Be kind to family: Make end-of-life wishes known

Yvonne Myers has little trouble talking about death. In her job as health systems director for Columbine Health Systems, with its many facilities for seniors, it’s a topic that comes up almost daily.

For most people, however, end-of-life issues are difficult to discuss, especially with family members. That’s why Myers – along with other health care professionals – encourages the use of “advance directives,” documents that indicate a person’s end-of-life medical wishes. With such documents available, people’s preferences can be followed even it they’re unable to voice them. An advance directive specifies what steps should and should not be taken to save a patient’s life.

There are various types of advance directives that can be used and none of them requires preparation by an attorney. In Fort Collins, the Aspen Club of University of Colorado Health helps people fill out advance directives, and they even offer an occasional class on the topic. Staff at hospitals, care centers and Pathways Hospice also assist.

In creating advance directives, it’s helpful to have end-of-life conversations with family members and/or the family doctor. Sometimes it’s difficult for adult children to bring up the topic; sometimes it’s the elderly parent who wants to avoid the issue.

“There’s a notion,” Myers said, “that if we have this conversation, we’re going to bring on death.”

Nonetheless, being brave enough to discuss advance directives can result in two very important benefits. The elderly person can die in the way he or she wishes, and the children or other family members are spared agonizing decisions about care for their loved one.

One segment of the U.S. population does a good job of providing advance directives: physicians. According to a survey cited in the Wall Street Journal, 64 percent of doctors have created an advance directive, compared to about 20 percent of the general public.

Ed Bender, M.D., family physician with the Family Clinic of Fort Collins, falls in with the majority of doctors; both he and his wife have advance directives. With 36 years of experience in medicine, Bender has seen what happens without documents.

For instance, Bender noted, if a patient becomes unconscious either at home or in a care facility, he or she is commonly rushed to the hospital emergency room. Paramedics arrive to transport the patient, and unless there are specific instructions to the contrary, they are obligated to do whatever they can to save the patient.

That can mean cardio-pulmonary resuscitation, a ventilator and “all kinds of aggressive things that may be totally against the patient’s wishes,” Bender stated.

Myers also has tales to tell of unfortunate situations that occur when a person’s wishes are not put into writing.

She cited an example of a Columbine resident who had a stroke when she was in her 80s. At the time, the decision makers in the family were in a remote location and unavailable by phone. Columbine staff called 911 and the woman was taken to the hospital and put on a ventilator. Although the neurologist pronounced her brain-dead, the ventilator could not be removed without consent of the family. “She was suspended between life and death in the most expensive place possible — the intensive care unit of the hospital,” Myers said.

If the patient had had an advance directive indicating “no resuscitation” or “comfort measures only” if recovery was not possible, she might not have been transferred to the hospital.

Even if a person has an advance directive, it does no good if emergency responders don’t know about it. Spouses or caretakers can provide this information, or it can be posted in a prominent place in the home, like the refrigerator door. Bright paper helps.

Types of directives
According to Ellen Pihlstrom of the Aspen Club, everyone over the age of 18 should have two important documents related to advance directives: a living will, which specifies end-of-life medical wishes; and a durable power of attorney for health care, which names a decision-maker in a medical emergency.
New in Colorado is an advance care planning tool for the elderly, chronically ill or seriously ill, including nursing home patients. Called Medical Orders for Scope of Treatment, or MOST, it was approved by the state legislature in 2010.

MOST is a one-page form that bears the weight of a medical order. It is honored in any setting, including hospitals, clinics or long-term care facilities. Even if a person already has a living will, the MOST form is valuable because it’s portable and covers more end-of-life situations.
Two other forms available are the CPR Directive and the Do Not Resuscitate Order.

In the United States, aggressive end-of-life interventions add significantly to the total cost of health care. The 1992 – 1996 Medicare Current Beneficiary Survey showed that the cost of medical care during the last year of life for people 65 or older averaged more than $37,000 – accounting for 22 percent of all health care costs.

Advance directives can allow for a higher quality of life in a person’s last weeks or months, and sometimes even a peaceful death at home with family. For many people, that end-of-life scenario is high on the “bucket list.”
For more information contact the Aspen Club at 970-495-8560 or pvhs.org/aspenclub or visit www.coloradoadvancedirectives.com.