Monthly Archives: January 2015

Week Three 1/28/15-2/4/15 The Basics: Definitions and Premise of Policy-Making.

Definitions

Policymaking is a term most Americans heard of; and all Americans have directly been effected by on a daily basis.  In a nutshell, policymaking occurs at a federal, state, or local level; and involves decision making to establish laws as solutions to problems with the goal of improving quality-of-life for all its citizens.

Premise of Policymaking

There are steps in the policy making process that include: (1) identification of a problem; (2) setting of an agenda; (3) formulation of a policy; (4) adoption of the policy; (5) implementation of the policy; and (6) evaluation of the policy (USHistory.Org, 2014).  This process is familiar to healthcare professionals, especially nurses, when speaking about the nursing process. Does anyone in nursing remember the acronym ADPIE (e.g., assess, diagnose, plan, implement, and evaluate) that was implanted into our novice brains?

Back to policymaking…when it comes to health care policy, they are formulated with the goal of the pursuit of health; and led to such reforms as Medicare and Medicaid in 1965; and now  the emergence of the Affordable Care Act (ACA) in 2010 (Longest, 2010).  Policies like these were made at the federal level, but with Death With Dignity laws, the federal government has placed the decision in the states’ hands.

Here is a recent map depicting the current states either with aid in dying laws passed (e.g., green states) or in the campaigning stage (e.g., orange states):

(Compassion and Choices, 2015)

As one can deduce, the blue states are not in the campaigning stage; and will have to wait until a bill for aid in dying is either introduced or re-introduced (as in the case of Arizona where the bill came up for debate in the house multiple times).

There was an interesting article in the New York Times (2013) pertaining to how getting laws passed on the national level is challenging due to political polarization.  In layman’s terms, this means Democrats and Republicans cannot reach an agreement in Congress to pass bills, hence the legislative process stalls. Such national issues like gay rights and aid in dying are now pushed to state governments to make decisions; and state officials have the power to challenge national policy by passing laws (New York Times, 2014).

This week I had the honor to interview former member of Maryland’s House of Delegates, Sam Arora.  Since this week’s blog featured policymaking, I thought it would be a perfect opportunity to get answers from a person who was actually part of a state policy making process. Some interesting points Mr. Arora had to share were the following:

1arora.jpg

  • A good bill usually doesn’t pass the first time it is introduced.
  • A bill that is continually vetoed still has the potential to pass.
  • Policymakers are not always “politicians”; and the majority of bills are drafted by lobbyist groups (although he didn’t operate that way).
  • The biggest challenge of policymaking was time, staffing, and resources (he only had a budget of $39,000).
  • A good policymaker has to reach across the aisle; and campaign for his bill to pass.
  • Healthcare professionals, like advanced practice registered nurses (APRNs), have an important voice in policymaking; and can be extremely credible attesters for proposed bills.

Please click on the audio below for this intriguing view into policymaking on a state level.

WORKING ON GETTING LINK TO YOU!…Email douglesgrube@gmail.com and I will email you directly.  Promise it is worth it!

We learned the definition(s) and premise of policymaking, especially pertaining to healthcare.  Please join me for Week Four for more thoughts on the issue of aid in dying.

References

Compassion & Choices AZ (2005). In your state. Retrieved from https://www.compassionandchoices.org/what-you-can-do/in-your-state/

Longest, B. B. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

New York Times (2014). States get things done, affecting national policy. Retrieved from http://www.nytimes.com/roomfordebate/2013/07/16/state-politics-vs-the-federal-government/states-get-things-done-affecting-national-policy

USHistory.Org (2014). Policymaking: Political interactions. Retrieved from http://www.ushistory.org/gov/11.asp

 

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Week Two 1/21-1/28 Healthcare Policy and the Role of Ethics

Healthcare Policy

Admittedly, as RN “in the field” I never paid attention to health care policy.  My thinking was those in administrative roles would engage in these types of issues.  It wasn’t until pursuing the DNP degree did the realization register that everyone, including patients, families, and healthcare workers, have a voice; and with a substantial amount of voices, changes can occur.

For this week I am beginning at ground zero; and asking the question, “What exactly is a healthcare policy?” To clarify for those who are wondering the same, the World Health Organization (WHO) describes healthcare policy as actions, decisions, and plans initiated to enact specific health care goals within a society (WHO, 2015).  Let’s take this concept and apply it the topic, Death with Dignity, and think about how healthcare policy (or the lack thereof) relates to this topic.  Clearly, as related in Week One’s post, the state of Oregon was a trailblazer with the landmark ruling to legalize physician-assisted suicide in 1994.  Since then, other states have succeeded, but many have failed in their attempts to establish aid in dying policies.  Arizona (AZ) is one such state where the Aid in Dying bill, sponsored by former State Representative, Linda Lopez (Democrat), has consistently been rejected in the House of Representatives.  For those of you who need a quick civics review of how a bill turns into a law, I included a picture because who doesn’t like visuals?

