End-of-Life Issues Need More Attention
Physicians undergo years of education and training to promote wellness, cure illness, and preserve and protect life. But we’re also conscious of the inevitability of death, and in recent years, we’ve been paying more attention to end-of-life issues. It’s important for us to do so because it’s important for our patients.
As a physician who specializes in geriatric medicine, I am acutely aware of how death and dying affect patients and their families. I am amazed when an 80- or even 90-year-old reports to me, after raising the topic, that he or she has never had a physician ask them about end-of-life issues.
End-of-life issues are never easy to discuss, but such a dialogue is critically important for families. Preparing for your final days, especially if the patient has a terminal illness, is prudent, to specify to family members what your end-of-life wishes are and to prevent confusion, regret, or trouble within families. Preparation also provides peace of mind for you, knowing your wishes will be honored.
While conversations between family members are essential, talking with your primary-care physician is also important. He or she needs to know what steps you wish to be taken or not taken should you find yourself in a critical medical condition or become unable to make decisions for yourself.
We all recognize the need for a will, to ensure that our possessions are left according to our wishes. But comprehensive end-of-life planning calls for additional documents. Here are the basics, courtesy of the Hospice & Palliative Care Federation of Mass.
Advance directives are instructions about your future medical care, should you become unable to communicate those instructions yourself. Such directives include a living will and durable power of attorney or health care proxy.
A living will, sometimes called a ‘directive to physicians’ or ‘declaration of health care,’ specifies the kind of lifesaving or life-sustaining care you want or don’t want in the event that you become incapacitated or terminally ill.
A health care proxy, or durable power of attorney for health care, designates a person of your choice to make health care decisions for you if you cannot do so for yourself. A health care proxy, legally binding in Massachusetts and many other states, ensures that your care will be consistent with your beliefs and values and that your final wishes will be fulfilled.
If terminal illness exists, you should also include an examination of hospice and palliative care, a medical specialty dedicated to relieving the pain and suffering of patients and providing them with the best quality of life possible. Hospice and palliative care are provided when care changes from cure to comfort during someone’s illness. It includes expert pain treatment, guidance with treatment choices, and emotional support for the patient and family.
As with most important decisions, having the right information to act on is critical. Here are some good resources.
The Hospice & Palliative Care Federation of Mass. at www.hospicefed. org is a comprehensive site that includes clear explanations on end-of-life issues. It also has a list of hospices and palliative care programs throughout the state.
The Mass. Medical Society at www.healthcareproxy.org provides a health care proxy form and step-by-step instructions on completing it.
Aging With Dignity at www.agingwithdignity.org presents Five Wishes, a living will that answers five simple but vital questions: who you want to make health care decisions for you when you can’t make them, the kind of medical treatment you want or don’t want, how comfortable you want to be, how you want people to treat you, and what you want your loved ones to know. The Five Wishes document, available in 26 languages, meets legal requirements in 42 states and is useful in all 50.
Finally, the Mass. Trial Court Library at www.lawlib.state.ma.us provides links to federal and state laws and regulations pertaining to durable power of attorney, health care proxies, and other advance directives. At the site, use the search function for ‘health care.’
Just three years ago, scores of national and local organizations came together to create National Healthcare Decisions Day, now celebrated every April 16, with the goals of raising public awareness about end-of-life issues and providing a call to action for people on these matters. If you missed the day, that’s OK. For those who haven’t acted, the time to act isn’t restricted to a single day. The time should be now. –
Dr. Prescott Lee is chair of the Mass. Medical Society’s committee on geriatrics, staff physician at Brooksby Village Retirement Community in Peabody, and attending physician and infectious-diseases specialist at North Shore Medical Center in Salem.
