End-of-Life Choice, Palliative Care and Counseling

Posts Taggedend of life care

Movement Grows in Planning End-of-Life Strategy

by T.J. Greaney
Columbia Daily Tribune
January 9, 2013

Kathe Ward could see that her mother was slipping away.

Suffering from advanced Alzheimer’s, the 77-year-old passed her days in a nursing home bed, unable to speak, sit up or control her bowels. So Ward, a St. Louis registered nurse, asked a lawyer to draw up a document forbidding medical personnel from aggressively trying to prolong her life by using CPR, dialysis or a ventilator.

Known as an “advance directive,” the document signed by her mother, with Ward’s help clutching the pen, gave Ward power of attorney in health care for her mother.

“I felt like I knew her well enough to know she wouldn’t want to linger in the state she was in,” Ward said of her decision in 2005 to prepare an advance directive. “But I knew there was a possibility she could have lived in that state for another 10 years.”

In 2007, when her mother stopped breathing correctly and a feeding tube implanted in her stomach fell out, Ward relied on the legal document to help her make the wrenching decision to let her mother die despite some resistance from siblings. “Had it not been for me really taking the bull by the horns and saying, ‘We are not taking her to the hospital to put another tube in her stomach,’ then I think my sisters would have just said, ‘We want everything done,’ ” Ward said. “And it would have been much harder for them to let go. And it would have been prolonged.” More

Hospice Myths to Avoid

by Joyce Baldrica
TC Palm
January 15, 2013

Hospice care offers the services you want. What stands in the way of more people choosing hospice care, is limited awareness of what services it offers and how to find it. When making a decision about hospice care, it helps to have a good understanding of what hospice is, and what it isn’t. Here are some of the most common misconceptions about hospice, along with the true facts about this special kind of care.

Myth: Hospice is a place.

Fact: Hospice care usually takes place in the comfort of your home, but can be provided in any environment in which you live, including nursing homes, assisted living facilities, and hospitals.

Myth: Hospice means that the patient will soon die.

Fact: Receiving hospice care does not mean giving up hope or that death is imminent. The earlier an individual receives hospice care, the more opportunity there is to stabilize your medical condition and address other needs. Some patients actually improve and may be discharged from hospice care.

Myth: Hospice care starts a few days before death.

Fact: Hospice is not just for the last few days or weeks of life. The benefit is designed to provide care for six months, or longer. For most people, it is a relief to find that there is another source of help and support. Hospice care, at any stage of illness, bur particularly early on, can significantly lighten the burden for both the patient and family.

Myth: Families have to pay for hospice care.

Fact: Hospice care is a Medicare benefit. Most private insurers also cover hospice care as well. Some Hospices have a charity program, which helps to care for all patients, regardless of an individual’s ability to pay.

Myth: Hospice is only for cancer patients.

Fact: A large number of hospice patients have congestive heart failure, dementia, chronic lung disease, or other conditions. More

Doctors Die Differently Than Their Patients

by Erica B. Cohen
Philly.com
January 16, 2013

“Do everything you can, doctor. Do anything it takes to save him.”

These are the unfortunate pleas that too many patients and their families make when dealing with terminal illness and end-of-life decisions. While the use of advance directives helps alleviate this problem by informing doctors in advance about a patient’s end-of-life wishes, there is still an underlying belief that medicine can cure everyone, even those people with the most terrible prognoses.

But doctors die differently than their patients. They often don’t want the fancy treatment, the life-prolonging chemotherapy, or the 2-hour-long cardiac resuscitation (CPR). They know the consequences, and they just say no.

In 2011, physician Ken Murray wrote an anecdotal essay on physicians’ end-of-life decisions called “How Doctors Die.” In 2012, Dr. Murray followed up with a second essay, “Doctors Really Do Die Differently,” which provided statistical evidence of the assertions he made in his first essay.

According to Dr. Murray, one physician friend was uninterested in taking advantage of his own invention to triple the survival rate of pancreatic cancer patients – from 5% to 15% – albeit with a poor quality of life. Instead, the physician left the hospital after his initial diagnosis, enjoyed time with his loved ones, and died a few months later. More

Hospice: a Caregiving Experience

by Miranda Klingenberg
Pilot Tribune
January 14, 2013

It takes two people to bring someone into this world, but how many does it take to help someone leave it?

If the death is one that can be anticipated or planned for, he answer might surprise you.

Hospice is a palliative form of care designed to support a patient and his or her family through the process of dying. And it requires a full team of professionals and sometimes volunteers to ensure that the patient’s physical, emotional, and spiritual needs are fully addressed. The hospice team administers everything from massage therapy and pharmacological management to bereavement and spiritual counseling. The team recognizes the strengths of each member and works together to provide care and support for patients and their families.

Sometimes people come with reluctance. Many do not want to hear ‘hospice,’ but the very word helps people come to terms with what lies ahead. Janel Kaufman, an RN with the Buena Vista Regional Medical Center hospice team said “You’re providing and coordinating care so that they as a family unit can cope with what they need to cope with.”

It takes a special kind of person to devote their lives to the care of those preparing to transition from this world to the next. Caregivers must be compassionate and comfortable with death, but they must also know their own boundaries. One must accept that death is a natural process. Kaufman said, “I had one of my relatives tell me, ‘Remember, if you do this, that they are not your family,’ which is pretty good advice because sometimes people would like you to move in with them and you need to remember it’s not your job to fix things.” More

A Precious Gift for Those You Love

by Terrell B. Vanaken
Daily Republic
January 10, 2013

During the holiday season, we often think of giving in terms of tangible, often costly items.

There is, however, an extremely valuable gift that we can offer at any time of year, and which costs virtually nothing. It’s something all of us can offer to our family and loved ones. It’s the knowledge and understanding of what we would want done at the time of a health emergency, when we cannot make decisions for ourselves.

An advance directive, when properly completed, is a legal document that stipulates who should make decisions at a time when an individual no longer can. It also allows you to specify your wishes for medical treatment and just how aggressive medical personnel should be with your care.

At a minimum, an advance directive should name the primary person you trust most to make major health care decisions about your welfare. This person is called your “agent” for health care decisions. You may also name an alternate in case your first choice is unavailable for any reason.

An advance directive can be completed by any adult and is made legal by the signature of a notary public or the signatures of two qualified witnesses. Of course, as we grow older, a directive becomes more and more important, since the incidence of health care emergencies increases as we age.

Many critically ill patients and families who I have met in the hospital have never sat down and actually talked about their wishes before such a tragedy occurs. We all tend to avoid these discussions, but after a stroke, a heart attack or life-threatening event, your loved one may not be able to talk at all or understand these issues. More