by Peg Sandeen
Living With Dying
January 9, 2013
The pundits are out and about this time of year making various predictions about 2013, and the forecasting provides for fascinating reading. You’d think we’d have learned something after the Mayan apocalypse failed to occur. Right now,we’re being told the price of gas will plummet in 2013; Nate Silver will become the model for all polling conducted for media outlets; Fidel Castro will die; Americans will pay more taxes and more for healthcare; and Lincoln will win best picture at the Oscars. We’re gobbling up predictions faster than your uncle’s attack on the pile of Christmas cookies.
So, here are my predictions for 2013:
POLST programs will be available in half of all states in this country by year’s end. POLST (Physician Orders for Life Sustaining Treatment) programs represent an important step forward in advanced planning for end-of-life care. They go further than living wills because they use standardized forms, converting patient wishes about end-of-life care into physician orders for treatment to be used by emergency personnel, hospital staff, and other healthcare providers. They provide physicians with a vehicle through which to lead conversations with patients and family members about how aggressively a patient wants his/her illness to be treated. If a patient wants limited treatment or palliative care only, this becomes part of the POLST form. The form goes in the patient’s chart as a medical order.
POLST programs have been made available in 15 states through legislation or regulation, and there is ongoing work in 28 other states. The Catholic Church has worked to oppose POLST programs in Wisconsin, suggesting the use of POLST forms would be a slippery slope to euthanasia. Regardless of the Church’s opposition to written end-of-life care plans in medical charts, I believe POLST programs will expand to half of all states in 2013.
Speaking of the Church, I believe they will continue to quietly fund 70% or more of the opposition’s work in states like Vermont, Montana, and Massachusetts. An analysis of the anti-Death with Dignity campaign spending in Massachusetts shows 71% of all money raised by opponent ballot question committees ($3.4M out of $4.8M) could be attributed to Catholic resources. An additional 15% came from sources traditionally associated with anti-gay activities ($730,000 out of $4.8M); nearly $500,000 came from major individual donors. More
by Terrell B. Vanaken
January 10, 2013
During the holiday season, we often think of giving in terms of tangible, often costly items.
There is, however, an extremely valuable gift that we can offer at any time of year, and which costs virtually nothing. It’s something all of us can offer to our family and loved ones. It’s the knowledge and understanding of what we would want done at the time of a health emergency, when we cannot make decisions for ourselves.
An advance directive, when properly completed, is a legal document that stipulates who should make decisions at a time when an individual no longer can. It also allows you to specify your wishes for medical treatment and just how aggressive medical personnel should be with your care.
At a minimum, an advance directive should name the primary person you trust most to make major health care decisions about your welfare. This person is called your “agent” for health care decisions. You may also name an alternate in case your first choice is unavailable for any reason.
An advance directive can be completed by any adult and is made legal by the signature of a notary public or the signatures of two qualified witnesses. Of course, as we grow older, a directive becomes more and more important, since the incidence of health care emergencies increases as we age.
Many critically ill patients and families who I have met in the hospital have never sat down and actually talked about their wishes before such a tragedy occurs. We all tend to avoid these discussions, but after a stroke, a heart attack or life-threatening event, your loved one may not be able to talk at all or understand these issues. More
by Steve Heilig
November 29, 2012
Nobody gets out of here alive, as somebody said — we all eventually die. But we don’t like to talk about that, even with our doctors. And as the New York Times just editorialized, some politicians like it that way and have done what they can to keep us ignorant of our choices and to keep our doctors ignorant of what we desire toward our ends. Remember those nonexistent “death panels,” a figment of politicized paranoia? The sad and maybe even lethal irony here is that, as with so-called “pro-life’ activism about reproduction, such politicization most likely has the opposite effect of what’s intended — more suffering and less control over our own lives.
There’s a better way, and some people and even states are moving forward, despite some lingering opposition by political opportunists, certain religious “leaders,” and the like. As noted by the Times:
Fortunately, advance planning for end-of-life decisions has been going on for years and is continuing to spread despite the demagogy on the issue in 2009. There is good evidence that, done properly, it can greatly increase the likelihood that patients will get the care they really want. And, as a secondary benefit, their choices may help reduce the cost of health care as well.
One of the advances the Times recommends is a relatively new tool called POLST — Physician Orders for Life-Sustaining Treatment. It’s another type of medical/legal “advance directive” that can give you, and your loved ones, more input in how you are treated — or not treated — when gravely ill, even if you can no longer express your wishes. Doctors often recommend it too, once they learn about it, and there is a concerted effort to spread awareness about POLST around the nation. It can allow you and your — or any — doctor to act in according to your preferences for medical care as you are dying. More