End-of-Life Choice, Palliative Care and Counseling

Posts Taggedend-of-life choice

My Experiments With Aging and Dying Naturally

by Tom Walz
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. More

10 Tips on Dying With Dignity

by Laurel Lewis
December 5, 2012

These tips come from my experience of being with hundreds of people as they have died and with the thousands of family members who have witnessed this event. Consider using these tips for dying well … and for living well!

10. Talk about what you do and don’t want.

Tell your family, friends and doctors how you want to be treated and what kind of treatments you want or don’t want! Consider a living will or other advance directives so that your wishes will be known prior to end of life choices. Consider your needs: physical, emotional and spiritual because they all impact your final days.

9. Have a life review. Recall significant and meaningful events .

Share your stories either verbally or written with your loved ones, in a journal or on tape. As you do this forgive yourself and others for everything! Let go of judgments. Judging people and events take up precious energy that could be spent loving instead. Release the judgments and allow yourself to be fully present to what is in your life right now.

8. Express gratitude daily – for something, anything!

This will help move you from the context of small self who is dying to connect with the bigger part of Life that is surrounding us always. Expressing gratitude creates a positive shift in our mental state, which in turn has positive physical benefits. More

End-of-Life Care: Mayo’s Advice

by Sondra Forsyth
November 28, 2012

One of the toughest issues patients and their loved ones can discuss with physicians is whether or not further medical treatment is futile. Mayo Clinic expert Christopher Burkle, M.D., J.D., lead author of an article published in Mayo Clinic Proceedings, is quoted in a clinic release as saying, “Health care professionals in the United States have struggled with the importance of maintaining patient autonomy while attempting to practice under the guidance of treatments based on beneficial care.”

The release notes that the conversation can become even more difficult if patients or their families disagree with health care providers’ recommendations on end-of-life care. Early, clear communication between patients and their care teams, choosing objective surrogates to represent patients, and involving third parties such as ethics committees can help avoid or resolve conflicts, according to Dr. Burke and co-author Jeffre Benson, M.D.

Here is advice from Drs. Burkle and Benson:

*Clear communication: Early and clear communication between health care providers and patients or their surrogates is the best way to avoid disagreement over whether medical care should continue. Recent studies show that more than 95 percent of such disputes are resolved through mediated meetings involving physicians and patients/surrogates. More

Care at the End of Life

The New York Times
November 24, 2012

Three years ago, at the height of the debate over health care reform, there was an uproar over a voluntary provision that encouraged doctors to discuss with Medicare patients the kinds of treatments they would want as they neared the end of life. That thoughtful provision was left out of the final bill after right-wing commentators and Republican politicians denounced it falsely as a step toward euthanasia and “death panels.”

Fortunately, advance planning for end-of-life decisions has been going on for years and is continuing to spread despite the demagogy on the issue in 2009. There is good evidence that, done properly, it can greatly increase the likelihood that patients will get the care they really want. And, as a secondary benefit, their choices may help reduce the cost of health care as well.

Many people sign living wills that specify the care they want as death nears and powers of attorney that authorize relatives or trusted surrogates to make decisions if they become incapacitated. Those standard devices have been greatly improved in recent years by adding medical orders signed by a doctor — known as Physician Orders for Life Sustaining Treatment, or POLST — to ensure that a patient’s wishes are followed, and not misplaced or too vague for family members to be sure what a comatose patient would want.

Fifteen states, including New York, have already enacted laws or regulations to authorize use of these forms. Similar efforts are under development in another 28 states. The laws generally allow medical institutions to decide whether to offer the forms and always allow patients and families to decide voluntarily whether to use them.

With these physician orders, the doctor, or in some states a nurse practitioner or physician assistant, leads conversations with patients, family members and surrogates to determine whether a patient with advanced illness wants aggressive life-sustaining treatment, a limited intervention or simply palliative or hospice care. More

Struggling: End-of-Life Conversations

by Patricia Patton
Huffington Post
November 17, 2012

It is the end of life.

My sister lies in her hospital bed, and I am being challenged to set her free. But what I really feel like doing is SCREAMING at the top of my lungs. The doctors have finally stated, “We can make her comfortable.” That means the family must now shift gears and face our reality.

I had been managing my sister’s emotional care from across the country. In truth, her husband had been her primary caregiver and I was his wing wo/man. I had been criss-crossing the country, trying to help her experience some joy by staying close to her and by helping her heal old wounds with her adult children. The downward spiral had begun in earnest at least 18 months before. However, consistent with our black southern tradition, my family had not taken even one of the AARP recommendations for those preparing for death. Why? Because of religious beliefs and my sister’s children and her husband were in denial. Also they really didn’t know what to do.

AARP research has found that 46 percent of family caregivers perform medical/nursing tasks for their patients who are suffering with multiple chronic physical conditions. My sister had been suffering from kidney failure and breast cancer among other things. So her husband was indeed a part of this 46 percent statistic. He was also one of the three out of four (78 percent) caregivers who managed medication, including administering intravenous fluids and injections. He performed these tasks to avoid institutionalizing her because their financial resources would not have allowed for assisted care or live-in help.

So, as I was saying, there we are in the hospital and clearly we are approaching the end of her life. The sister I know is gone, even though her body is lying in the hospital bed. Technically she is still here, thanks to a ventilator — but I don’t think this could be called living. More