End-of-Life Choice, Palliative Care and Counseling

Posts TaggedAdvanced Directive

Dignity and End-of-Life Care

Winston-Salem Chronicle
November 15, 2012

Consider this situation: you are driving home in a rain storm; you lose control of your car and hit a tree. You are taken to the hospital and need emergency medical attention. After the surgery, they determine that there is no hope of recovery, and you can only be kept alive by machines. What happens to you now? Would you choose to be kept alive artificially, or would you prefer to die with dignity? Unless you make your wishes known beforehand, you will not have a say. Your family will decide your fate without knowing what you wanted done.

Unfortunately in our society today, very little planning is done for the certainty of death.  In the absence of documents stating someone’s preference regarding end-of-life issues, the person is vulnerable to the will of the physician, family, friends or other acquaintances. Alarmingly, only 11 percent of African Americans express their wishes regarding end-of-life care, compared to 38 percent of whites. More

The Elder Law Minute: Do I Have the Right to Die?

by Ron Fatoullah
The Queens Courier
November 10, 2012

On October 5, 2012, a New York Appeals Court ruled in support of SungEun Grace Lee (Grace), a 28 year old banker who wanted to be taken off life support and allowed to die. Grace, who has terminal brain cancer, is paralyzed from the neck down and is being kept alive by artificial means. Her family disagreed with her decision and petitioned for guardianship to make health care decisions on her behalf. They argued that she was incapacitated due to her medicated state. The issue of an individual’s right to die is complex, to say the least. While the law does not permit assisted suicide, a patient always has the right to refuse medical treatment. This may include the refusal of life-sustaining treatment which could lead to death. Proper planning and possessing the necessary legal documents can help to enforce our right to refuse medical treatment. In addition, having the proper legal documents can help avoid or minimize conflict between loved ones when the difficult decision pertaining to “pulling the plug” arises.

Health care decisions, including decisions regarding life-sustaining treatments, are made by the individual patient. The issue presented in the case of Grace (and the famous Terri Schiavo right-to-die case), is one in which the capacity of the patient to make such decisions is questionable. In New York State, once a person is deemed incapable of making health care decisions, these decisions can be made by an appointed agent under a duly executed Health Care Proxy.

Planning for health care decision-making, in the event of incapacity, is not an easy process. It is often the most difficult process for our clients who are engaged in elder law planning. The issue requires individuals to delve into grim and morbid topics of illness and whether or not to “pull the plug” and in which scenarios to do so. Understandably, individuals often avoid signing a Health Care Proxy or sign a Health Care Proxy without having an informed discussion with their appointed agent. Having a Health Care Proxy allows one to choose the person he/she trusts to speak on his/her behalf and ensure that one’s rights and wishes are upheld. The discussion about one’s wishes regarding health care decisions is as important as naming the person to make these decisions. Again, the discussion ensures that decisions are made based on the individual’s expressed wishes. It avoids or minimizes conflict that can lead to litigation as in the cases of Grace and Schiavo. It also lessens any guilt on the part of the agent who may have to make the decision about whether or not to withhold or withdraw life-sustaining treatment. Most importantly, the law requires clear and convincing evidence of an individual’s wishes before an agent can have the authority to withdraw or refuse life sustaining treatment. Therefore, having a serious and in-depth discussion with the appointed agent and any successor agents is a vital part of the process of executing a Health Care Proxy. More

5 Reasons I Won’t Die the Way My Mother Did

By Erica Manfred
Next Avenue
September 21, 2012

When a parent dies, it’s common for surviving children to have a raft of regrets, from not spending more time with Dad to not telling Mom you loved her to failing to do more for them in their final years. Today there’s often one other regret in the mix — not protecting a parent from invasive end-of-life interventions.

Few of us die in our own beds now. Modern medicine keeps many of us living longer, and then some of us die by inches, in an ICU or on a ventilator, sedated or in excruciating pain, while others fade slowly with Alzheimer’s disease or other dementias. When my mother died 15 years ago, after much unnecessary suffering, I determined to keep her fate from becoming mine.

