Week Five 2/11/15 – 2/18/15 Healthcare Policymaking Including Statutory and Regulatory Mechanisms

Welcome to Week 5! Let us begin this week by reviewing some definitions. What exactly are statutes and regulations?; and how do they link in with the policymaking process, especially regarding Death with Dignity?

Statues and Regulations

Statutes are written laws made by legislators on a federal or state level (Georgetown Law, 2014).

Regulations are the force of the law that governs; and an explanation on how a governing agency intends to carry out laws (Kraft and Furlong, 2014; USA.gov, 2015).

How Does This Relate to Policymaking?

Let’s simplify this some more by giving a recent example. For instance, the Affordable Care Act (ACA) was passed by Congress; and signed into law (a statute) by President Barack Obama in 2010. With the passing of the ACA how does Congress have the time to enforce the new law? Truth is, after a law is passed there are agencies, boards, or commissions assigned to help with the rulemaking process. During this process, rules are created and with the help of public feedback, the rules are either changed, added, or kept; and then final rules are registered with the Federal Register (USA.gov, 2015). One regulatory agency for the ACA was the Center for Consumer Information and Insurance Oversight (CCIIO), which assisted with implementing many of the provisions of the ACA that dealt with private health insurance (Centers for Medicare and Medicaid Services, n.d.).

How Does This Apply to Our Death with Dignity Discussion?

As mentioned in previous posts, Arizona currently does not have any aid in dying laws on the horizon; and the federal government has told states to make their own statutes regarding aid in dying. So who helps with regulation process once an aid in dying law passes?

Let’s look at the state of Oregon, the Death with Dignity statue was initiated in 1997. Within the Death with Dignity Act (1997), it required the Oregon Health Authority (OHA) to be involved in the regulation process. For instance, the OHA collects all patient and physician information; mandates certain reporting practices, and publishes yearly statistical reports (Oregon Health Authority, (n.d.).

Here is the link to the most recent Death with Dignity Statute in Oregon; and Death with Dignity Rules:

http://public.health.oregon.gov/RulesRegulations/Pages/index.aspx

Final Thoughts

This week we talked about statutes and regulations. The policymaking and implementation process does appear to have its good points. I especially like the fact that during the regulatory process the public can voice opinions. But what do you think?

Please join me next week when we discuss how the public sector influences healthcare policy (especially in regards to aid in dying).

References

Centers for Medicare and Medicaid Services (n.d.). Consumer information and insurance oversight: Ensuring the Affordable Care Act serves the American people. Retrieved from http://www.cms.gov/cciio/

Georgetown Law (n.d.). Overview of administrative law. Retrieved from https://www.law.georgetown.edu/library/research/tutorials/admin/upload/1_overview_text.pdf

Kraft, M. E., & Furlong, S.R. (2015). Public policy: Politics, analysis, and alternatives (4th edition). Los Angeles, CA: Sage Publications, Ltd.

Oregon Health Authority (n.d.). Public health’s role. Retrieved from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ohdrole.aspx

Oregon Health Authority (n.d.). Rules and regulations. Retrieved from https://public.health.oregon.gov/RulesRegulations/Pages/index.aspx

USA.gov (2015). Laws and regulations. Retrieved from http://www.usa.gov/Topics/Reference-Shelf/Laws.shtml

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11 thoughts on “Week Five 2/11/15 – 2/18/15 Healthcare Policymaking Including Statutory and Regulatory Mechanisms

  1. kmangold78

    It is certainly a wonderful thing in our country that the public has an opportunity to voice opinions. I was first introduced to the effectiveness of this process when I was in high school on a much different topic than the one you are discussing, however. My father was active in the soil conservation board in our rural county and was asked to go to the one of the committees at the state legislature to testify and provide comment about a bill under consideration. He took me along for the day. His part was very short, perhaps less than 10 minutes. But we spent the entire day roving about the different committees in the morning and then observing the full house in session in the afternoon. I was able to see the policy process in action. I learned two important lessons that day. The first is that having a public voice is a gift not afforded to all, so one must be brave and confident enough to use that voice. The second lesson was that passion and interest are not enough. One must present themselves well and be informed to truly make a difference. The majority of what I saw was well done, but those who did not represent themselves and their opinions well were very ineffective. Yours is a topic where it might be easy to let passion overtake preparation and those using a public voice surrounding the topic of dying with dignity must do so with great care.

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    1. dignitydiscussion Post author

      Kara,

      Thank you for sharing your personal memories about your experience with policymaking. I agree with you about the passion overtaking the preparation. Although it is a good thing to be passionate about your platform, when presenting in front of legislators it has to be mainly objective so the information can be presented effectively.

