Monthly Archives: April 2015

Week Fourteen 4/19/15 to 4/25/15 Strategies for Increasing Consumer Participation in the Policy Process.


Policy Process

Hello! Welcome back to this week’s discussion on the policy process and how to increase consumer participation. All the way back in Week Four we discussed how policies ensured that people’s basic needs and rights are being met (e.g., health, education, and safety).

People reading this blog may sit back and wonder how death with dignity fits into this explanation? In the past 14 weeks this discussion on Death with Dignity was meant to not only provide information, but to (possibly) get interested parties involved in supporting a bill in Arizona.


Consumer Participation

Policy making should involve consumers, but why? The obvious answer is that consumers should be considered major stakeholders; and have input on expectations, needs, and preferences (Pask, 2011). The World Health Organization (WHO) mentions how consumers play a central role for healthcare quality and safety (2015). For change to occur in healthcare, it takes vast community education, consumer advocacy, and constructive debates (Palmer and Short, 2000).

In Arizona, there is nothing on the horizon for a Death with Dignity bill. With the help from advocacy groups like Compassion & Choices or Death with Dignity National Center the message will continue to spread across the United States.

For those interested parties there is a petition (found on for Arizonans to sign who support a death in dignity. The goal is 200 signatures to be delivered to the Arizona State House, the Arizona State Senate, and Governor Doug Ducey (, 2015). There is also a local chapter of Compassion & Choices in Arizona; and a meeting is scheduled on March 28, 2015 in Tucson with guest speaker, State Senator Steve Farley (D), to discuss the introduction of a new aid in dying bill (Compassion & Choices Arizona, 2015).

Final Thoughts…A Wrap-Up

Since this is the last week of the dignity discussion, I wanted to end with an news story  I read in the Denver Post. It was a discussion about the Death with Dignity movement in Colorado (CO); and an interesting statistic about how 80% of people agreed with an aid in dying, but when asked if it should be enacted into a law that number dropped to 45% (Denver Post, 2015). It appears strange that in conversation people say they agree terminally- ill people should have the right to choose how they die, but won’t support a bill. Is is because this subject matter is an ethical dilemma for most?

I want to hear from the you…the consumer.

Thank you for all your comments; and remember you have a voice!


Compassion & Choices Arizona (2015). About us. Retrieved from

Denver Post (2015). Lamm: Death with dignity: A new civil rights movement. Retrieved from

MoveOn.Org (2015). Arizona death with dignity act. Retrieved from

Palmer, G.R. & Short, S.D. (2000). Health care and public policy: An Australian analysis. South Yarra, AU: Macmillian Publishers Australia.

Pask, Robert (2011). Getting the whole picture-consumer participation in health policy. Journal of the Health Forum in Australia, 9(1), 1-2.

World Health Organization (2015). Patients have a voice to! Retrieved from


Week Thirteen 4/12/15 to 4/18/15 Sustaining Innovative Environments: Considerations of Time and Scope.

Brazil Rio+20

Sustainability and Innovative Environments

We talked about innovators and change agents in past weeks, so let’s discuss sustainability. Sustainability builds and maintains the conditions to ensure human health and the environment is protected; and living in productive harmony (United States Environmental Protection Agency (EPA), n.d.). This definition comes from the EPA, but the concept still applies to health care. Do we have the materials and resources to acquire and maintain human health?

The United Nations’ drafted 17 sustainable goals (deadline is 2030) and they focused on ending poverty, hunger, and  discrimination against women. It also listed equitable and quality education; ensuring healthy lives through prevention; affordable energy; and sustained economic growth (The Guardian, 2015). These goals would take trillions of dollars. Let me state this more clearly, ending poverty would approximately take 66 billion dollars a year; and sustaining infrastructure (e.g., water, agriculture, power, and transport) would be 17 trillion annually (The Guardian, 2015). The World Health Organization drafted a Health Impact Assessment to determine which health indicators can indicate if we are advancing sustainable development (WHO, 2015). For instance, if we can prevent pollution then pulmonary and cardiovascular diseases may decrease (WHO, 2015).

Sustainability and Death with Dignity

Since Death with Dignity does not exist in the State of Arizona it makes it difficult to have dialogue about sustainability. Looking at states like Oregon, Washington, and Vermont it is important to mimic what they have done to legalize and maintain death with dignity. As time moves on, so does healthcare. It will be imperative the laws reflect these changes. For instance, there may be a day where the definition of physician-assisted death may include nurse practitioners. To date, only physicians can write a lethal prescription (Death with Dignity National Center, 2015).

As stated in previous weeks, I believe sustainability of the Death with Dignity movement hinges upon continued education of the American people, especially in states where this end-of-life option does note exist. Also, bills modeled after the Oregon Death with Dignity Act will help those drafting the bill utilize correct verbiage; and  (most importantly) Oregon has years of data to prove its safely enforced (Death with Dignity National Center, 2015).


