The miracle of a long life today is often accompanied by an incremental decline involving a series of crises followed by progressively shorter health plateaus. Recent statistics illustrate that the length of the “golden years" has extended over the past decades and today Americans can expect to live into their 80s. According to the CDC, the two fastest growing age groups in this country are individuals over the age of 65 and those over the age of 100. The effect of longer life and an increased focus on maintenance of health, is clearly reflected in the “new normal” trajectory of death.
Societal changes have compounded the plight of the elderly and impacted medical practice.
• The elderly’s children are more likely to have dual career households, spread across the country and less able to give support or assist in care
• Families have limited experience with death and dying. Many have never directly experienced loss due to death
• The experiences of patients and families with chronic illness make recognition and acceptance of terminal status difficult
Overarching a complex set of medical issues, are the difficult discussions and decisions when patients are no longer able to speak for themselves. Decisions to approve or forgo heroic measures can be filled with emotion and anxiety for decision makers who are not certain of the choices of their loved ones. In the absence of a living will or clear communication and documentation of desires from patient to decision maker, there is not clear directive of patient choice
So, how do we begin the important work of clarifying end-of-life healthcare choices? Begin with yourself and your loved ones. If you haven’t completed an advance directive, start the process today!
Remember the most important facts:
• Living Will
a. Allows you to document your healthcare choices in the event that you are not able to speak for yourself
b. No special form is required. It can even be written on a regular piece of paper
• Healthcare Surrogate
a. A legal document that allows you to choose another competent adult to make healthcare decisions for you when you are not able to speak for yourself
• Both Living Will and Health Care Surrogate
a. Must be written and signed by the person executing it
b. Must be signed by two competent adult witnesses
c. At least one witness should not be a spouse or blood relative
d. May be cancelled at any time by destroying the document or by verbally telling your healthcare provider you want to cancel or revoke it
• Durable Power of Attorney for Healthcare
a. Commonly includes designating certain financial rights as well as rights for healthcare decisions
b. It is recommended that you obtain the services of an attorney to complete
Once you have gone through the process, it will be easier to make discussion of advance directives a regular part of your practice. Begin simply and talk openly about the kinds of choices a patient may make. Gently encourage discussion about fears. Encourage patients to consider what quality of life means to them, based on their culture and beliefs. How much would they want to know about their condition or prognosis? How much medical information would they want their family to have? Who would they want to speak for them?
Be assured that a large majority of patients and close family members are interested in discussing end-of-life issues in advance. Good communication and well prepared advance directives can facilitate the development of a comprehensive treatment plan that is in accord with the patient’s wishes and values. The greatest gift a person can give themselves and their family is to consider, document, and communicate healthcare wishes in advance.
There are a variety of excellent resources available online.
The Other Talk, a book by Tim Prosch Guides for completion of advance directives:
• Physician Orders for Life Sustaining Treatments
• Holding discussions about end of life care