Choices in Planning for End of Life Care Committee 

Meeting of November 5, 2003

Present:  Diana Peirce, John Campbell, Fred Crowley, MD, Annette Blanchard, Olivia Weed, Joan Madison, MD   Excused: Bob Orr, MD  (through an oversight, Angel Collins was not contacted about the scheduled meeting.

It was first decided to alter the name of the committee slightly so that it would not be confused with a prominent advocacy organization newly formed to promote PAS legislation.

John Campbell started by announcing that the Vermont Ethics Network had lost its State support and had been asked to relocate by January, 2004, per a new policy of the Governor.  Plans are underway and he was confident the move would be accomplished.

Diana Peirce indicated that the ExCEL Steering Committee was preparing for a presentation for the Vermont Program in Quality Health Care (VPQHC) and had requested goal statements from each committee.

Following good discussion among participants the following draft goals were suggested for the Choices in Planning for EOL Care Committee:

1. Increase the use of advance directives.
2. Standardize the process for implementing out-of-hospital DNR orders.
3. Increase the dialogue between families, patients and health caregivers by
   1. encouraging advance care planning as part of routine health care in all settings;
   2. providing more information about planning for choices in health care near the end of life; and
   3. evaluating the effectiveness of advance directives and advance care planning.
4. Develop more effective education programs for the public at large.

Several minutes were spent discussing new approaches to community education, especially for young people in high schools and college settings.  One suggestion was a take-off on the anti-drug ad fostering more communication between parents and children.  In reverse, it was essentially: “Do you know what your parents’ plans are for end of life care?”  (This could be used to get younger people to approach their parents about preparing advance directives).  Assemblies could emphasize issues around organ donation and related topics as well. 

Diana Peirce next shared the results of a statewide survey on the implementation by region of out-of-hospital DNR protocols from the standpoint of key stakeholders in the health care system.  What became obvious was the degree to which confusion reigns in many districts about what is in place and who is “on board” for knowing about and following procedures.  Where there is a cohesive team (such as in Central and northern Vermont hospital areas) there tends to be better communication and understanding.  An identified need is for more standard implementation procedures statewide.  It was suggested that we try to arrange for our next meeting to be at the Vermont Department of Health in early December at a time when, hopefully, both Dan Manz and new VHD Commissioner Dr. Paul Jarris could join us for part of the meeting to discuss this point and brainstorm possible next steps toward this goal.

John Campbell will see if we might meet on either December 3 or December 10 in the afternoon at 108 Cherry St. in Burlington. 

In closing, we talked briefly about the need for more baseline data on use of advance directives.  John indicated that that is still a goal of VEN’s proposed project about the effectiveness of advance directives, perhaps through hospital censuses.  He also mentioned the funeral director survey that has been developed for families to respond to about several aspects of end-of-life care, including several questions about whether people had advance directives and whether they were helpful in the final week(s) of life in improving care and communication between physicians, family and other caregivers.  (He mentioned that the Vt. Community Foundation has been asked for funding but will not act on the request until late December.)