Final Thoughts…on Sustainability

While researching this topic, I found the very essence of true sustainability. This story is truly for our green readers. It appears the funeral business has been causing havoc on our Mother Earth. Here are some alarming facts about the funeral business and waste:

  1. Approximately 30 million board feet of chemically-treated hardwood; 827,000 gallons of embalming fluid; and tons (in the thousands) of concrete, steel, copper and bronze are used yearly.
  2. Embalming fluid, containing formaldehyde, has been found in groundwater; and is carcinogenic.
  3. The wood used for some caskets, mahogany, that is endangered.
  4. Cremations cause approximately 600 pounds of mercury (i.e., fillings from teeth) to be released into the atmosphere. There have been legislative attempts for filters with cremations.
  5. A 10-acre cemetery has enough wood to build 40 houses (Death with Dignity National Center, 2015).

The Green Burial Council is a non-profit organization dedicated to environmentally sustainable death care (Death with Dignity National Center, 2015). It starts with choosing a designated conservation burial ground that is owned by a non-profit. There will be no vases or plastic flowers at burial sites, but only indigenous plants and flowers; and 5% of burial costs go towards an endowment to invest back into the land (Death with Dignity National Center, 2015).

This was the first time I heard of a green burial. Just a thought for those literally worried about sustainability (even in death).


Death with Dignity National Center (2015). Dying to give back to the Earth. Retrieved from

Death with Dignity National Center (2015). Death with dignity around the U.S. Retrieved from

The Guardian (2015) Sustainable Goals:All you need to know. Retrieved from

United States Environmental Protection Agency (2015). What is sustainability. Retrieved from

World Health Organization (2015). Health indicators for sustainable goals. Retrieved from

Week Twelve 4/5/15 to 4/11/15: Health Care Financing


Health Care Financing

This week we will talk money and healthcare. The main concern regarding health care is what will something cost. Projections by the Congressional Budget Office (CBP) estimate that the total spending on healthcare will double by the year 2035; and will consume more than 30% of the gross domestic product (GDP) (Longest, 2012).

Medicare and Medicaid remain the biggest of the fiscal challenges for the United States (U.S.) (Longest, 2012). As stated in a previous posts, the Affordable Care Act (ACA) has created the Innovation Center (a segment of Medicare & Medicaid Services) in order to test new health care payment and service delivery models to improve quality of care; and decrease healthcare expenditures for Medicare & Medicaid beneficiaries (U.S. Department of Health & Human Services, n.d.). Currently, the Innovation Center is evaluating 18 major payment and service delivery models. Some of those models are as follows:

  • Partnership for Patients: Aims for 40% reductions in hospital acquired conditions; and a 20% reduction in readmissions.
  • Strong Start for Mothers and Newborns: Reduce risk of complications and long term healthcare problems for expectant mothers and newborns (U.S. Department of Health & Human Services, n.d.).

Financing and Death with Dignity

Death with Dignity participants will never receive federal monies to pay for lethal prescriptions. In Oregon, the Death With Dignity Act does not specify who pays for the services; and payment is determined upon individual insurers. Insurance companies cannot view lethal prescriptions as a suicidal act during the decision phase of payment (Oregon Public Health Division). If Medicaid is the insurer, only state funds can be utilized (Oregon Public Health Division, 2014).

Financing and End-of-Life

A saving grace for people seeking some form of comfort care at end-of-life is that Medicare Part A does pay for hospice services. The requirement for hospice services include:

  • Two physicians (e.g., following and a hospice physician) confirming a terminal diagnosis (6 months or less)
  • Agreement to accept comfort vs. aggressive treatments
  • Patient (or MPOA) signature providing consent to hospice services

It must be stated that the ACA is now allowing that patients under 21 years of age can seek curative (aggressive) treatments while in a hospice program without the worry of being discharged or paying out-of-pocket for hospice services (, n.d.).

Final thoughts on Healthcare and Financing

According to the World Health Organization the goal is for universal health coverage to ensure that all people of the world have the health services they need without suffering financial hardship (WHO, 2015). Some staggering statistics provided by WHO:

  • One billion people cannot receive needed health services
  • 150 million people suffer financial catastrophe upon receiving health services
  • 100 million people are pushed below poverty line upon receiving health services (WHO, 2015).

Please watch this eye-opening video about financing health care. What are your opinions about health care and financing?



Centers for Medicare & Medicaid Services (n.d.). About the CMS innovation center. Retrieved from

Longest, B. B. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press. (n.d.). Hospice benefits. Retrieved from

Oregon Public Health Division (2014). FAQs about Death with Dignity Act. Retrieved from

United States Department of Health and Human Services (n.d.). HHS FY2015 budget in brief. Retrieved from

World Health Organization (2011, July 6). WHO: Financing health care. Retrieved from

World Health Organization (2015). Universal health coverage. Retrieved from