reports on a town in Wisconsin with the highest rates of living wills in the country.
"[N]early all adults who die in La Crosse, 96 percent of them, die with a completed advance directive. … But it's expensive to spend time with patients filling out living wills. Medicare doesn't reimburse for the time the hospital's nurses, chaplains and social workers do this. Bud Hammes, the medical ethicist who started the program [at Gundersen Lutheran Hospital], called Respecting Choices, says it costs the hospital system millions of dollars a year. 'We just build it into the overhead of the organization. We believe it's part of good patient care. We believe that our patients deserve to have an opportunity at least to have these conversations.'"
A proposal in the health bill recently passed by the House "would pay for the kind of periodic and continued end-of-life discussions with patients that are routine in La Crosse. Gundersen Lutheran is pushing for it. Hammes says claims that government-run panels would pressure sick people to die are bizarre exaggerations — and that the experience of this Wisconsin city proves it. … One result of the way that care is delivered: At Gundersen Lutheran, less is spent on patients in the last two years of life than any other place in the country" (Shapiro, 11/16).