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:
- 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
dignitydiscussion 
This week when researching I came across some videos that you may want to post on your blog. Since your topic is so close to mine I wasn’t surprised when I came across it.
This first is a ABC news clip on the new legislation for California to have an assisted suicide law.
http://abc7.com/politics/brittany-maynards-family-pushes-right-to-die-bill-in-california/485712/
The next a clip on global trends of assisted death and opinions of other countries.
Please watch them. I think your audience will find them informative and interesting. I sure did. Also on the first clip the news reporter stated that some other states are developing similar policies such as Washington D.C., Colorado, and Wyoming
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Kelly,
Thank you for your links; and I hope my blog audience finds them as compelling as I did!
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Hi Leslie
What a great topic that needs to be addressed. Reports have stated that most of money spent on healthcare is in the last few years of life. The criteria in Washington is that the person needs to be “decisional competent and have a limited life expectancy of about 6 months or less” (Starks, Dudzinski, & White). Since you work in the Hospice area, do you often find that people meet this criterion? How hard is it to determine decisional competence?
Currently three states allow physician aid-in-dying, Washington, Oregon and Vermont, all the terminology seems to stats “physician” does this apply only to medical doctors or all providers, such as Nurse Practitioners and Physician Assistant.
Most people think of Dr Kevorkian when you mention Physician aid in dying. I think this would bias most people.
Tara
Starks, H., Dudzinski, D., & White, N. (n.d.). Physician aid-in0dying. Retrieved from Ethics in Medicine: University of Wahington School of Medicine: http://depts.washington.edu/bioethx/topics/pad.html
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Tara,
Thank you for your comments and question. I was an admission nurse for three years; and it was part of my job requirement to evaluate the person wanting to be admitted to hospice services. It was essentially a checklist of tangible symptoms a patient had to demonstrate in order to be deemed “hospice appropriate.” For instance, cancer patients had to be Stage 4 (meaning metastasis was present); or we could no longer go further in the evaluation process (and they could possibly be directed towards palliative care). I actually should preface this whole response by stating that as admission nurses, we absolutely had to have a terminal certification from a physician stating that the patient had a terminal diagnosis; and it his/her opinion was 6 months or less before an admission could be completed. Although, we did evaluations on people who may not have a terminal certification in hand, but we absolutely could not complete without one (and then have our Medical Director provide secondary terminal certification). It is quite a well oiled, precise machine. Especially now since Medicare has cracked down on hospices around the country for admitting people; and having them on service for over 6 months without documentation proving continued decline.
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Thank you for including your interview with Mr. Arora! I found several of the points he made intriguing. I was happy to learn that a large portion of policy making does not fall to politicians. It appears that politicians are the experts at the policy making process, they are rarely experts on the subject matter of the policy. Mr. Arora also mentioned that good policy bridges ‘the aisle’. I’m sure you have found this to be the case when discussing ‘death with dignity’. For policy makers, or politicians, to fully engage the topic they should be surrounded be the experts, in this case health professionals. They should also recognize that your topic reaches to the heart and core values of each political party. Clearly, policy making in this arena is easier said than done. I was encouraged to find the Bipartisan Policy Center (BPC) is working to find solutions for the big issues facing our country at this time. I found their mission and vision to echo what many of us our searching for with regard to policy making. The ‘Death with Dignity’ discussion was not yet a part of their agenda but I expect it will move to the forefront with upcoming legislation. I look forward to following your discussion!
This is a link to the introduction video from the BPC.
http://bcove.me/moogwj3j
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Katie,
Thank you for sharing this link from the BPC. I did not find this valuable resource while writing this week’s blog; and it proves the power of this blog in terms of sharing information amongst each other. I only hope that politicians on Capitol Hill can agree to disagree; and move on to get things accomplished. Personally speaking, politics always left a bad taste in my mouth, especially around campaign time, due to the constant mudslinging and negative press candidates release about each other. When really the focus should always be on important issues like health care, education, and equal rights for all United States (US) citizens (e.g., gender wage gap, gay marriage).
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One of the biggest obstacles in policymaking, which you identified, is partisan issues and ultimately getting a bill passed into law. Even at a local or institutional level, there will always be individuals from various different social backgrounds with different perceptions and beliefs regarding healthcare. In the case of the Death With Dignity movement, ethics is probably the number one partisan issue, but issues that may arise with other healthcare policy changes may relate to funding or prior commitments made to constituents. Sam Arora offered some great advice and viewpoints regarding the policymaking process. Advanced practice nurse practitioners, especially those savvy in palliative care, could have a great impact on the implementation of a dignity decision (either for or against). But, one of the most important aspects regarding this issue, in my opinion, is timing. As a result of the media surrounding this issue, everyone seems to have an opinion, effectively setting the agenda for discussion and change (Kraft & Furlong, 2015). So, now is the time for healthcare professionals and patients alike to pursue the introduction of such a bill for debate. As Sam Arora pointed out, a bill that was continually vetoed still has the potential to pass.
Reference
Kraft, M. E. & Furlong, S. R. (2015). Public policy: Politics, analysis, and alternatives. (5th ed.). Thousand Oaks, CA.: CQ Press.
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What a wonderful blog submission! You did a wonderful job.
Mr. Arora’s comments resonated with me. I work for the state and have been part of discussions involving policy development, refinement, etc. It is true, sometimes it’s the little (sometimes insignificant) things, like a small budget, or understaffing, that truly drives or dives a policy implementation. Having health care professionals at the table also aids in this process, specifically when they are distinguished and advanced in their field. I enjoyed reading Mr. Arora’s assessment of bill approval/denial; a practical way to view things.
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Mr. Arora’s statement about healthcare professionals needing to be involved in policy making couldn’t be more accurate. What has been the involvement of nurse practitioners in policy making for Death with Dignity laws? JHM
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To be truthful, I have researched NPs role in Death with Dignity and there are articles regarding the ANA’s Code of Ethics; and some from personal perspectives regarding their own thoughts on aid in dying. I am assuming in the near future we will be addressing if NPs will be more involved in the prescribing process.
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