The bill considered in this paper introduces the Palliative Care and Hospice Education and Training Act (PCHETA). The latest version of this bill, updated in 2019, requests to amend the Public Health Service Act and increase the presence of palliative care in the healthcare sphere of the United States (Congress, 2020). In particular, it calls for a grant to establish new permanent palliative care faculties in various medical organizations, nursing and social work schools, and other programs. The bill also urges the government to support staff training in palliative care. According to the PCHETA description, the Department of Health and Human Services (HHS) should:
- Provide academic career awards to palliative care workers to support their career development;
- Support palliative care education faculties;
- Financially assist persons who pursue an advanced degree in palliative or hospice care;
- Award grants for this education path (Congress, 2020).
Background
Palliative care is a healthcare segment that focuses on alleviating pain and other symptoms in patients whose condition is chronic and life-threatening. Thus, palliative care aims not to cure the illness but to improve one’s quality of life, allowing them to live a fulfilling life without being held down by their health problems. According to statistics, approximately 90 million Americans currently live with chronic or serious illnesses, such as stroke, dementia, and diabetes (Brent, 2020). This number is expected to grow significantly in the next decades, and the aging generation of people with such severe conditions will likely require constant medical assistance. Palliative and hospice care shift the focus away from treatments that some patients may not want to measure that improve everyday living (Ornstein et al., 2017). However, many health professionals are not educated in palliative care, which remains primarily related to nursing.
Relevant History, Votes, Issues
This bill has a rather long history in the United States government. Earlier versions were introduced in 2012, 2013, and 2015; the third revision of this bill passed House in 2018 and headed to the Senate. In January 2019, the bill was reintroduced again and referred to the Senate Health, Education, Labor, and Pensions Committee (GovTrack, 2020). It passed House in October 2019 and is currently awaiting a Senate decision, although it may take more time to progress. According to the House records, the bill was passed with two-thirds voting positively (Congress, 2020). However, opposition to the bill from several associations and individual activists is potentially stalling the legislation’s passage in Senate and its subsequent enactment.
Support and Opposition
First of all, the bill was proposed by Eliot Engel, the Representative for New York’s 16th Congressional district (GovTrack, 2020). He is a Democrat, and his history of sponsoring bills includes international affairs, health, crime, and law enforcement as the three major areas. Apart from that, the bill has 295 sponsors from both Democrats and Republicans (194 to 101 representatives, respectively), which shows a great urge from the government officials to enact this bill (Congress, 2020). Engel argues that palliative and hospice care have helped people and led to the improvement of patients’ well-being (Congress, 2020).
The bill would help educate health professionals, patients, and families about the benefits of palliative care. Engel also states that 54 national organizations have voiced their support for the PCHETA (Congress, 2020). Alzheimer’s Impact Movement (2019) writes that palliative care demand grows quicker than the available services and their quality. Thus, this and other organizations argue for passing the bill to improve the care quality and expand the reach of palliative care.
One of the opposing organizations to this bill is the Association of American Physicians and Surgeons (AAPS). In 2018, the organization wrote that the dedication of $100 million to palliative care is inappropriate as it would “persuade patients to forgo treatment that might prolong life” (AAPS, 2018, para. 3). Moreover, the AAPS urges Congress to roll back all existing policies that “perpetuate a culture of hastening death,” which lowers patients’ access to potentially curative treatment (AAPS, 2018, para. 3). Finally, the opposition considers palliative care, not as a separate specialty but as a skill that all physicians should have to decrease patients’ pain. Also, several faith-based and pro-life movements oppose this bill, as it questions the sanctity of life and health professionals’ fundamental idea of “no harm.”
Pros and Cons
The position of the bill’s supporters is that the PCHETA will expand palliative care education in the US. Thus, the benefit of this financial support would be that nurses, physicians, and other health professionals would learn about palliative care treatments and strategies, implementing them in their organizations. The center of this bill is education and development, which could support students who seek palliative care courses. Patients treated in the new system may meet professionals who are ready to consider both disease treatment and quality of life improvement.
In contrast, the opposition argues that palliative care institutions threaten patients’ lives, potentially shortening their life spans and interfering with their doctor-patient relationship (AAPS, 2018). They cite patient mishandling and abuse in the system and show that palliative care education takes away from patients’ willingness to try treatments that could prolong their lives. According to research, adverse outcomes occur in palliative care, but significant studies support this approach’s benefits for patients’ life, everyday activities, and mental and even physical health (Alzheimer’s Impact Movement, 2019; Ornstein et al., 2017; Parker, 2019).
Impact on Nursing
If this bill were to pass and become law, the careers of many nurses would be impacted. In particular, palliative care and hospice nurses would receive additional opportunities for continuing education, gaining further knowledge about how to accommodate patients and treat them with dignity. Next, the number of future student nurses could increase with financial awards and grants. Palliative care faculties could introduce courses for all nurses, raising their awareness of palliative care. Patients and their families would become informed of several possibilities for treatment and symptom management. In the end, the bill could become a start of shifting away from the view of health as the absence of disease toward the idea that one can live a happy life with a chronic or severe condition.
Actions
To pass or defeat this bill, nurses can use their voices and experience. For example, they can track the bill on such websites as GovTrack for updates. Then, they should reach out to their legislator and voice their support (or opposition). Letters and calls are the two main strategies for contacting the representatives, and they should contain one’s opinion and professional explanation of reasons and arguments for or against the bill. If the bill passes, nurses should take further action to employ it in their workplace. For example, a nurse educator may talk to the organization’s dean and encourage them to apply for the grant. Students and those wishing to continue learning may apply for educational programs in palliative care. Nurse legislators should talk to people in their district, educate them on the bill’s contents, and gather the public’s opinions.
References
Alzheimer’s Impact Movement. (2019). Palliative and hospice care. Web.
Association of American Physicians and Surgeons. (2018). AAPS asks senators to oppose Palliative Care and Hospice Education Training Act (PCHETA). Web.
Brent, N. J. (2020). This year, make your voice heard on a healthcare bill. Web.
Congress. (2020). H.R.647 – Palliative Care and Hospice Education and Training Act. Web.
GovTrack. (2020). H.R. 647: Palliative Care and Hospice Education and Training Act. Web.
Ornstein, K. A., Schulz, R., & Meier, D. E. (2017). Families caring for an aging America need palliative care. Journal of the American Geriatrics Society, 65(4), 877. Web.
Parker, J. (2019). House approves Hospice Education Act. Hospice News. Web.