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Several years ago, the idea of elderly people receiving counseling on end-of-life decisions sparked deep controversy. Now, these counseling sessions seem poised to become an accepted, appreciated part of the aging process.
Not long ago, the federal government announced that Medicare will begin compensating doctors for discussing with patients their preferences for end-of-life care. These conversations could include whether they would want medical interventions to keep them alive if they become too sick to speak for themselves. They could also address the specific measures patients would want doctors to try, such as hospitalization, or the use of feeding tubes or ventilators.
In past generations, families were often reluctant to have end-of-life conversations at all. Death was a taboo topic, and many families assumed that a loved one in a medical crisis should receive any and all measures to stay alive.
The problem with not discussing the end of life, however, is that many people do have well-developed opinions about the way they would like to spend their final days. It’s very typical for people to hope to remain at home if possible. If hospitalized, some people may be amenable to certain interventions, like IV fluids, but may oppose others, like ventilators.
There’s really no way to know unless the person has verbalized or recorded his wishes. Even then, the high emotion that surrounds a health crisis can muddle the issue. If a person has expressed his wishes to certain family members but not others, families can dissolve into bickering and debating instead of spending precious time with their loved one.
Enter end-of-life counseling. This process could involve one trusted family member, professionals including a lawyer and a doctor, or a whole team of people. As the population grows older, a wider range of health-care professionals, including nurses and nurse practitioners, are involved in these conversations.
Some of the questions that should be addressed in end-of-life discussions are financial in nature: Does the person have a will? Has she chosen a power of attorney? These decisions should be settled in legally binding documents. If it’s not already clear, an end-of-life discussion could be a time to review insurance coverage and any death benefits.
Most of the other major issues are medical in nature. Just like an aging person should designate a power of attorney for financial issues, it should also be clear — and documented — if they’ve chosen a different person to make medical decisions. This person is sometimes referred to as a “proxy.”
A written plan for the end of one’s life is called an “advance directive.” These are required by many nursing homes and other health-care facilities. They may cover everything from artificial feeding, resuscitation, mechanical ventilators, administration of medicine, and continuation of ongoing medical treatments like dialysis or chemotherapy.
The advance directive can also be a place to specify wishes regarding palliative care or hospice care. Many patients with long-term illnesses ultimately receive palliative care, in which doctors treat the symptoms to reduce pain and suffering, but may no longer work to eradicate the disease. For example, a patient with terminal cancer may stop receiving chemotherapy, but her doctor would still treat her pain and prescribe measures to keep her as comfortable as possible. Hospice care has similar goals — keeping a patient comfortable — but is typically given near the end of a patient’s life, and it may encompass emotional or spiritual care.
There’s still plenty of controversy surrounding the issue of end-of-life planning. Some opponents of the process say it unjustifiably influences patients to reject lifesaving measures. Others speculate that the doctors’ aim is primarily to reduce health-care costs, not to benefit the patient.
Nonetheless, the conversation about paying for end-of-life counseling has undoubtedly opened the door for many families to address these painful issues, whether privately, with a trusted professional, or both.
Article Submitted by:
Tim and Alison Dinan, Owners
Cook Family Funeral Home, Cremation Service, and Hillcrest Cemetery
206-842-2642
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