to exit polling. Men and women, Hispanics and whites and people with and without college degrees said they backed the proposal—and it received more total votes than any other measure or candidate on the Colorado ballot—a major accomplishment at a time when Americans agree on very few policy solutions.

We believe the strong support for medical aid in dying is evidence of a larger concern faced by all aging Americans: a sense that the health care system is simply not responding to their goals and preferences for end-of-life care. Unwanted medical treatment, failing to fully explain available options to patients, and failing to consider patients’ values or even their written directives, are far too often the norm in end-of-life care. While the medical system, foundations and national organizations have been trying to address these and similar concerns to develop a more person-centered approach to care, the results have been mixed at best.

As our op-ed notes, more doctors are in engaging in conversations with patients about advance planning for their end-of-life care and the new medical specialty of palliative care is taking hold. However, despite these worthy efforts, the health care system has made limited progress on key quality indicators: non-beneficial treatment of patients is still on the rise; patients’ advance directives are still ignored; and patient admissions to intensive care units (ICUs) in the last 30 days of life continue to rise.

A large and diverse cross-section of older Americans, their caregivers, and the public at large are looking for greater control at the end of life, including—but not limited to—shortening an intolerable dying process. Drawing on the strength of this movement, we have the opportunity to transform end-of-life care by identifying other policy solutions that give Americans with serious or advanced illness greater control over their health care decisions. If you would like to learn more about this important subject, join Compassion and Choices for the first in a series of three ASA webinars, “What Advances in Medical Aid in Dying Can Tell Us About Integrating the Patient’s Voice into End-of-Life Care” on Jan. 18, 2017, at 10:00 AM Pacific Time.

Kim Callinan is chief program officer for Compassion & Choices. She holds a Master’s degree in public policy from Georgetown University, a graduate certificate in public health from the University of South Florida and a Bachelor’s degree in government from Oberlin College.