living wills

Guest Blogger Jane Markley: If I Complete An Advance Care Plan, Will I Die Sooner?

July 29, 2013 By Carolyn Parr Leave a Comment

Now some of you may laugh at this question and others of you may be nodding your heads in complete understanding. Honestly, this is a question I was asked earlier this year at a community presentation and the person asking it was very serious and concerned. Superstition is alive and well in the world in which we live and when it comes to dying no one wants to tempt fate. Believe it or not, this is also one of the reasons why people do not complete a financial power of attorney. They are afraid that if they do, it will be needed immediately and they are doing just fine anyways, thank you very much.

We are all driven by our culture and the world in which we live and were brought up. Superstition is defined as “a belief or notion, not based on reason or knowledge, in or of the ominous significance of a particular thing.” How true it is. Death has such ominous significance for most of us but the key point is that it is a belief not based on reason or knowledge. My hope is that I can help people over this hump to the point of realization that their fear is unrealistic so that they can move forward and complete their advance care plan and give the gift.

As I mentioned last month, death, serious illness, and injuries do not happen only to the elderly but also to young people and even children. It occurs when it does, unaffected by whether a plan is in place or not. And that is extremely important because if your plan is not in place then you have lost control because no one will know what your desires are. You will not have had the conversations that are so necessary in allowing people to treat you as you wish to be treated. You will leave a huge burden on your friends and loved ones as they try to guess the best direction for your care and wonder if they are doing what is right for you and what you would have wanted.

So don’t let superstition drive your direction. Talk to your loved ones, tell them what is important to you, and share your feelings and beliefs so that you can help them along the way to helping everyone do the right thing. If you need assistance in working through these discussions or your superstitions, we would be happy to help. That’s what we do. If you can do it on your own, go forth and get it done. The most important thing is that you have the conversation and document your desires in your advance directives for everyone to see and use.

Have ‘The Conversation’
And
Give ‘The Gift’

Sig notes: A registered nurse with more than 30 years’ experience helping people deal with ethical issues in both healthcare and business, Jane Markley is a board-certified healthcare executive who has chaired and works on hospital ethics committees; speaks and consults on advance care planning and ethical dilemmas; and teaches ethics in both healthcare settings and corporate environments. Check her website, www.mjanemarkley.com.

Tube Tales

September 25, 2011 By Carolyn Parr Leave a Comment

(The following stories are true; only the names have been changed.)
1. My friend Linda’s grandmother was in a coma. The doctors had put her on life support. After several months in this condition Linda’s mother, Gail, was unsure how to proceed even though she was named grandmother’s health care proxy. So Gail invited the 12 closest family members to grandmother’s bedside. Once assembled, she asked them to vote on whether to remove life support. Nine voted yea; three nay. Life support was withdrawn, and grandmother died within hours. The three nays realized that removing life support made sense and were relieved to know that grandmother expired painlessly.
2. Twenty years ago Stuart moved to Washington having renounced his family ties. We knew nothing about Stuart other than he had previously lived in upstate New York. Stuart developed a virulent form of abdominal cancer, which went untreated. While visiting a friend his condition deteriorated such that he was taken by emergency vehicle to a nearby hospital, placed on life support, and administered morphine. Stuart had no living will nor a DNR order. (Do Not Resuscitate.) His friends were at a loss how to proceed as was the medical staff. After three days the doctors decided to reduce the morphine drip to the point that Stuart regained consciousness. When he did, a doctor asked him what he wanted to do. Stuart mumbled that he wanted to ‘go home.’ His answer gave the doctors sufficient justification to remove life support and transfer him to a hospice where he died a few days later.
3. When my cousin Joan’s mother was admitted to the ICU of a local hospital, it was clear that she might never regain consciousness. Joan’s older brother, Sam, was her mother’s health care proxy. Both Joan and her younger sister Carol did not want their mother to remain indefinitely on life support. Sam did, and because he was named health care proxy, he prevailed. Their mother remained in a coma for the next two years before she passed away. Given the sisters’ anguish over their mother’s prolonged coma and the huge cost the family incurred, they haven’t spoken with Sam since.
Moral of the stories? Plan ahead. Make sure that everyone in the family whether they suffer from a chronic disease or not has a living will or a health care power of attorney, or proxy. Try to reach consensus on whether to use life support or allow nature to take its course. One of the best tools we’ve found is “Five Questions” which has become America’s most popular living will because it is written in everyday language and helps start and structure important conversations about care in times of serious illness. See www.agingwithdignity.org.
Sig Cohen

