End of Life Talks
A recent survey of nearly 1,700 by the California HealthCare Foundation found that 76% of respondents did not have written advance directives even though 40% said they had talked with a loved one about what medical treatments they would want at the end of life. Even worse, only 8% of the patients had ever been asked about end-of-life treatment wishes by a physician even though 80% of patients believe it is important to have their end-of-life wishes in writing. Want some more numbers? Here are the things that mattered most to people at the end of their lives:
- 67%: Making sure family is not burdened financially by my care
- 66%: Being comfortable and without pain
- 61%: Being at peace spiritually
- 60%: Making sure family is not burdened by tough decisions about my care
- 60%: Having loved ones around me
- 58%: Being able to pay for the care I need
- 57%: Making sure my wishes for medical care are followed
- 55%: Not feeling alone
- 44%: Having doctors and nurses who will respect my cultural beliefs and values
- 36%: Living as long as possible
- 33%: Being at home
- 32%: Having a close relationship with my doctor
That is a lot of information. The advanced directive discussion should not be taken lightly. The idiots who came up with the “death panel” complaints are just that…idiots. I, as a doctor, am guilty of rarely having these talks with patients. We could save so much money for our healthcare system if we did a better job educating patients and respecting their wishes. That being said, we need a better system in place to do it and we need more time which means a better way of paying for these talks. I challenge anyone to handle that list above in fifteen minutes. Then multiply that by 1000 or 2000 just for your aging population panel. Anyone have some solutions or ideas?
I’m sure it is difficult for Dr.’s to have this discussion as they feel it’s their job to make you well. That doesn’t always happen. When my husband was diagnosed with cancer, I brought his living will into the oncologists office. He handed it back to me saying it was much too early for that. I still think before you need it is when you should have it on file. You can always change it if you feel differently. My husband died 49 days later, at home where he wanted to be.
I don’t see why such discussions need to be with an MD, since they are primarily mental/emotional/spiritual issues. Of course, lots of docs are excellent counselors, but not all by a long shot. Perhaps there’s a need for counseling specialists to whom docs can refer. Probably cheaper, as well. (disclosure: I’m a retired school/mental health/addictions counselor).
I’m 77, and in unjustifiably good health (On top of a ladder yesterday, hanging a heavy mirror; rode a motorcycle until last year’s accident; consistently good lab results; etc.)I’ve made living will, etc. Most geezers I associate with are comfortable talking about these issues.