Mom was an extremely healthy and active woman who, until age 85, had few medical problems besides arthritis. In her mid-80s she displayed some memory loss, though nothing that inhibited her lifestyle. I suspected she was developing Alzheimer’s, as her brother had, but that she had many active years left. She also had a heart valve that needed replacing or she’d face serious restrictions of her daily activities, along with an increased likelihood of a heart attack.

She wanted the surgery, and it was a success. But then she had an allergic, near-fatal reaction to the valve, after which she went rapidly downhill cognitively and became unable to take care of herself and severely depressed. Two years later, when her kidneys failed, her doctor suggested dialysis, which would have gone against her living will specifying no further invasive treatments. I arrived at her Florida home just in time to refuse the dialysis. She died peacefully at home, under hospice care, two weeks later. We had spoken about her wishes, and I knew that’s what she wanted.

After my mom passed away, I realized that I had to begin to make hard decisions about my own death, when I was still relatively young and healthy, to avoid an equally drawn-out end. Jane Brody, a New York Times health columnist and author of Jane Brody’s Guide to the Great Beyond: A Practical Primer to Help You and Your Loved Ones Prepare Medically, Legally, and Emotionally for the End of Life, helped me craft these five steps, designed to increase one’s chances of a dignified death (although there are, of course, no guarantees): More

What Are Living Wills and How Can They Benefit People With Alzheimer’s Disease?

By Esther Heerema, MSW
August 30, 2012

What Is a Living Will?

A living will is a document that contains your wishes for what kind of medical care you desire and how aggressive you want the healthcare providers to be in caring for you. Some living wills include the option for you to designate a medical power of attorney in the same document as you indicate your various healthcare choices. Others are drawn up in separate documents. This can vary by state and by document. Note that not all states will recognize a living will but regardless, it is a helpful tool to communicate your preferences.

Why Is a Living Will an Important Document for People With Alzheimer’s?

A living will is a good document for everyone to have, but especially so in Alzheimer’s disease and other kinds of dementia. Because dementia is progressive, you can anticipate that the ability to make decisions, including medical ones, will deteriorate. A living will provides you with the opportunity to outline ahead of time what your wishes are and how you want your medical decisions to be made. More

Advance Care Planning Is a Subject Many People Prefer to Ignore

By Alex Branch
September 9, 2012

Chaplain David Lowe has seen his share of grief-stricken family members at the bedsides of hospitalized loved ones in the final stage of life.

He has watched sons, daughters and spouses buckle under the pressure of difficult decisions, such as whether to keep that loved one on life support after doctors say they see no hope of recovery.

Those circumstances add extra stress and anxiety that, in Lowe’s view, often could be lessened if the patient and family had previously discussed what kind of care he or she wanted in those final days.

It’s why Lowe is promoting public workshops in Tarrant County this fall intended to help families prepare for end-of-life care options.

“When someone finds themselves suddenly in that role of decision maker during a major illness or hospitalization, it is laden with emotion and a very hard place to be,” said Lowe, director of pastoral care for the western region of the Baylor Health Care System. “I tell folks it doesn’t have to be that way. We want to move people out of the role of decision maker and more into a role of a spokesman, or an advocate, for their loved ones’ wishes.”

The Coalition for Quality End of Life Care, an Arlington-based organization, will present the workshops, which cover advance care planning, powers of attorney, wills, guardianship, funeral planning and financial benefits.

The workshops, which start Saturday, are free, though attendees are encouraged to register in advance, said Diane Wolfe, who is handling publicity for the events.

The subject matter is something that many people prefer to avoid, said Dr. Kendra Belfi, a recently retired Fort Worth internal medicine and geriatrics physician.

A 2008 report to Congress by the Department of Health and Human Services estimated that between 18 and 36 percent of the adult population had completed advance care directives.

“Advances in medical care and technology during the latter half of the 20th century have prolonged life expectancy in the United States,” the report concluded. “However, these same advances have blurred the boundary between life and death, challenging our expectations about how Americans could experience the end of life.” More