End-of-Life Choice, Palliative Care and Counseling

My Experiments With Aging and Dying Naturallyby Sonja

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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.

I am grateful for this opportunity.

Advance directives: This quasi-legal document is a way to maintain some control over the course of one’s aging. It specifies a conservator to be responsible for seeing that the directives are carried out. The directives usually have to do with health, social and economic decisions.

I have prepared an advance directive and revised it several times.

For example, it specifies a preference for cremation to include a simple box for transport and a tobacco can for the urn. I was a pipe smoker, but the main statement I want to make is about the high cost of dying.

If I were a songwriter, I would write a song titled, “Bury Me Cheap.” Use what money I have for the living.

The advanced directive is in a way an extension to my will. My conservator is my eldest son for both. Regarding health matters, in accord with my geriatrician, I plan to experiment with what I call “natural dying.”

If a terminal disease process is present, let it follow its normal course. I am grateful for my already long life.

Medicare reform: As a teacher of public policy and the aging, I have a long-standing concern about Medicare costs and sustainability.

I am particularly troubled by the high cost of end-of-life care. My plan is to reduce as much as possible my use of the health care system despite available insurance coverage. For example, I accept treatment for my high blood pressure. It is simple, cheap and has few side effects. On the other hand, I have refused colonoscopies, biopsies and other high tech explorations of my body, all of which are expensive and in my case unnecessary.

It’s unnecessary because I already have lived a full life and am not interested in buying a few more months or even years at a high cost to the next generation. The treatments anyway often are more troublesome than the disease left alone.

I wonder if there is a place for a new movement — Seniors for Responsible Health Care Utilization — whose mindset thinks of Medicare insurance as something to be used sparingly, with special attention given to avoiding heroic end-of-life care.