End-of-Life Choice, Palliative Care and Counseling

Posts Taggedhealth care proxy

The Next Steps: How to Start Your End-of-Life ‘Conversation’

By Dr. Shari Barnett
ABC News
August 16, 2012

You have started to think about what you would want for the end of your life, but where should you start?

Fortunately, there are several resources to which you can refer to help you start your own conversation, including those that will help you decide what questions you should ask yourself and what choices you or your family will be faced with at the end of life.

Initiate the Conversation

The Caring Conversations Workbook, published by the Center for Practical Bioethics, is a great place to start. This workbook will help you ask yourself questions that will be important for your decision-making process. It will help you explore your feelings about certain scenarios and provide you a place to start collecting your thoughts.

Another resource, produced by the American Bar Association, is its Tool kit for health care advanced planning. This collection of 10 simple tools to help you and your family have an end-of-life conversation can also help you explore, refine and voice what is important to you at the end of life.

Get Your Documents in Order

These resources can help get you started in preparing the documents you need to secure your end-of-life plans.

There are three major terms you should know when you are trying to communicate your wishes to your loved ones and your health care team.

Advanced directive: It refers to any document that gives instructions about your health care. Your advanced directive is often made up of a living will and durable power of attorney for health care.

Living Will: Your living will is the section of your advance directive that states your wishes regarding the medical treatments you would want if you were terminally ill, permanently unconscious or in the end-stage of a fatal illness.

Durable Power of Attorney of Health Care (or Health Care Proxy): Your durable power of attorney for health care is person (or proxy) who will make medical decisions for you if you can no longer make them for yourself. You should give the proxy instructions for how to make these medical decisions in your living will and also discuss these topics with all of your loved ones, but especially your proxy. Your proxy is supposed to communicate to the health care team what you would want in the event you can no longer do so.

Choices like these can be demanding on not just person who is setting up the living will but also on the family member or friend who will be called on to act as a health care proxy or agent.

Act as a Health Care Proxy or Agent

There are resources for the health care proxy or agent, as well. The American Bar Association has produced guide on how to serve as an effective advocate for a loved one.

Start the Process Online

There are many resources to help you establish an advance directive online. Mydirectives.com (mydirectives.com) can also help you establish a Web-based universal advance digital directive for free. The directive can be digitally signed, is encrypted and stored so it is available to you any time you might need it.

The American Bar Association has an online form to establish a universal durable power of attorney for health care that can be used in 45 states. The ABA has also compiled a list of resources by state.

The Caring Conversations Workbook can help you establish a durable power of attorney as well as an advanced directive.

Personal Decisions Matter at End Of Life

The Republican
Wednesday, April 27, 2011

When family members take on the responsibility of caring for a loved one nearing the end of life or are called upon to make health-care decisions on behalf of their loved one because he or she is unable to speak, suddenly the enormity of this responsibility looms large.

What would my loved one want? Do we continue with yet another medical treatment?

Do we withhold high-tech life support? Do we want intensive medical interventions that may prolong suffering?

How far do we go? How do we assure quality of life as the end nears?

Of primary concern is the question, “How do we honor those we love, respecting the dignity of their values and preferences for life care?”

As an individual, your decisions matter. This is especially true when it comes time to examine how you plan and prepare your health-care and quality-of-life decisions as they communicate your wishes for end-of-life treatment.

Did you know that nearly 70 percent of Americans say they would rather die at home, surrounded by family members? Yet in Massachusetts this expectation is reversed; 70 percent die in nursing homes or in hospitals, often spending their last days hooked up to high-tech life support machines. Fewer than 25 percent die at home.

Recently, family members caring for their dying mother at home related how grateful they were because their mother had made her wishes known and clearly communicated what she desired and wanted.

“She made it easy for us because all we have to do is follow what she wanted,” they said.

This reality does not remove the gamut of emotions that accompany them as they tend to their mother. But it does remove the struggle of having to decide on their own without the assurance their decision would in fact really be what their mother wanted.

They do not have to worry about the guilt, remorse or uncertainty that comes when loving guidance is not clearly communicated.

Do yourself and your loved ones a favor. Be willing to enter into conversations about what health-care choices you would desire if you were unable to speak for yourself. Convey your wishes through an advance directive. Advance directives enable others to know in advance what your choices are.

A “health-care proxy” documents the person you select to be your voice when you cannot speak for yourself.

A “living will” documents what kind of medical treatments you would or would not want at the end of life.

Quaboag Valley Hospice is available to offer assistance by providing literature and tools to assist with thoughtful reflection on health care choices. They are also available for group presentations and additional information as needed. They may be reached at (413) 283-9715.

Most importantly, remember and affirm that your decision matters. Take the time to reflect on what you desire for your health care and what quality of life means for you. Then offer your gift of love by adequately communicating your choices so your wishes and life may be fully honored.

The Rev. Domenic K. Ciannella, an Episcopal priest, is hospice chaplain with Quaboag Valley Hospice of Wing Memorial Hospital in Palmer. He is also certified as a grief recovery specialist and is well versed in crisis intervention and pastoral care.