End of life care in the U.S.

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CATEGORY: Academics
TYPE: Articles
RELATED PROGRAMS: Political Science

By Ben Bartenstein ’16

Health care policy has been a longstanding passion for Anna Schmitz ’14 (St. Paul), but “death panels were not something I was interested in as a child,” she admits.

Schmitz’s curiosity about health care policy was stimulated by a four-year internship she held with Planned Parenthood’s public affairs department. But it wasn’t until she took Professor Michael Zis’s course Politics and Policymaking that she began thinking about end-of-life care policies.

Zis’s course inspired Schmitz to pursue research on the subject matter with former Macalester professor and retired Minnesota state legislator Julie Bunn. Schmitz’s findings became part of her senior capstone thesis, titled “Beyond Death Panels: Why the United States’ End-of-Life Care System is Broken and How It Can Be Fixed.”

Working with political science professor Paul Dosh, Schmitz focused her capstone research on the link between spending and quality of care in the United States. “The United States spends more on end-of-life care than anywhere else in the world, but when you put the U.S. within a global ranking of end-of-life care, we’re eighth,” Schmitz says. “The big questions of my project were why this is and what can we do to change it.”

Schmitz points to the United Kingdom—which came out on top in a global ranking of end-of-life care policies—as a country with a more centralized care system that prioritizes end-of-life care. Although the United States offers patients official forms in which they can specify their preferred end-of-life care options, most people do not fill out these forms, says Schmitz, leaving these difficult decisions to their families or care providers.

“You end up having these sustained medical interventions at the end of life that people don’t necessarily want for themselves,” Schmitz says. “They end up being really expensive and painful.”

Along with her paper, Schmitz also developed the website Empowered Endings, which presents her thesis in an interactive and accessible format. Dosh credits Schmitz’s research for providing tangible policy recommendations to be considered on the national stage. “Although it continues to be a really difficult arena to work in, I think Anna’s project maps out some specific ways that we can actually improve health care,” Dosh says.

During her final months at Macalester, Schmitz was balancing her coursework, research with Bunn, an internship with the Minneapolis nonprofit Grassroots Solutions, and her final season on the track team. She hopes to work for a progressive nonprofit organization after graduation.

PUBLISHED: 05/01/2014