The Oregon Legislature has passed a bill that essentially updates the state's law regarding advance directives, the documents in which people specify what medical actions should be taken on their behalf in the event that they themselves cannot make their wishes known.
In 1993, Oregon was the first state in the nation to adopt advance directive legislation, but the advance directive in current use hasn't been modified since then. Surely, after a quarter-century, you would think that some updating would be necessary, considering the advances made since then in health care — and you might also think that a bill to that effect would be relatively uncontroversial.
As it turned out, however, the bill that passed the Legislature this week (House Bill 4135) did attract a fair measure of controversy and passed on party-line votes. And at least some of that controversy suggests that Oregon has more work ahead of it in terms of educating people about what these advance directives do — and what they don't do.
First, of course, you should have an advance directive on file. If you have one, good for you, but you might want to pull it out to see if it still reflects your wishes. Having such a document ensures that your wishes for medical treatment will be followed, even in the event that you are unable to communicate those. And an advance directive also has the huge benefit of giving guidance to family members about your preferences; that takes a huge weight off their shoulders. The advance directive, of course, does not apply in cases in which people can communicate or make their own health care decisions.
House Bill 4135 updates the portion of the advance directive form that deals with the appointment of the personal representative — the person who makes health care decisions for another individual when that person becomes incapacitated. The bill also establishes a 13-member Advance Directive Adoption Committee that is charged with reviewing, every four years, the instructions portion of the form to make sure it's current and as understandable as possible. That ease of use is important, because there's some evidence that the forms currently in use can lead to some confusion.
Part of the legislative opposition to the bill focused on worries that it erodes protections for patients, but those worried don't seem to be justified by the text of the measure. Another argument, that the Legislature should have the primary duty to ensure that the advance directive form is crafted correctly, seems misplaced. The bill specifies that the committee created by the bill should do the heavy lifting. Legislators still get to review that work.
Other opposition to the bill centered on the incorrect belief that it allows food and water to be withheld from dementia patients without their consent. This worry, which might remind you of the fracas a few years ago regarding so-called Medicare "death panels," simply is not borne out by the bill. (The online version of this editorial includes a copy of the bill.)
Part of the anxiety over the bill is a reflection of our general unwillingness as Americans to spend much time thinking about our own mortality. And who wants to spend much time with loved ones making sure that advance directives are on file and properly updated? Such a downer.
But think of the grief that a properly handled advance directive can save families in the event that it's needed. It's a conversation that needs to take place.
The fact that Oregon was the first state in the nation to adopt legislation regarding advance directives speaks well of this state's leadership in end-of-life issues. But there's obviously still a lot of work ahead, work to dispel rumors, work to explain the huge difference that an advance directive can make — not just for better deaths but for better lives as well. (mm)