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
The Chicago Tribune
January 9, 2012
Mr. J. had an implantable cardioverter defibrillator (ICD) for advanced heart failure. Having survived one episode of cardiac arrest, in which he nearly died, he was at high risk for another episode caused by a rapid, unorganized heart rhythm called ventricular fibrillation. Should this happen, the ICD would shock his heart back into normal rhythm. But at his daughter’s wedding, the ICD fired nine times. Each time, it saved his life, but the painful episodes terrified him, and he asked that the ICD be turned off.
Dr. Eva Chittenden, associate director of palliative care at Harvard-affiliated Massachusetts General Hospital, met with Mr. J. to explore his decision further. He stated that he’d already been hospitalized five times within 12 months, and he felt this took too much time away from his family.
They discussed his personal values and what action he’d want taken if his heart stopped, and the ICD was no longer there to revive him.
After long talks with Dr. Chittenden and his family, Mr. J. chose a “Do Not Attempt Resuscitation/Do Not Intubate (DNAR/DNI)” order. The decision meant he could continue seeing his cardiologist and other doctors, remain on his medications, and return to the hospital for intravenous diuretics. But he would not be revived if his heart stopped.
Doctors wish all their patients would make their preferences known in advance, like Mr. J. did. More
by Lindsay Abrams
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
by Jean Vaneps
Duluth News Tribune
November 8, 2012
How would you like to star in your own reality show?
In applying the concept of “reality” to healthcare costs, some stark truths need to be realized by all U.S. citizens to avoid an inevitable crash. The challenge to all of us as consumers is to honestly examine our health habits and to take personal responsibility in being part of the solution to our country’s healthcare crisis.
There is one thing all of us can do, and it’s painless, proactive and will not call for any diet plan, smoking-cessation plan or payment plan. It is taking the time to complete an Advance Healthcare Directive (or just Advance Directive). The potential healthcare cost savings are staggering, but
70 percent of Americans do not have an Advance Directive, according to the Centers for Disease Control.
According to federal Medicare statistics, end-of-life care provided in 2010 accounted for more than 25 percent of total annual spending. Reasons for this include aggressive treatment that was not necessary or was not desired by the patient. Advanced medical technology has brought increases in life spans, despite chronic diseases. U.S. studies show that in areas where increased Advance Directives exist, health-care costs are reduced and patient satisfaction is high. More