End-of-Life Choice, Palliative Care and Counseling

Posts TaggedArchives of Internal Medicine

Pastoral support, not life-prolonging care, improves QoL at end of life

By Sarah Guy
News Medical
July 18, 2012

Quality of life (QoL) at the end of life (EOL) is improved when advanced cancer patients avoid being hospitalized, when their worry is reduced, they are given pastoral as well as medical care, and when they feel they are in alliance with their physician, show results of the Coping With Cancer (CWC) study.

To date, there is no comprehensive model for the strongest predictors of QoL at EOL, says the research team, but the findings indicate that when medicine is unable to offer patients a cure, physicians may still positively and significantly influence their patients’ lives.

The challenge, remark Alan Zonderman and Michele Evans from the National Institutes of Health in Baltimore, Maryland, USA in an invited commentary, is in physicians’ and caregivers’ ability to develop and maintain effective integrated relationships with their patients that are strong enough to deliver the emotionally difficult messages relevant to prognosis, among other things. More

Let’s Stop Paying for Unwanted Treatment at Life’s End

In 2002, an elderly client of Compassion & Choices, Margaret Furlong, went to the hospital armed with her advance directive, clearly stating she did not want elaborate, life-extending treatment.

The hospital delivered those treatments anyway. She spent ten miserable days in the ICU, tethered to machines and tubes and pleading for it all to stop. Finally it did, and Margaret died. Then the hospital billed Medicare for all her unwanted treatment and Medicare paid – without objection, with our taxpayer dollars.

Margaret’s story is far too common. At Compassion & Choices we intend to put teeth into advance directives, and we need your help.

It is well documented that although advance directives are offered and included in the medical chart – as the law requires – in the end they are usually ignored. The pattern is cruel and absurd, and even the medical profession is starting to understand that. Last year the Archives of Internal Medicine reported, “Persons dying in the hospital often receive burdensome care immediately before death that may not match patient preferences.”

Aggressive medical interventions in the setting of terminal illness do not prolong life, but they do increase the suffering of patients and their loved ones. Sadly, Medicare, Medicaid and private insurance carriers incentivize healthcare providers by paying for unnecessary and unwanted treatments.

This could end if public and private health payers required, as a condition of payment, that treatment in the weeks prior to death conform to the patient’s advance directive.

Here is one way you can help. Tell us if you know of a situation where a doctor or hospital disregarded a person’s explicit instructions or the instructions of a surrogate decision-maker. Your stories will help drive that point home with health insurers, hospitals, and health care providers.

As soon as providers realize the costly, unnecessary and painful procedures, tests and treatments they contemplate for a dying patient may be at their own expense, advance directives will acquire unprecedented power and authority. When providers choose treatment based on what patients want, we will have achieved real progress in shielding people near the end of life from the type of suffering Margaret Furlong endured.

Study Finds Patients Use Oregon DWD Act to Die at Home, Stay Independent

A new study published today in the Archives of Internal Medicine, in which clients of Compassion & Choices of Oregon participated, found that terminally ill individuals using the Oregon Death with Dignity Act did so because they wanted to die at home, remain independent and control pain at the end of a terminal illness.

“The study’s findings continue to confirm the safety and benefits of Oregon’s Death with Dignity Act,” said Barbara Coombs Lee, president of Compassion & Choices, the nonprofit organization that serves as the steward of the law and serves terminal patients and their families throughout the U.S.

Read the press release here