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.