I also included a link to a news clip on how Death with Dignity remains dead in the water (no pun intended).  (For effective view please right click and open as new link).

Death with dignity’ legal in only 5 states, Arizona is not one of them | KVOA.com | Tucson, Arizona.

For those terminally ill patients (living in AZ) seeking to make their own choice in when and how they want to die, this is an extremely frustrating situation.  The only choice for these patients may be a hospice program, where at least end-of-life symptom management is offered.  For others, desperate times call for desperate measures, like violent suicide (e.g, guns); and looking for organizations that may assist in finding measures to hasten one’s death.  For instance, the case of a 58 year old Phoenix woman, Jana Van Voorhis, who inquired the help from Final Exit members to help with her suicide.  Final Exit is an organization that counsels and supports mentally competent people with intolerable diseases end their lives (Final Exit, 2011).  The problem was Jana told members, one being a retired anesthesiologist, that she had terminal conditions that were never verified by her physicians.  In fact, Ms. Van Voorhis had been recently diagnosed as having psychosis; and had persistent disturbing hallucinations.  These members were tried in an AZ court for manslaughter.  The physician was acquitted; and the three other members pleaded to lesser charges (AZ Central, 2012).  This led to a bill, recently signed by former Governor Jan Brewer in 2014, to prosecute any individuals with manslaughter who assist in suicides.  The term assist means providing physical means to end one’s life (Arizona Capitol Times, 2014).

Watch Dr. Sanjay Supta, my favorite CNN consultant, investigate the Jana Van Voorhis case.  Think about what side of the fence you are on in this debate; and if heath care policy could have prevented tragedies like this case.

There are still those in the community keeping the Death with Dignity debate alive.  Arizona State University (ASU) hosted an event, that I attended, in September 2014 titled “Should Arizonans Have the Right to Die with Dignity?”  This event had a panel discussion with two highly informed professors on the topic: Dr. Courtney Campbell, from Oregon State University; and Dr. Helene Sparks, from the University of Washington.  Both taught courses in ethics; and have numerous articles published on topics like physician-assisted suicide.

Here is the video discussion for those interested in this debate.  Think about the question, “Do Arizonans have the right to die with dignity?”

http://www.ustream.tv/embed/recorded/53409222?v=3&wmode=direct

 Role of Ethics

The ASU discussion on Death with Dignity leads us to the topic of ethics.  How does the role of ethics affect the decision-making policy regarding aid in dying for terminally ill patients?  As it stands, the American Nurses Association (ANA) has this position statement regarding assisted-suicide that “prohibits nurses’ participation in assisted suicide and euthanasia because these acts are in direct violation of Code of Ethics for Nurses with Interpretive Statements, the ethical traditions and goals of the profession, and its covenant with society (ANA, 2013, p. 1).  This code also applies to advanced practice registered nurses (APRNs).  With the ANA against assisted-suicide, only strengthens the debate for those opposed to an Aid in Dying bill in AZ.  As a hospice RN in AZ, I believe those diagnosed with a terminal illness; and who are mentally deemed competent should be able to end their own life.  If for any reason to stop drastic, desperate measures by those seeking a safe, painless, monitored way to die.

Let’s talk further about this topic in Week Three when I will delve more into the actual policy-making process!

 References

American Nurses Association (2013). Position statements: Euthanasia, assisted suicide, and aid in dying. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/Euthanasia-Assisted-Suicide-and-Aid-in-Dying.pdf

Arizona Capitol Times (2012). Brewer signs bill targeting assisted suicide. Retrieved from http://azcapitoltimes.com/news/2014/04/30/brewer-signs-bill-targeting-assisted-suicide/

Arizona State University (2014). Should Arizonans have the right to die with dignity? Retrieved from https://www.lincolncenter.asu.edu/events/should-arizonans-have-right-die-dignity

AZ Central (2012). Jury acquits Phoenix doctor in assisted-suicide case. Retrieved from http://archive.azcentral.com/community/ahwatukee/articles/2011/04/21/20110421phoenix-doctor-assisted-suicide-verdict.html

Final Exit Network (2011). Our guiding principles. Retrieved from http://www.finalexitnetwork.org/

Mullins, Jean (2015, November 4). Sanjay Gupta, MD: Assisted suicide or manslaughter? Retrieved from https://www.youtube.com/watch?v=_of5pFqLB-k

News 4 Tucson (2014, November 3). Death with dignity legal in only 5 states, and Arizona is not one of them. Retrieved from http://www.kvoa.com/news/death-with-dignity-legal-in-only-5-states-arizona-is-not-one-of-them/#.VL7aKRev61M.wordpress

World Health Organization (2015). Health policy. Retrieved from http://www.who.int/topics/health_policy/en/

