Advance Directive

Jan 9, 2013When Doctors Need E-mail Reminders to Talk to Patients About Death

by Lindsay Abrams
The Atlantic
January 7, 2013

You know how if someone e-mails you over and over, and doesn’t stop until you finally respond or just go ahead and do what they’ve been asking you to, it’s really annoying, but also a pretty good strategy on their part because they ended up getting what they wanted?

The same thing, it turns out, works with doctors. Only in this case what they’re being nagged about is having an important conversation with terminally ill patients that, let’s be honest, they shouldn’t have been avoiding or forgetting in the first place.

The number of patients with incurable cancer whose charts indicate whether or not they want to be resuscitated can be doubled, a new study in the Journal of Clinical Oncology found, provided doctors are sent e-mails reminding them to ask.

Per national guidelines, this conversation is supposed to occur when a patient’s prognosis is less than a year. More

Dec 29, 2012My Experiments With Aging and Dying Naturally

by Tom Walz
Press-Citizen
December 26, 2012

Most of us who grow old become conscious of our aging. Our bodies and minds give us daily reminders. Life changes. Typically we retire from our employment and think about seeing and doing things not possible when we were working.

Retiring at age 67 in 2001, I worked out something of a plan for my remaining years based on some beliefs. Included were the following.

• 1) How to keep doing what I had being doing for as long as my mind/body would let me.

• 2) How to control the decisions that may be associated with my aging and dying.

• 3) And how to reduce the high cost of dying and simplify the event.

Reverse retirement: Rather than retire, I wanted to renew my life’s work life and stay with it to the end. It wouldn’t matter how slow and inefficient I might become. Just keep going.

A par golfer at the end might have a 24 handicap, but enjoy the game even more. After retirement at age 67, I found a way to keep working. Though unpaid, the full time I have put in as a volunteer for a nonprofit serving persons with disabilities has been “ health” giving. More

Dec 11, 2012Advance Care Planning Can Ease Difficult Decisions

by David Wahlberg
Wisconsin State Journal
December 10, 2012

When patients near the end of life, many doctors say there’s nothing more they can do.

But “there is so much we can do for people at the end of life,” said Dr. Jim Cleary, UW Health’s director of palliative care.

Doctors can provide pain relief, comfort care and guidance to families, Cleary said.

“For a physician to say, ‘There is nothing else I can do,’ is really, I think, a neglect of their physician duties.”

Cleary’s comments are from “Consider the Conversation: A Documentary on a Taboo Subject.” The 2011 film by two Wisconsin men has sparked an initiative to expand advance care planning around the state.

In the first phase of the effort, nurses, social workers and clergy at Madison’s health systems will begin offering discussions about end-of-life decisions to select groups of patients in March. Broader outreach is planned in 2014.

Instead of merely asking patients if they have living wills or health care power of attorney documents, hospitals and clinics will offer discussions about a variety of questions — from whether to resuscitate and ventilate to what kind of people, music and lighting patients want to be surrounded by when they approach death. More

Dec 6, 201210 Tips on Dying With Dignity

by Laurel Lewis
IntentBlog
December 5, 2012

These tips come from my experience of being with hundreds of people as they have died and with the thousands of family members who have witnessed this event. Consider using these tips for dying well … and for living well!

10. Talk about what you do and don’t want.

Tell your family, friends and doctors how you want to be treated and what kind of treatments you want or don’t want! Consider a living will or other advance directives so that your wishes will be known prior to end of life choices. Consider your needs: physical, emotional and spiritual because they all impact your final days.

9. Have a life review. Recall significant and meaningful events .

Share your stories either verbally or written with your loved ones, in a journal or on tape. As you do this forgive yourself and others for everything! Let go of judgments. Judging people and events take up precious energy that could be spent loving instead. Release the judgments and allow yourself to be fully present to what is in your life right now.

8. Express gratitude daily – for something, anything!

This will help move you from the context of small self who is dying to connect with the bigger part of Life that is surrounding us always. Expressing gratitude creates a positive shift in our mental state, which in turn has positive physical benefits. More

Nov 29, 2012End-of-Life Care: Mayo’s Advice

by Sondra Forsyth
ThirdAge
November 28, 2012

One of the toughest issues patients and their loved ones can discuss with physicians is whether or not further medical treatment is futile. Mayo Clinic expert Christopher Burkle, M.D., J.D., lead author of an article published in Mayo Clinic Proceedings, is quoted in a clinic release as saying, “Health care professionals in the United States have struggled with the importance of maintaining patient autonomy while attempting to practice under the guidance of treatments based on beneficial care.”

The release notes that the conversation can become even more difficult if patients or their families disagree with health care providers’ recommendations on end-of-life care. Early, clear communication between patients and their care teams, choosing objective surrogates to represent patients, and involving third parties such as ethics committees can help avoid or resolve conflicts, according to Dr. Burke and co-author Jeffre Benson, M.D.

Here is advice from Drs. Burkle and Benson:

*Clear communication: Early and clear communication between health care providers and patients or their surrogates is the best way to avoid disagreement over whether medical care should continue. Recent studies show that more than 95 percent of such disputes are resolved through mediated meetings involving physicians and patients/surrogates. More

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