Doctor-Patient End-of-Life Discussion
As a starting point, the Family Caregiver Alliance (FCA) recommends:
“Ask your doctor for a time when you can go over your ideas and questions about end-of-life treatment and medical decisions. Tell him or her you want guidance in preparing advance directives. If you are already ill, ask your doctor what you might expect to happen when you begin to feel worse. Let him or her know how much information you wish to receive about your illness, prognosis, care options, and hospice programs.”
A doctor-patient discussion will help clear up a number of matters on both sides. The patient will be better able to make responsible decisions, and the physician will be better able to help the patient take measures to ensure his or her wishes are carried out when the time comes. Unfortunately, as Abrahms Spring points out in her letter to the Times, “doctors tend to avoid end-of-life discussions with their aging patients” because they fear upsetting patients and “assume that they would ask for details, if they wanted them.”
Abrahms Spring’s observations seem to back up the Family Caregiver Alliance’s suggestion that patients approach doctors about scheduling end-of-life discussions and not simply wait for doctors to bring up end-of-life concerns.
A comprehensive patient-doctor discussion can make it easier for the patient to establish a living will. According to the American Psychological Association, about a quarter of Americans had living wills in 2010. It is almost universally understood that living wills are especially important for seniors, and can be vital when it comes to ensuring that seniors’ final wishes concerning potentially life-prolonging measures are respected.
These are a few issues the Family Caregiver Alliance (www.caregiver.org) recommends discussing with a physician or other qualified individual:
- What medical treatments and care are acceptable to you? Are there some that you fear?
- Do you wish to be resuscitated if you stop breathing and/or your heart stops?
- Do you want to be hospitalized or stay at home, or somewhere else, if you are seriously or terminally ill?
- How will your care be paid for? Do you have adequate insurance? What might you have overlooked that will be costly at a time when your loved ones are distracted by grieving over your condition or death?
The FCA also recommends asking and discussing:
- What actually happens when a person dies? Do you want to know more about what might happen? Will your loved ones be prepared for the decisions they may have to make?
For people needing help preparing a living will, the nonprofit organization, Aging with Dignity, may be a good source of help. According to the organization’s website, Aging with Dignity’s mission is “to affirm and safeguard the human dignity of individuals as they age and to promote better care for those near the end of life.”
Since 1997, Aging with Dignity has offered a living will program called Five Wishes. According to the Aging with Dignity website, Five Wishes meets the legal requirements for living wills in 42 states and has helped millions of people plan for and receive the kind of care they want. Five Wishes is also described as user-friendly, easy to read, and easy to complete.
Aging with Dignity offers a preview of Five Wishes to show how easy it is to use as a living will document. On page 3 there is a list of the 42 states that, along with the District of Columbia, accept Five Wishes as a legal testament or expression of a living will. To residents of the other eight states, Aging with Dignity suggests it may be advisable to complete Five Wishes along with any legal forms required in those states.
There is also an online version of Five Wishes, which allows quick completion of a living will and an immediately-printable personalized document.
According to the FCA, “most advance directives cover life-sustaining treatment such as artificial feeding, mechanical ventilators, resuscitation, defibrillation, antibiotics, dialysis and other invasive procedures.” Living wills can also specify when treatment should go no further than for alleviation of pain, essentially allowing nature to take its course. Most physicians will be quick to respect your wishes, says the FCA, and, while “a health care provider may refuse to observe your stated wishes or the decisions of your agent because of conscience or the institution’s policies or standards … the provider must inform you or your surrogate immediately and transfer to another provider should be arranged.”