December 04, 2015

[Sen. Chris Coons] Encouraging Advance Directives is About Supporting Individual Choice


As Americans, we treasure the freedom to make our own choices about our future. Yet far too often, families in Delaware and across the United States find themselves making difficult and complicated health care decisions for loved ones who are no longer able to speak for themselves. These decisions are heartbreaking for families, who want nothing more than to respect their loved ones’ preferences but may not know what those preferences are. The decisions are equally heartbreaking for patients themselves, who would never wish such a choice upon the family and friends they care about most.

These situations are too common in the United States, even though most us want to spend our final months on our own terms. Recent studies have shown that more than two-thirds of Americans have thought about their preferences for care in the event of serious illness or injury, and 9 in 10 believe doctors should have these conversations with their patients. Despite this widespread support, fewer than 20 percent of Americans actually have had these discussions with their doctor.

The overwhelming need for improving these conversations is nothing new to Delaware doctors. When I first ran for the Senate in 2010, I sat down with a group of physicians to get their thoughts on America’s health care system. I asked them, “What are the most important health care problems that Washington or elected leaders aren’t fixing?”

I expected 17 different answers from the 17 physicians I spoke with – but I got the opposite. Every doctor could think back to a case in which a patient faced a terminal illness and did not have long to live – yet each performed operations or interventions that the doctor didn’t think the patient would have wanted and that often came at an enormous emotional cost for the patient’s family.

Fortunately, we’re seeing signs of progress. In June, Senators Johnny Isakson and Mark Warner reintroduced a bipartisan bill that would encourage advanced care planning by providing incentives for health care providers to discuss and document end-of–life decisions made by patients while in their care. In October, the Centers for Medicare and Medicaid Services (CMS) finalized new rules allowing Medicare to reimburse doctors for speaking with their patients about end-of-life preferences.

Last month, I led a coalition of six Republicans and Democrats in Congress to build on that momentum by introducing legislation that represents the next step forward. The Medicare Choices Empowerment and Protection Act establishes a financial incentive for Medicare beneficiaries to create electronic advance directives by providing a one-time payment of $75. Advance directives would be maintained by outside organizations approved by CMS and could be modified or canceled at any time.

Our bill simply seeks to make an extraordinarily difficult conversation a little easier. By encouraging patients to start thinking about these decisions earlier and giving them time to compile the necessary information from their health care providers, the Medicare Choices Empowerment and Protection Act reduces confusion and empowers patients to make their preferences clear. 

Support for these important reforms transcends political party. Our bill is supported by organizations as diverse as the American Nurses Association and the National Right to Life Committee, America’s largest right-to-life organization. It’s also been endorsed by local advocacy groups, including the Delaware Academy of Medicine/Delaware Public Health Association.

Delaware has already taken action to empower patients to improve the quality of care they receive at the end of their lives by passing a law earlier this year establishing the Delaware Medical Orders for Scope of Treatment program. Now it’s time to make progress on a national scale. 

The Medicare Choices Empowerment and Protection Act is a key step in that direction. It preserves each and every American’s right to a good life, from one chapter to the next.


-U.S. Senator Chris Coons


The above op-ed was featured on DelawareOnline.