End-of-Life Care in the United States

Current Reality and Future Promise -- A Policy Review

Lisa A. Giovanni, MSN, RN


Nurs Econ. 2012;30(3):125-126. 

In This Article

The Patient Protection and Affordable Care Act

This national avoidance became blatantly evident when misconceptions from a portion of the 2010 Patient Protection and Affordable Care Act (PPACA) that would have enabled physicians to be reimbursed for having advanced care planning discussions with patients, was publicized as something that would result in a "death panel" that would "ration healthcare care in the United States" (Brody, 2011). As a result, the portion of the PPACA dealing with advanced planning conversations was deleted from the final version of the policy. Unfortunately, the true intent of this portion of the proposed act was not realized by the public or policymakers, since it was dismissed too rapidly for consideration. In the end, as with multiple other facets of end-of-life care, the fallout for not addressing this issue results in financial impact to the nation, as well as a quality of life impact for the individuals and families who require end-of-life care for advanced illness in the United States.

Ironically virtually no portion of the PPACA deals with reform, reimbursement, or policy changes related to end-of-life care. There are minor sections of the PPACA that can have an effect on end-of-life care, but no portion relates directly to this vital and hugely important aspect of American health care. Unfortunately, the result is the unique needs of the terminally ill remain poorly addressed in the United States health care system. Perhaps one of the most concerning concepts when it comes to end-of-life care is the fact that so often the care provided is not necessarily the care the patient and family have elected, wanted, or even understood.