End-of-Life Choice, Palliative Care and Counseling

Advance Care Planning Can Ease Difficult Decisionsby Sonja

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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.

John Maycroft, policy analyst at the Wisconsin Medical Society, said a showing of clips from “Consider the Conversation” to the society’s ethics council inspired the group to launch the effort, called Honoring Choices Wisconsin.

Michael Bernhagen and Terry Kaldhusdal made the film on a shoestring budget, with $43,000 in private donations. They’re working on a second film about the doctor-patient relationship.

Bernhagen, director of community engagement at Rainbow Hospice Care in Jefferson, became a hospice worker after his mother died from vascular dementia at age 81.

Kaldhusdal, a fourth-grade teacher in Genesee Depot, lost his brother to pancreatic cancer at 53.

The hourlong film explores why American patients and health care providers are often ill prepared for death. Advance care planning, the film suggests, can prevent unwanted procedures while giving people more control over their final days.

“If you talk with people at a time when they’re not dying and not in crisis,” Bernhagen said, “you can prevent a lot of unnecessary suffering that is certainly physical in nature but also emotional and spiritual and social and financial.”

Public television stations in 29 states have shown the film 366 times, Bernhagen said. It aired on Wisconsin public TV in August 2011 and is expected to be shown at the Beloit International Film Festival in February.

Honoring Choices Wisconsin is based on the Respecting Choices program started in 1991 at Gundersen Lutheran Health System in La Crosse. It’s also modeled after Honoring Choices Minnesota, started by the Twin Cities Medical Society in 2008.

The programs encourage families to talk about what makes life meaningful and worth preserving. They also urge competent adults to fill out forms that legally guide their future medical care if they can’t make decisions on their own.

Patients with advance directives generally prefer comfort care over medical interventions and use $2,000 less doctor and hospital services in the last six months of life, according to Gundersen Lutheran.

They also give family members peace of mind.

A few days after I watched the film last month, I received an envelope from my parents, who are 83, healthy and living in Minnesota.

Through Honoring Choices Minnesota, they filled out health care directives and sent them to my brother and sister and me.

I already had a general sense of their wishes, but now those are written down in detail. I hope we don’t have to make any decisions for a long time. But if or when we do, now it will be easier.