HCN News & Notes

One Conversation Can Make All the Difference on End-of-Life Care 

SPRINGFIELD  When is the right time to name someone to speak for you in case of serious illness? 

A: When you’re in good health? 

B. When you’re in a coma? 

The answer, of course, is “A.” But the problem is that we are reluctant to talk about our medical wishes in case of serious illness or end of life. Too often the result is family conflict and confusion at a time when you are most vulnerable and cannot speak for yourself.  

But, there are some things we can do to help us be prepared — both for ourselves and the people we care about when it comes to making important life decisions. 

April is National Healthcare Decisions Month and a time when people across the country are encouraged to get the conversation going about their wishes for end-of-life care. The annual event is sponsored by The Conversation Project, a program of the National Institute for Healthcare Advancement. 

“We encourage you to take this opportunity to think and talk about what your approach would be when difficult healthcare decisions become necessary,” said Dr. Yael Tarshish, medical director, Palliative Care, Baystate Medical Center. “Completing advance directives to make your wishes known helps guide your loved ones and healthcare providers to honor your goals and values if a crisis arises and you are not able to speak for yourself.”  

The Conversation Project suggests three important things you can do immediately to make your wishes known: 

• Pick your person to be your health care decision maker; 

• Talk about what matters most to you; and 

• Think about what you would want if you became seriously ill. 

“Although we recognize your thoughts and wishes can change, it’s never too early to begin having these challenging conversations,” noted Tarshish. 

All adults over the age of 18 should have a healthcare proxy, so that they have a decision maker prepared in the case of an emergency or they are unable to speak for themselves. 

According to a Survey of Californians by the California HealthCare Foundation and Kaiser Family Foundation Serious Illness in Late Life Survey, 92% of people said that talking with their loves ones about end-of-life care is important, but only 32% had actually done so and said that they hadn’t had the conversation because they don’t want to upset their loved ones. 

Because these conversations can often be uncomfortable and thus delayed, the Conversation Project has created a downloadable free Conversation Starter Kit at www.theconversationproject.org, so that you can have a say in your health – today and tomorrow. 

Once you have had that important conversation, there are two important legal documents – a Health Care Proxy and Advance Directive — to complete in order to make sure that your wishes are clearly stated and respected when the time comes. 

A Health Care Proxy is a simple legal document allowing you to name someone you know and trust to make healthcare decisions for you if, for any reason and at any time, you become unable to make or communicate those decisions.  

An Advance Directive, also known as a Living Will, is a legal document in which you state your wishes regarding end-of-life medical care — including the types of treatments you do and do not want such as “do not resuscitate (CPR) “or “intubate” to help the patient breathe — in case you are no longer able to make decisions or communicate your wishes.          

According to Mass. Medical Society, Massachusetts is one of only three states that recognizes Health Care Proxies but does not recognize Living Wills. However, they say Living Wills are still potentially useful “because they guide agents and physicians about the types of choices a person would make.” 

Tarshish noted that is important to make sure the person you identify as your proxy is someone who understands your wishes. 

“We often rely on those close to us, such as a parent or spouse, to make those hard decisions on our behalf, however, they may be unable to do so as different emotions get in the way. That’s why it is so important to put your wishes in writing, and to select someone who is emotionally able to carry out your wishes and who can answer any questions the doctor may  have about your care,” she said. 

Every state has its own Advance Directive forms. Honoring Choices Massachusetts was founded to help empower adults to make a personal plan and to support health care providers to work in partnership with adults to match good care to their goals, values and choices. Their “Getting Started Tool Kit” provides easy step by step instructions to start to make your personal health care plan. The tool kit includes helpful information, a Massachusetts Health Care Proxy and Personal Directive, and handy discussion guides to talk with your family and care providers about your care choices. The Health Care Proxy instructions and document is available in English, Spanish, Portuguese, Vietnamese, Russian, Chinese, Haitian-Creole, Khmer, Albanian, and Arabic. It can be downloaded at honoringchoicesmass.com. For more information on Baystate Health, visit baystatehealth.org.