Encouraging Medicare participants to write living wills could end up saving the government large amounts of money, HHS Secretary Mike Leavitt said Monday.
The Terri Schiavo case has put new focus on living wills and advanced directives, documents written in advance of serious illness that typically stipulate the kind of life-prolonging medical care people want if they become terminally ill or lapse into a vegetative state.
Speaking to hospital administrators, Leavitt said he recently was approached by a congressman who raised the idea of incorporating living wills into Medicare consultations.
"It may be that we could build into Medicare a means by which there was a consultation as part of the Medicare physical where that decision could be discussed and potentially made," Leavitt said, and "it would not just save families anguish but would likely save the system a remarkable amount of money, allowing that money to be spent in other ways and in other places."
Leavitt did not specify how living wills would save the government money. But presumably, if such a proposal is enacted, the government would not spend money keeping alive terminal patients who had filled out living wills rejecting life-prolonging medical care.
Medicare serves about 42 million senior citizens and disabled people. The government is projected to spend $345 billion on the program during the next fiscal year.
The importance of living wills was reinforced in the legal battle surrounding custody of Schiavo, 41, who died March 31 at a Florida hospice, almost two weeks after her feeding tube was removed by court order.
Her death ended a bitter legal battle between her husband, Michael, and her parents, Bob and Mary Schindler, who wanted to keep the tube in place.
One of the results of that case has been a substantial increase in inquiries to doctors and hospitals about how to establish advance directives, or living wills. Hospitals are required to inform their patients about advanced directives, but it's often too late at that point, said doctors who spoke at an American Hospital Association press conference.
Rick Wopat, M.D., a family physician from Lebanon, Ore., said he advises all his patients to draw up living wills and to discuss their views with family members and their physicians.
"Don't wait for the accident or stroke to make the decision," Wopat said. "Or you may not have the opportunity to make it."
The AHA on Monday announced an education campaign on living wills in response to numerous inquiries its members have received since the Schiavo case. The association established a Web site that provides a downloadable card patients can carry to alert caregivers that the patients have filled out advance directives.
The site also links to advance directive forms from every state. Laws that pertain to living wills can differ from state to state.