Over 40 With a Living Parent? Some Questions to Consider

June 12, 2011 By Carolyn Parr 2 Comments

Last week we described our recent workshop and named some questions we posed to older parents and their surprising answers. This week we look at the questions and answers for their kids:

1. What is your greatest concern about your parents’ aging process?
[Driving safety was a huge concern. Some didn’t want their children to ride with the parent. But adult kids are torn. They are sensitive to the loss of freedom if parents can’t go when and where they want. Some expressed an obligation to offer alternative transportation and thought about how that would complicate their own lives.]

2. What do you want to know about your parents’ future plans that you hesitate to ask?
[Many said they don’t know whether parents want to be cremated, what kind of service they would want, or where they want to be buried. They hesitate to raise the topic of a parent’s death, regardless of how near or far in the future that seems. They suspect the parents themselves may not have thought it through.]
[But a few said parents had actually written out the details of their own funerals: hymns, who will speak for them, and even a liturgy.]

3. How satisfied are you with your knowledge of your parents’ finances?
[If their parents had not volunteered the information, most children did not want to ask directly, for fear of sounding greedy or eager for the parent to pass. They agreed they might be able to ask for a list of bank accounts and insurance policies, etc. Many children had knowledge; others had none. Sometimes one sibling did know and was willing to share the information.]

4. How much do you want to be involved in helping your parents make health care decisions?
[Even if a child or siblings did have a power of attorney for health care, they hoped the parent would also prepare a “living will” or a Five Wishes document, so that all the siblings would be on the same page. That way, if a hard decision has to be made, all will know what the parent wants. One man told me that his brother, who had the POA, extended their mother’s suffering for two years because she left no instructions and he could not bring himself to let her go. The siblings are still not speaking to him.]

5. Where do you imagine your parents will be living later in their lives?
[Most expect the parents to live in their own homes as long as possible, then go into some assisted living near the child. If parents live in another state, they anticipate some resistance from the parent. Some are worried about the cost of assisted living.]

6. What’s your deepest hope for your parents as they age?
[That they can be lucid, peaceful and pain-free and feel loved.]

What questions would you like to ask your parents? Please share your thoughts by writing a comment.

Carolyn

One Tough Conversation Just Got a Little Easier

December 31, 2010 By Carolyn Parr Leave a Comment

What can be harder that engaging a parent or close friend or relative in a discussion about his or her end-of-life care? This may be the toughest of conversations. Yes, even harder than the one we dread about a parent’s no longer driving.
Unless a parent or loved one initiates a conversation about his or her end of life care, we may avoid the topic, fearing it’s too insensitive or emotional. But if we wait until the person is incapacitated, final decisions may be made by strangers – and the result may not be one that our loved one would have chosen.
Thankfully (yes, we mean it: thankfully) the Obama Administration has issued a rule authorizing reimbursement of doctors who counsel their patients about end of life care. Note that these discussions are voluntary. The government does not require such conversations. But importantly doctors may include an explanation of advance directives (sometimes called “living wills”) by which a patient requests or foregoes life-sustaining treatments under certain circumstances. Doctors may also discuss end-of-life options such as pain management or hospice care. In this way a doctor will learn how his or her patient wishes to be treated if they should become too sick to decide for themselves. It puts the patient in control.
We believe this is a boon for families who have avoided such ‘tough conversations’. Now medical professionals (who are usually best qualified to discuss the issue) may engage in these conversations knowing they will be reimbursed for their time and hearing first hand what kind of care their patients desire when and if they can no longer communicate their wishes.
Contrary to what some fear, research published in the British Medical Journal found that advance care planning actually improves end of life treatment, increases patient and family satisfaction, and reduces stress, anxiety and depression among surviving relatives.
According to Dr. Sharon Brangman, President-Elect of the American Geriatrics Society and Chief of Geriatrics, SUNY Upstate Medical University in Syracuse, NY, end-of-life consultations could also save the healthcare system money by eliminating unnecessary testing and procedures that patients don’t want. But that’s not why she (and we) support it. The focus is really on ensuring that patients’ wishes are known and met.

Sig Cohen