Week One 1/14-1/21: Introduction to the Health Policy Topic

Health Policy Topic



Legalizing Death with Dignity  in the state of Arizona

Background and Significance of the Death with Dignity Act

The Death with Dignity movement made national headlines in 2014 when Brittany Maynard, a young woman with terminal brain cancer, chose to end her life with the assistance of a physician (through prescribed medications) on November 1, 2014. Brittany moved and established residency in the state of Oregon, which was the first state to pass the Death with Dignity Act in 1997.  To date, their are four other states where patient-directed dying (PDD), also known as physician-assisted dying, is occurring either by mandated state laws (e.g., Vermont and Washington) or court rulings (e.g., Montana; and one county in New Mexico) (CNN.com, 2014); sparking the national debate of should terminally ill patients, deemed mentally competent, be allowed the choice to end their own life?  Proponents for PDD, like the Death with Dignity National Center, want to proliferate the movement for people facing terminal illnesses to have control and options when facing end-of-life decisions, including PDD (Death with Dignity National Center, 2015).  Some interesting statistics since the inception of these mandated laws or court rulings include:

  • In Oregon, there have been 1,173 physician prescriptions written; and 752 deaths since 1997 (Oregon Health Authority, 2014).
  • In Washington, there have been 549 prescriptions written; and 529 deaths since 2009 (Washington State Department of Health, 2014).
  • In Vermont, there has been no deaths reported since the passing of the doctor-prescribed suicide bill in 2013 (CNN, 2014)

For those patients diagnosed with terminal illnesses in states with no Death with Dignity laws, it can be a frustrating journey. Most are dealing with painful and debilitating disease processes like cancer or amyotrophic lateral sclerosis (ALS).  This is the case in the state of Arizona (AZ) where an Aid in Dying Bill (HB 2572) was proposed in 2007; and continues to remain in the Health, Judiciary, and Rules Committees (Life Issues Institute, Inc., 2014).  In 2005, an AZ Opinion Poll conducted by the local new channels, KAET-TV/Channel 8 and the Walter Cronkite School of Journalism and Mass Communication at Arizona State University (ASU), telephoned 442 voters inquiring about a physician-assisted suicide law for people with terminal illnesses.  The results revealed 53% of those polled were in support of a law being passed (Compassion & Choices AZ, 2005).

Establishing Death with Dignity laws can potentially do the following:

  • Lower healthcare costs for those with terminal illnesses. Studies show 1 in 4 Medicare dollars,  over 125 billion dollars, are spent on care at end of life (Time, 2014)
  • Mandate safe and effective means over ending a person’s life.  Stopping potential suicide attempts that are horrific and traumatic for all involved.
Please watch the video of Brittany Maynard’s fight with terminal brain cancer; and her decision to die with dignity.

Significance to Me

My name is Leslie Moses-Grubenhoff; and I have been a registered nurse (RN) for the past 10 years.  Currently, I am a Doctor of Nursing Practice (DNP) student at Arizona State University (ASU) concentrating in adult and geriatric primary care.

Working for a non-profit hospice in Phoenix, AZ for the last 9 years, I have encountered patients who have inquired or requested assistance with dying.  Many had lost their abilities to feed, bathe, or toilet themselves; and all had lost their overall quality of life.  They assumed being admitted to a hospice program would hasten the dying process due to the morphine the agency could provide.  Clarification and education on what a hospice does never includes providing medications to end a person’s life.  Comfort medications, like morphine, are only utilized for symptom management for issues such as pain and/or shortness of breath.  This left some patients feeling hopeless because they were ready to die; and wanted control in when this would happen.  One story that I will always remember is an admissions call I received for a man who attempted suicide with a helium tank and a paper bag, but failed.  This man was suffering from terminal cancer; and had unrelieved pain.  He told me he got all his affairs in order; said his goodbyes to his family and friends; and distributed out all his life savings only to receive an empty helium tank for a botched suicide attempt.  He was angry and frustrated that the state of Arizona did not have laws in place to help him die with dignity.

Please watch the video below of an elderly man who shot his wife of more than 40 years as a “mercy killing.”

Man shoots elderly wife in alleged ‘mercy killing’ – FOX 10 News | fox10phoenix.com

Looking forward to the upcoming weeks to discuss this topic further.  See you in Week Two!

References

CNN (2014). Physician-assisted suicide fast facts. Retrieved from http://www.cnn.com/2014/11/26/us/physician-assisted-suicide-fast-facts/

Compassion & Choices (2014, October 29). A new video for my friends. Retrieved from http://www.youtube.com/watch?v=1lHXH0Zb2QI

Compassion & Choices AZ (2005). Arizona opinion polls. Retrieved from http://www.choicesarizona.org/azpoll2.htm

Death with Dignity Center (2015). About us. Retrieved from http://www.deathwithdignity.org/aboutus

Fox 10 News (2013, November 13). Man shoots elderly wife in ‘mercy killing.’ Retrieved from man shoots elderly wife in alleged ‘mercy killing’ – FOX 10 News | fox10phoenix.com

Life Issues Institute (2014). Current attempts to legalize assisted suicide in the United States. Retrieved from http://www.lifeissues.org/euthanasia/current_attempts.htm

Time (2014). Cutting the high cost of end-of-life care. Retrieved from http://time.com/money/2793643/cutting-the-high-cost-of-end-of-life-care/