The 107th Congress' Legislative Proposals Concerning End-of-Life Care

Purpose: The current health care system cannot reliably meet the needs of patients with eventually fatal chronic illnesses near the end-of-life. Enduring change requires improved public policy, in part because most paid care for serious illness at the end of life now relies on federal programs. This project reviews the legislation proposed in the 107th Congress (2001-2002) related to improving end-of-life care. Methods: The authors searched THOMAS, the search engine of the Library of Congress, to identify all bills relating to end-of-life care introduced in either house of the U.S. Congress during the 2001/2002 legislative period. Using explicit criteria intended to find any that received serious attention and incorporating recommendations of political consultants, the initial 563 bills narrowed to 22. They summarize their status as of October 24, 2002. Results: The 22 bills identified dealt with the following topics: demonstration or research projects (9), palliative care or hospice (8), caregivers (7), chronic illness generally (5), care coordination (2), and long-term health care (3). Dementia, graduate medical education, nursing, and pain appeared in 1 bill each. Congress enacted only 1 of the bills. Only 7 bills had more than 10% of either house as sponsors. Conclusions: While Medicare reform and health care costs are prominent topics among policymakers, Congress is considering essentially no fundamental changes that would remedy the problems associated with health care for the elderly who are seriously ill near the end-of-life. The mismatch between the urgency of policy reform and the lack of vehicles and momentum to achieve reform calls for consensus and leadership from those concerned with hospice and palliative care.