End-of-Life Choice, Palliative Care and Counseling

Posts Taggedadvance directives

Advance 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

Hard Decisions in the I.C.U.

by Paula Span
The New York Times
October 24, 2012

Your relative has spent five days in a hospital intensive care unit, unable to breathe without a ventilator and incapable of making her own medical decisions. Because she appointed you her health care proxy, or simply because you’re her closest relative, the choices about treatments — trying them or stopping them — fall to you.

It’s not a hypothetical situation: One-fourth of elderly people die in an I.C.U. A patient in intensive care on a ventilator probably requires a feeding tube, a catheter, various IV lines. Perhaps her doctors are suggesting dialysis or recommending surgery. There are many choices to be made.

To act as her surrogate is a daunting proposition. “It’s incredibly intense to not only be confronted with loved ones at death’s door, but to have to make treatment decisions you hope are in their best interests — and sometimes you’re not sure,” said Douglas White, a bioethicist at the University of Pittsburgh Medical Center who has studied end-of-life decision-making for years.

Discussions about the end of life, when they happen at all, often focus on what would happen if someone becomes irreversibly comatose or faces a terminal disease. But the victim of a severe stroke, for instance, may remain extremely impaired, physically and mentally, and institutionalized for the rest of her life — yet still be semiconscious.

“Is this a state in which a person would want to be kept alive?” Dr. White said. “It’s a tough question to answer.” More

The Facts on End-of-Life Care Programs

by Terri Schmidt
Milwaukee Journal Sentinel
October 23, 2012

In 2001, my frail 94-year-old grandmother – a lifelong Wisconsinite – died in a way consistent with her wishes. But it wasn’t easy. It required relentless advocacy by her daughter, who signed “Do Not Resuscitate” paperwork three separate times in one week after my grandmother fell and was taken to the hospital with a serious brain injury.

My grandmother’s loving Brookfield foster home wanted her back with hospice care. Her daughter needed to sign paperwork to confirm her desire to avoid hospitalization and die at home – first at the hospital, then just for the ambulance ride home and again for the hospice admission.

All of this could have been avoided if a system had been in place that made it possible for health professionals to follow a seriously ill patient’s wishes when transferred from one facility to another. With a system in place, patients with advanced illness might have thoughtful conversations with doctors and family about treatments they do or do not want, complete advance directives and appoint trusted loved ones as their health care decision-makers when they cannot speak for themselves. More

Death With Dignity in Massachusetts

by Lauren Mackler
Huffington Post
October 23, 2012

Watching a loved one die without dignity is devastating. Sadly, both of my parents experienced prolonged, painful, and what I considered to be, unnecessarily inhumane deaths.

Twelve years ago I attempted to discuss end-of-life planning with my mother and father. Because I believe that death is simply a transition to another plane of existence, I tend to approach the topic in a rather direct and practical way, as was the case with my parents back in 2000. I suggested that they do end-of-life planning in advance, to ensure clarity about their wishes and to avoid any potential family conflict. But because neither of my parents were able to discuss or plan for death, at the end they were each kept alive by artificial means and suffered heart-wrenching deaths.

Following emergency surgery for a ruptured intestine, my 90-year-old father languished on a hospital respirator for more than a month. During this time, I happened upon a documentary on HBO called How to Die in Oregon. The film is about the Death with Dignity laws in Oregon and Washington, which allow mentally competent, terminally-ill adults to voluntarily request and receive a prescription medication to hasten their death. How to Die in Oregon doesn’t tell people how they should die, but it shows how having more options for end-of-life care gives people more peace of mind in their final days.

I had always felt conflicted about physician-assisted suicide. But after watching the How to Die in Oregon documentary, I became convinced that Death with Dignity should be a legal option for any adult facing terminal illness. On November 6, 2012, the Death with Dignity Initiative (also known as Question 2) will appear on the general election ballot in my home state of Massachusetts. More

Making Their Wishes Known: Advance Directives Ease Fear

by Carol Harrison
October 21, 2012

Amy Cirincione hails from a large Italian family, the kind that flocks to the hospital when one of their own is an emergency admission.

“The way we deal with crisis is yelling,” Cirincione said on the last Saturday in August. “I filled out an advance directive to help my husband deal with my family.”

Laughter, smiles and nods filled the Hospice of Humboldt annex where Cirincione is the director of social services. For the past year, she’s used humor, experience and knowledge to help almost 75 people plan for the end of life by filling out an advance directive.

”Anyone over 18 should have one,” she said while setting up for the free, two-hour workshop in August. “You can be hit by a bus or have routine surgery with complications. You need to make sure your wishes are known.” More