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27 Voice Experience 1 (2015)

handle is hein.aba/voiex0027 and id is 1 raw text is: .. . .. .. zI ............ -------- ....... ....... ........... The Policy and Political Challenges of Being Mortal By Charles P Sabatino Editor's Note: At the ABA Midyear Meeting in February 2015, the Com- mission on Law and Aging and the Health Law Section will cosponsor a resolution to support legisla- tion and regulation that promotes access to comprehensive long-term supportive services and carefor per- sons with advanced illness. In this article, Commission Director Charles P Sabatino describes the resolution and the reasons therefor. This article was first published in the December 2014 issue of Bifocal, vol. 36, no. 2, and is reprinted with permission. T wo recent publications sug- gest that as a society we may be getting closer to recognizing and doing something about how we treat our sickest and most vulnera- ble citizens and their families as they cope with illness near the end of life. The first is the release of a landmark report from the Institute of Medicine, Dying in America: Improving Quality and Honoring Individual Preference Near the End of Life. The other is the publication of a powerful book by phy- sician-surgeon Atul Gawande: Being Mortal: Medicine and What Matters in the End. The report by the Institute of Medi- cine (1OM) starts with a recognition that for patients and their loved ones, no care decisions are more profound than those made near the end of life. But our healthcare and payment sys- tem, despite the efforts of dedicated health professionals, largely fails to provide care for those nearing the end of life that is compassionate, coordinated, affordable, and of the best quality possible. Consider this story, one of many submitted to the IOM: As my 88-year-old father-in-law was in decline with eight different chronic conditions, he had more specialists than we could keep track of, and nobody was steer- ing the ship. Most of all, his pain was poorly managed, but finding an outpatient palliative care phy- sician was impossible, even in a city like Los Angeles. He resisted hospice mainly because he thought that meant he was giving up, so he continued to suffer and experience recurring runs to the emergency room. When he finally agreed to home hospice, his care and con- dition improved dramatically, and during the final month he lived under hospice he was comfortable, he had heartfelt conversations with all 11 of his children, and he died in peace and dignity in his home. It was a good death, but the period of serious, progressive illness before hospice was a nightmare, because hospice-type care is kept out of reach until the last moments of life. Atul Gawande's book, Being Mor- tal, grippingly portrays Dr. Gawande's personal evolution as a surgeon and pillar of Western medicine into a humble awareness of what really matters to individuals nearing the end of life and how our health sys- tems tragically miss the mark: continued on page 12 Image: iStock Published in Voice of Experience, Volume 27, Number 1, 2015. © 2015 by the American Bar Association. Reproduced with permission. All rights reserved. This 1 information or any portion thereof may not be copied or disseminated in any form or by any means or stored in an electronic database or retrieval system without the express written consent of the American Bar Association.

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