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  2. mcivic2015

    This is such an interesting ethical topic. I attended a lecture on this topic recently, and left thinking “Why does our society consider it humane to end a suffering animals life, but not extend this to suffering humans?” To be honest, I don’t know my stance on this personally, but from a policy prospective I feel everyone should have a right to choose. That being said, there should be certain safeguards built into the regulation process. One of the regulations I think is helpful in Oregon’s law is the need for two separate physicians to agree the patient is eligible (Oregon Health Authority Website, n.d.).

    Reference
    Oregon Health Authority Website. (n.d.). Public health’s role. Retrieved from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ohdrole.aspx

    Liked by 1 person

    Reply
    1. dignitydiscussion

      I couldn’t agree with you more about the second opinion regulation mandated by the state of Oregon. Also, I find how they clarify that not any person is a candidate for a lethal prescription. The person must be mentally competent. In past weeks, I included a video on how a woman in AZ ended her life, with the assistance from a aid in dying advocacy group. Upon investigation, it was determined the woman had a severe psych history; and the advocacy group members were arrested. Please check out my Week Two blog if you have not already viewed.

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  3. SHEllis

    Great information on statutes and regulations related to death with dignity. When I first heard about this topic, I assumed that there would be significant regulations controlling who could prescribe medications, for example, only those certified in palliative care. However, I should admit, I have very little background regarding this movement aside from popular media outlets sharing Brittany Maynard’s story. After doing some research on my own, it looks like in Washington, any doctor of medicine or osteopathy can write the prescription if they so choose (Washington State Department of Health, 2015). In addition, I was surprised to learn that a survey among Vermont providers revealed that those physicians who do not care for patients through the end of life were significantly more likely to favor legislation of physician assisted suicide as compared to those physicians who do care for patients with a terminal illness (Craig et al., 2007). In my experience, palliative and end-of-life care is directly related to understanding and advocating for a patient’s wishes, thus establishing a natural correlation between palliation and death with dignity.

    In your research on this policy and the regulatory considerations, are there a large number of physicians choosing to participate? Do you believe that those choosing not to participate are referring patients to other providers or counseling against death with dignity?

    References

    Craig, A., Cronin, B., Eward, W., Metz, J., Murray, L., Rose, G., . . . Vergara, M. E. (2007). Attitudes toward physician-assisted suicide among physicians in Vermont. Journla of Medical Ethics, 33(7), 400-403. doi: 10.1136/jme.2006.018713

    Washington State Department of Health. (2015). Death with Dignity Act: Frequently asked questions. Retrieved from http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/DeathwithDignityAct/FrequentlyAskedQuestions

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    1. dignitydiscussion Post author

      Great information. In the regulations, a following physician is allowed deny prescribing lethal prescriptions. They are also suppose to provide optimal patient care until another provider is found (Oregon Health and Science University, 2008).. You would think this would be assumed, but I was happy to see it included in the regulations. I already posted for next week, and I delve more into this topic you mentioned. I invite you to read next’s week topic, public sector influences.

      Reference
      Oregon Health and Science University (2008). The Oregon Death with Dignity Act: A guidebook for healthcare professionals. Retrieved from http://www.ohsu.edu/xd/education/continuing-education/center-for-ethics/ethics-outreach/upload/Oregon-Death-with-Dignity-Act-Guidebook.pdf

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  4. katieboone0108

    I was intrigued by your introduction to the Federal Register. I frankly was unaware of how the public could voice their opinion during the legislative portion of the policy making process. I went to the Federal Register and looked at their ‘proposed rules’. I found the site easy to navigate and the link to post comments is quite obvious. The site offers tips on how to post an effective comment that I found quite helpful. It was interesting to see that one of the proposed rules was regarding environmental emissions in the county I live in! Although it is quite easy to be skeptical about whether or not these comments are effective, every comment appears on the public docket. Further, the website states that adverse comments will be addressed and could amend the rule.

    I viewed the tips on posting an effective comment and found this tip very encouraging with regard to public interaction in the legislative process.

    “The comment process is not a vote – one well supported comment is often more influential
    than a thousand form letters” (federalregister.gov).

    I will certainly be more apt to comment on appropriate legislation after viewing this website and would encourage others to do the same!

    (https://www.federalregister.gov/articles/2015/02/12/2015-02855/revisions-to-the-california-state-implementation-plan-san-joaquin-valley-unified-air-pollution)

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    1. dignitydiscussion Post author

      Katie,
      I am happy you actually viewed the website. Yes, the public does have a voice! If only we could cure the laziness factor (I, too, am included); and become more proactive in change! Thank you for posting the link. I found it highly informative.

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    1. dignitydiscussion Post author

      I believe groups like Death with Dignity and Compassion & Choices are taking a grassroots approach and are holding meetings to educate people on the law; and encouraging people to sign petitions and write to their lawmakers.

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